Davajah Botley
Dallas
Overview
7
7
years of professional experience
Work History
Clinical Staff Assistant
UT Southwestern Medical Center
08.2024 - Current
- Created and implemented a new workflow to improve clinic metric, 'Lag Time'.
- Coordinates communication between patients and healthcare providers regarding test results or follow up instructions.
- Ensures that all required paperwork is completed accurately before submitting it to the appropriate department or personnel.
- Builds rapport and communication with internal and external team members to ensure the best outcomes for the patient in a comprehensive clinical care model.
- Maintains patient confidentiality in accordance with HIPAA and UT Southwestern policy.
- Ensures there is an adequate inventory of items necessary for the day-to-day functions of the clinic, such as office supplies and patient forms.
- Participates in continuing education programs related to clinical protocols and procedures.
- Assists in coordinating patient care activities and providing administrative support for clinical staff.
- Processes incoming mail, faxes, emails and other correspondence related to patient care or clinic operations.
- Maintains accurate medical records, enters data into the electronic health record system (Epic), and updates patient information as needed.
Senior Claims Specialist
Premera Blue Cross
08.2020 - 07.2024
- Handles the processing of medical claims and makes necessary adjustments for disputed claims (both professional and facility) in accordance with departmental, contractual, and regulatory requirements.
- Conducts prepayment audits on medical claims (professional and facility) as per departmental, contractual, and regulatory guidelines.
- Responds to telephone inquiries using the "Automated Call Distributor (ACD) Telephone System" when necessary.
- Updates authorization information based on information obtained from providers.
- Interprets and verifies information in vendor contracts to address any issues that may arise.
- Provides training to analysts and oversees general office support functions as needed.
- Adheres to unit procedures for call processing, claim adjustments, and denials. Utilizes policies/procedures, job aids, provider contracts, and other reference materials to ensure accurate and comprehensive decision-making.
- Maintains strict adherence to Health Insurance Portability and Accountability Act (HIPAA) standards when handling and disclosing patients' protected health information (PHI).
Insurance Verification Specialist II
United Health Group
05.2018 - 08.2020
- Verifies insurance eligibility and benefits to perform financial clearance of patient accounts, ensuring that all notifications and authorizations are completed within the required timeframe.
- Coordinates the submission of clinical documentation from physicians to payers for authorization needs.
- Calculates the patient's financial responsibility accurately. Maintains timely communication with Utilization Review and collaborates effectively with physicians and facility staff to ensure the patient's account is financially cleared before scheduled or unscheduled services during their hospital stay.
- Interprets complex payer coverage information, such as network participation status, limited plan coverage, and inactive benefits.
- Document systems per the insurance verification guidelines to ensure accurate and timely reimbursement.
Education
Associates Degree - Business Administration
Strayer University
Dallas, TX09-2025
BBA - Business Administration
Strayer University
Dallas, TX09-2025
Skills
- Medical Terminology
- Typing Proficiency 70 WPM
- Microsoft Office
- Documentation Review
- Data Analysis
- Medical Billing
- Strong Written and Oral Communications
- Claims Management Expertise
- Process Improvement
Timeline
Clinical Staff Assistant
UT Southwestern Medical Center
08.2024 - Current
Senior Claims Specialist
Premera Blue Cross
08.2020 - 07.2024
Insurance Verification Specialist II
United Health Group
05.2018 - 08.2020
Associates Degree - Business Administration
Strayer University
BBA - Business Administration
Strayer University
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