Demitria Davis
Summary
Seasoned Billing Operation Manager with a proven track record at ABS Billing Service, excelling in revenue cycle management and fostering team leadership. Expert in insurance verification and claims processing, I significantly maintained a claim rate over 97%, demonstrating effective communication and process improvement skills. Seasoned Billing Operations Manager with comprehensive knowledge of billing systems and processes. Possess strong ability to manage complex projects, streamline operations and improve accuracy in billing functions. Notable strengths in team leadership, problem-solving and strategic planning. Demonstrated success in improving operational efficiency and enhancing revenue generation in previous roles.
Overview
15
15
years of professional experience
Work History
Billing Operation Manager
ABS Billing Service
04.2024 - Current
- Manage the intake team to ensure the charges are pulled from the EHR and posted within 2 business days
- Oversee team working overseas
- Monitor payer rejects
- Ensure the claim rate stays over 97% every week
- Internal auditor errors with team members (Charge and payment team)
- Manager of the payment posting team to ensure payments are posted within 2-3 business days
- Managed EOM to close within 2 business days
- Handle guest complaints, concerns, or special requests in a professional and timely manner with outstanding customer service
- Conduct triannual employee performance reviews and deliver reviews to employees
- Managed remote EHR access such as Simple Practice, Practice Infusion, WebPt, Antena Health, CernerCintrix, Chronos, Y-chc.org
REVENUE CYCLE INTAKE & FINANCIAL SERVICES MANAGER
GI Alliance
02.2022 - 01.2024
- Create and implement efficient processes for patient registration, insurance verification, and appointment scheduling
- Improve operational efficiency and accuracy by streamlining workflows
- Assist the billing department in verifying insurance coverage and eligibility
- Manage the appointment scheduling system and ensure that proper scheduling protocols are followed
- Ensure that healthcare legislation, privacy rules (such as HIPAA), and paperwork requirements are met
- Implement quality assurance measures to ensure that patient registration data is accurate and full
- Conduct regular audits and, where needed, provide training or corrective actions
- Assist with inquiries and requests and provide personalized recommendations to enhance their experience
- Handle guest complaints, concerns, or special requests in a professional and timely manner with outstanding customer service
- Conduct annual employee performance reviews and deliver reviews to employees
- Determine employers' job requirements for the roles that were for the company
REVENUE CYCLE INTAKE MANAGER
AIS Healthcare
10.2019 - 02.2022
- Developed and implemented efficient processes for patient registration, insurance verification, and eligibility determination
- Provided guidance and performance feedback and supported professional development
- Oversaw the patient registration process, ensuring accurate and complete demographic and insurance information was obtained
- Coordinated insurance verification activities, including contacting insurance providers, confirming coverage details, and obtaining necessary authorizations
- Ensured compliance with healthcare regulations, privacy policies (e.g., HIPAA), and documentation requirements
- Maintained accurate and updated patient records in the electronic health record system
- Informed the Director of Financial Services of any significant collection issues with patient accounts or payer reimbursement/contracting challenges
- Developed and maintained relationships with contract and non-contracted payers to identify reimbursement issues or changes, regulatory pressures, etc., before they occur
- Managed staff, providing recommendations for hiring, promotion, salary adjustment, and personnel action where appropriate to the Director of Financial Services
- Trained new team members and conducted ongoing training and skills assessments as necessary for 3 locations
INTAKE MANAGER
Option Care Home Infusion
03.2018 - 10.2019
- Designed and executed standardized intake methods and procedures to enable effective and accurate client or customer information acquisition
- Supervised and mentored a team of intake coordinators to ensure they were appropriately prepared and equipped to carry out their responsibilities
- Oversaw the accurate gathering, verification, and documentation of client or customer information while adhering to data protection requirements
- Maintained confidentiality and security of client or customer information
- Monitored and evaluated patient registration team member productivity and performance to goal for 3 locations
- Managed all referral coordination activity for three areas between Sales, Hospital Case Managers/Physicians, and Operations
- Partnered with Sr
- DO, Regional Director, and Sales to drive market development and execute market-based sales strategy
PATIENT FINANCIAL COORDINATOR
UT Southwestern Medical Center
01.2016 - 03.2018
- Generated and reviewed patient bills, ensuring accuracy and completeness
- Kept track of financial transactions, updated insurance, and demographic data, and maintained patient accounts
- Confirmed the benefits, eligibility, and coverage of the patient's insurance
