Davida Holloway
Greensboro,NC
Summary
Experienced Healthcare Professional with 15+ years of extensive experience in Healthcare Administration, Insurance Benefits Verification, Pharmacy Benefits Management, and Case Management. Strong work ethic, adaptability, and exceptional interpersonal skills. Proven ability to handle multiple tasks efficiently in a fast-paced environment. Recognized for empathetic, solutions-oriented approach that enhances patient satisfaction and builds trust with healthcare team.
Overview
10
10
years of professional experience
Work History
Reimbursement Specialist
TEKsystems - IQVIA
12.2024 - Current
- Provides exceptional customer service to clients throughout the claims process, addressing inquiries promptly and professionally while keeping them updated on claim status progressions at all stages of the process.
- Identifies trends in reimbursement denials, recommending process improvements to minimize future occurrences.
- Supports company objectives by maintaining compliance with all relevant state and federal regulations governing medical billing practices.
- Coordinates with insurance providers to verify customer's policy benefits in relation to claims.
- Maintains patient confidentiality by adhering to strict HIPAA guidelines when handling sensitive information.
- Enhances the overall financial performance of the organization by diligently monitoring outstanding claims and following up on overdue payments.
- Prevents delays and claim denials by correcting information prior to submission.
- Delivers timely information to insurance representatives to resolve common and complex issues.
- Helps minimize escalations by reaching out to clients in advance of expected problems.
Pharmacy Benefits Coordinator
CVS Healthcare
06.2021 - 10.2024
- Provided education and support to Medicare/Medicaid members with pharmacy-related inquiries, complaints, and claims in a high call volume environment.
- Used de-escalation techniques to manage difficult member interactions by using active listening and empathetic responses, achieving a 97% customer satisfaction rate.
- Handled 50+ calls per day, maintaining a first-call resolution rate of over 95%.
- Ensured pharmacy claims aligned with plan guidelines and reduced claim denials by 25%, through proactive claims management and detailed plan compliance checks.
- Processed Prior Authorizations and Tier Exceptions for drug coverage, and lowered drug costs.
- Assisted with Grievances and Appeals submissions for Medicaid, Medicare, and Commercial prescription drug plans.
- Applied conflict resolution skills to manage members' concerns and complaints, reducing repeat or escalated calls by 95%.
Case Manager
Proverbs Psychology & Consulting, LLC
01.2020 - 12.2024
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Enhanced care coordination for patients with complex medical needs through effective communication and collaboration with multidisciplinary teams.
- Educated patients on self-care strategies and preventative measures to improve overall health outcomes and reduce the need for future interventions.
- Conducted regular follow-ups with patients to monitor progress, adjust treatment plans as needed, and provide ongoing support.
- Collaborated with insurance providers to secure coverage for necessary medical services, reducing financial burdens for patients and their families.
- Collaborated with healthcare providers to drive continuity of care.
- Enhanced communication between clients and service providers, resulting in better coordination of care.
- Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.
- Exceeded performance metrics by consistently meeting and surpassing assigned caseload requirements while maintaining high-quality care standards.
- Participated in interdisciplinary case conferences fostering teamwork collaboration sharing best practice insights to optimize patient care outcomes.
- Served as a liaison between patients, families, physicians, insurance providers, and other healthcare professionals for seamless care coordination efforts.
Administrative Assistant
Embody Nutrition
03.2018 - 12.2019
- Assisted in onboarding new employees, providing training materials, and coordinating orientation schedules to ensure a smooth integration into the team daily team meetings on sales, product knowledge, and customer satisfaction.
- Ensured high levels of customer satisfaction by addressing complaints, resolving issues, and maintaining strong customer relationships, resulting in 98% Medallia customer satisfaction surveys.
- Improved document organization with thorough file maintenance, archiving outdated records as necessary for efficient retrieval when needed.
- Developed and implemented strategies to increase employee engagement and satisfaction, resulting in a 65% reduction in team turnover rate.
- Increased sales performance by 48% within 3 months by implementing targeted training on product knowledge and customer engagement strategies..
- Delivered excellent customer service through prompt responses to client inquiries, addressing concerns effectively, and building strong relationships.
Medical Office Administrative Assistant
Danville Regional Medical Center
12.2014 - 07.2016
- Managed master calendar and scheduled appointments for providers based on patient loads and clinician availability.
- Completed coding tasks using ICD-10 codes for insurance claims processing purposes.
- Cooperated with Medicare, Medicaid and private insurance providers to resolve billing issues.
- Collected information, verified insurance and collected co-payments for patients as part of check-in process.
- Verified insurance coverage for medical procedures and treatments.
- Organized patient records in an efficient way to ensure easy access and retrieval.
- Used knowledge of medical terminology to transcribe patient information from written copy, electronic equipment, or verbal direction.
- Demonstrated excellent multitasking abilities while simultaneously handling various administrative tasks such as answering phones, greeting patients, and data entry.
- Collaborated closely with medical staff to coordinate patient care plans and support overall clinic operations.
Education
Bachelor of Science - Health Administration
Liberty University
Lynchburg, VA05-2027
Associate of Science - Practical Nursing
Danville Community College
05-2009
Skills
- Administrative Support
- Active Listening with Empathy
- Conflict and First Call Resolution
- Claims Processing
- Skills Management
- Data Entry
- Case Management Support
- Microsoft Office and Outlook proficiency
- Insurance Benefits Verification
- Medicare & Medicaid Adept
- Patient Health Information Access
- HIPAA Compliance
- Eligibility Determination
- Critical-Thinking
- Time-Management
- Verbal and Written Communication
- Effective Problem Solving and De-Escalation skills
Timeline
Reimbursement Specialist
TEKsystems - IQVIA
12.2024 - Current
Pharmacy Benefits Coordinator
CVS Healthcare
06.2021 - 10.2024
Case Manager
Proverbs Psychology & Consulting, LLC
01.2020 - 12.2024
Administrative Assistant
Embody Nutrition
03.2018 - 12.2019
Medical Office Administrative Assistant
Danville Regional Medical Center
12.2014 - 07.2016
Bachelor of Science - Health Administration
Liberty University
Associate of Science - Practical Nursing
Danville Community College
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