Damecia Hall
Fort Worth,TX
Summary
Army veteran and healthcare professional with expertise in care coordination, claims resolution, and process optimization. Skilled in Epic, TruCare, and CRM systems. Strong analytical, problem-solving, and customer service skills. Proven track record in improving patient outcomes, driving efficiency, and leading teams in high-pressure environments to achieve impactful results.
Overview
8
8
years of professional experience
Work History
Care Advocate Team Lead
United Health Care
05.2021 - Current
- Lead and mentor a team of care advocates to enhance service quality and patient outcomes through guidance and training
- Coordinate with healthcare providers to ensure seamless patient transitions during the critical 30-day post-discharge period
- Resolve claims and address issues to optimize operational efficiency and improve patient satisfaction metrics
- Manage communication tasks including appointment scheduling, service information delivery, and referral handling
- Utilize TruCare system for patient case management, care plan tracking, and timely follow-ups
- Guide the team in using TruCare to resolve complex claims, aligning with organizational goals to improve claim approval rates
- Support team performance by conducting call evaluations and providing feedback on patient interaction techniques
- Collaborate with leadership to implement process improvements that enhance patient care and operational outcomes
- Complete special projects in Epic to improve data accuracy and reporting processes for service delivery enhancements
Benefit Verification Specialist (Contract)
Aston Carter
10.2022 - 01.2024
- Reviewed patient insurance information to ensure accurate benefit verification, covering patient coverage, cost share, and provider options
- Triaged cases with missing information to appropriate team members, identifying restrictions to expedite patient access
- Verified coverage and medical necessity for injectable medications and biologics, facilitating timely reimbursement and reducing claim denials
- Initiated and documented prior authorization processes and claims appeals for effective case management
- Collaborated with patients, providers, and insurance companies to resolve coding discrepancies, ensuring accurate data entry
- Completed enrollment applications with proper application of J-codes, HCPCS codes, and ICD-10 codes for prompt processing
- Monitored payer issues, tracked trends, and identified opportunities to enhance claims processing and improve approval rates
- Reported reimbursement trends and delays to management for proactive resolution
- Conducted quality reviews to ensure accuracy in documentation, code updates, and claims processing
Healthcare Specialist
Army National Guard
02.2019 - 11.2022
- Provided emergency medical treatment in both combat and humanitarian contexts, aiding military personnel and civilians
- Oversaw the medical readiness of personnel, maintaining health records, and managing medical supplies and equipment
- Developed and executed training programs for Combat Lifesaver and First Responder certifications
- Facilitated medical evacuations and field health protection, ensuring prompt care for injured or ill individuals
PCMH Panel Care Coordinator
JPS Health Network
04.2017 - 10.2018
- Coordinated care for high-risk patient populations, ensuring timely appointments and follow-ups for improved health management
- Verified patient insurance coverage and financial information to support accurate billing processes
- Managed Epic work queues, maintaining precise clinical files and health records
- Trained staff on Epic functionalities, enhancing workflow efficiency and data accuracy
- Promoted patient health by communicating vaccination schedules and necessary screenings proactively
- Improved HEDIS measures by ensuring timely follow-up for preventive screenings and chronic disease management, contributing to enhanced quality scores
- Collaborated with clinical teams to identify care gaps and ensured necessary services were provided for optimal patient outcomes
Education
High School Diploma -
C.F. Brewer High School
06.2015
Skills
- Medicare, Medicaid, & Commercial Insurance
- Benefit Verification & Prior Authorization
- Claims Billing & Coding (J-codes, HCPCS, ICD-10)
- Project Management & Process Improvement
- Skilled in Both Verbal and Written Communication
- Problem-Solving & Conflict Resolution
- Attention to Detail/ Data Accuracy
- Training and Staff Development
- HEDIS Measures & Quality Improvement
- HIPAA Compliance
- Microsoft Office
- Epic Systems (Ambulatory, Cadence, Resolute Billing)
Timeline
Benefit Verification Specialist (Contract)
Aston Carter
10.2022 - 01.2024
Care Advocate Team Lead
United Health Care
05.2021 - Current
Healthcare Specialist
Army National Guard
02.2019 - 11.2022
PCMH Panel Care Coordinator
JPS Health Network
04.2017 - 10.2018
High School Diploma -
C.F. Brewer High School
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