- Tracked the status of claims, found denials or anomalies, and followed up with insurance providers to address problems and guarantee prompt payment
- Helped patients understand their financial obligations, billing statements, and insurance coverage
- Collected and handled patient payments, such as co-pays, deductibles, and owed sums
- Resolved electronic claims rejections and EOB denials promptly
- Regularly contacted Medicare, Medicaid, commercial payers, and government payers to obtain benefits/limitations and ensure services provided will be reimbursable
REIMBURSEMENT SPECIALIST
UT Southwestern Medical Center
07.2012 - 01.2016
- Examined and evaluated medical claims for precision, thoroughness, and compliance with coding standards and payer criteria
- Prepared and submitted claims manually or by electronic means
- Verified the correctness and accuracy of the coding and associated documentation
- Identified opportunities for additional billing codes, modifiers, or other reimbursement procedures to maximize remuneration for services performed
- Implemented corrective measures after analyzing and resolving claim denials or discrepancies
- Responded to pre-certification questions and complaints as required to resolve problems and maintain high patient satisfaction levels
- Obtained authorizations/referrals from the insurance company promptly with a great degree of accuracy
- Resolved electronic claim rejections and EOB denials promptly
MEDICAL CLAIM ANALYST
UT Southwestern Medical Center
01.2010 - 07.2012
- Reviewed and analyzed medical claims to ensure compliance with coding guidelines, payer policies, and regulatory requirements
- Validated the accuracy and appropriateness of medical codes (e.g., CPT, ICD-9) assigned to services and procedures
- Processed claims by determining coverage, verifying patient eligibility, and evaluating reimbursement amounts based on contractual agreements and fee schedules
- Evaluated the adequacy and completeness of medical documentation supporting the claims
- Investigated and resolved claim denials by identifying the root causes, correcting errors or discrepancies, and initiating the appropriate appeals or resubmissions
- Analyzed reimbursement trends, identified patterns, and assessed the accuracy of payment amounts received
- Ensured compliance with healthcare regulations, privacy policies (e.g., HIPAA), and coding guidelines
- Maintained accurate records of claims, review outcomes, and actions taken
TEAM LEAD MEDICAL CLAIMS
M2 Health Care
07.2009 - 05.2010
- Led, advised, and supported a group of analysts for medical claims
- Established performance standards, carried out frequent performance reviews, and offered team members coaching and mentorship
- Oversaw the processing of medical claims to ensure accuracy, adherence to coding guidelines, and compliance with payer policies and regulations
- Measured team output and performance data, including the number of claims processed per day, the turnaround time, and the accuracy percentages
- Identified areas for process optimization to maximize output while upholding standards of quality
- Investigated claim discrepancies, denials, or appeals and collaborated with internal departments, insurance companies, and healthcare providers, as necessary
- Responsible for placing delinquent patient accounts with our collection agencies and acting as the liaison between the business office and the collection agencies
- Regularly contacted Medicare, Medicaid, commercial payers, and government payers to resolve claims not paid or not paid according to plan benefits
Education
Associate of Health Care Reimbursement Degree -
Virginia College
Birmingham, AL01.2009
Diploma -
Rich Central High School
Olympia Fields, IL01.2001
Skills
- Revenue Cycle Management
- Patient Intake Processes
- Insurance Verification
- Effective Communication
- Training and mentoring
- Denial management
- Team Leadership
- Process Improvement
- Claims Submission
- Performance Evaluation
- Reimbursement
- Electronic Health Records
- Knowledge of HCPCS/CPT codes
- Collections management
- Cash flow management
- Dispute resolution
- Audit support
- Staff training and development
- Claims processing
- Collections
- Team building
- Insurance verification
- Workflow planning
Area Of Expertise
- Revenue Cycle Management
- Patient Intake Processes
- Billing and Reimbursement
- Insurance Verification
- Effective Communication
- Compliance
- Team Leadership
- Process Improvement
- Claims Submission
- Performance Evaluation
- Billing Software
- Revenue Optimization
- Reimbursement
- Electronic Health Records
- Knowledge of HCPCS/CPT codes
- Knowledge of ICD-10 Codes
Timeline
Billing Operation Manager
ABS Billing Service
04.2024 - Current
REVENUE CYCLE INTAKE & FINANCIAL SERVICES MANAGER
GI Alliance
02.2022 - 01.2024
REVENUE CYCLE INTAKE MANAGER
AIS Healthcare
10.2019 - 02.2022
INTAKE MANAGER
Option Care Home Infusion
03.2018 - 10.2019
PATIENT FINANCIAL COORDINATOR
UT Southwestern Medical Center
01.2016 - 03.2018
REIMBURSEMENT SPECIALIST
UT Southwestern Medical Center
07.2012 - 01.2016
MEDICAL CLAIM ANALYST
UT Southwestern Medical Center
01.2010 - 07.2012
TEAM LEAD MEDICAL CLAIMS
M2 Health Care
07.2009 - 05.2010
Associate of Health Care Reimbursement Degree -
Virginia College
Diploma -
Rich Central High School
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