Darineisha E. Davis
Powder Springs,GA
Summary
Experienced with medical billing processes and leading teams in healthcare settings. Utilizes knowledge of healthcare regulations and coding standards to ensure accurate billing and compliance. Track record of developing efficient workflows and fostering collaborative team environments.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Account Resolution Specialist-Lead
Wellstar Heath System
01.2023 - Current
- Assisted in improving claim processing efficiency through detailed examination and assessment of denial trends.
- Supported expedited denial resolution processes to enhance reimbursement speed and optimize cash flow.
- Helped recognize denial patterns from payers and initiated corrective measures to mitigate future issues.
- Processed medical claims by evaluating documentation, determining benefits, initiating payments, and drafting denial notifications.
- Reviewed medical claims for regulatory compliance and rectified inconsistencies.
- Investigated and addressed intricate medical claims challenges to facilitate prompt processing.
- Accurately coded and billed medical claims for diverse healthcare facilities.
Precertification Specialist
WellStar Paulding Hospital
01.2023 - 02.2024
- Streamlined precertification processes by implementing efficient tracking systems and prioritizing urgent cases.
- Reduced patient wait times for approval by diligently reviewing medical records and obtaining necessary documentation.
- Increased accuracy of submitted claims through meticulous attention to detail in verifying insurance eligibility and benefits.
- Ensured smooth communication between healthcare providers, patients, and insurance companies, resulting in timely approvals and positive experiences.
- Conducted thorough follow-ups with insurance companies, ensuring timely receipt of authorization numbers for approved services.
- Minimized claim denials by accurately coding procedures according to CPT guidelines before submission for approval.
- Improved team productivity with regular training sessions on new software programs and tools utilized in the precertification process.
Secretary/Scheduler
Northside Hospital
12.2021 - 01.2023
- Scheduled appointments and conducted follow-up calls to clients.
- Responded to emails and other correspondence to facilitate communication and enhance business processes.
- Handled daily scheduling tasks and provided administrative support for entire department.
- Corrected data entry errors to prevent later issues such as duplication or data degradation.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Posted payments and collections on regular basis.
Medical Biller and Coder
Murray Medical Center
01.2021 - 01.2022
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
- Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Resourcefully used various coding books, procedure manuals and on-line encoders.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Accurately selected proper descriptive code when more than one anatomical location was indicated.
Referral Coordinator, Front Office Lead
Wellstar Hospital
01.2014 - 05.2021
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
- Weighed patient need, provider availability and insurance coverage to determine optimal scheduling.
- Enhanced patient satisfaction by implementing efficient front office procedures and streamlining appointment scheduling.
- Improved staff productivity through regular training sessions, performance evaluations, and feedback.
- Increased revenue collection by diligently monitoring insurance claims and following up on outstanding balances.
- Spearheaded the implementation of a new electronic health record system, resulting in enhanced data accuracy and accessibility.
Executive Secretary
Patterson Services
08.2012 - 11.2020
- Operated weigh scales and issued tickets as needed.
- Followed safety regulations to maintain a secure work environment.
- Assisted in the routing and tracking of 10 fleet vehicles.
- Supported training program evaluations and suggested enhancements to management.
- Compiled training materials and developed a comprehensive handbook.
- Coordinated administrative tasks for event planning, including bookings and promotions.
- Processed vendor invoices and managed incoming payments.
- Organized invoices, files, and receipts with proper coding for easy access.
- Cultivated positive vendor relationships and addressed any disputes.
Education
Bachelor of Science - Nursing
Chamberlain College of Nursing
Atlanta, GA05.2028
Associate of Science - Medical Billing & Coding
Gwinnett College
Marietta, GA05.2022
High School Diploma -
South Cobb High School
Austell, GA05.2013
Skills
Assisted in processing and analyzing CPT code modifiers for accurate claims management
Supported efficient billing and collections procedures for enhanced revenue flow
Facilitated medical coding and billing tasks to ensure compliance with standards
Aided in resolving denials for improved claims acceptance
Contributed to revenue cycle management processes for optimized financial performance
Helped manage appeals processing to address claim disputes effectively
Participated in utilization review to ensure appropriate patient care and resource allocation
Supported audit processes to maintain compliance and operational integrity
Certification
- Certified Medical Billing and Coding Association, National Healthcare
- CPC -AAPC- Pending
Additional Information
- ICD-10/CPT Coding, Cerner/Epic, Expert Microsoft Office, Patient Scheduling, EOB/Superbills, Remittance Advice, HCPCS Coding, Posting Payments, Insurance Verification, Claims Processing
Timeline
Account Resolution Specialist-Lead
Wellstar Heath System
01.2023 - Current
Precertification Specialist
WellStar Paulding Hospital
01.2023 - 02.2024
Secretary/Scheduler
Northside Hospital
12.2021 - 01.2023
Medical Biller and Coder
Murray Medical Center
01.2021 - 01.2022
Referral Coordinator, Front Office Lead
Wellstar Hospital
01.2014 - 05.2021
Executive Secretary
Patterson Services
08.2012 - 11.2020
High School Diploma -
South Cobb High School
Bachelor of Science - Nursing
Chamberlain College of Nursing
Associate of Science - Medical Billing & Coding
Gwinnett College