Fretecia Davis
Katy,TX
Summary
Knowledgeable and dedicated customer service professional with extensive experience in medical and customer service industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.
Overview
11
11
years of professional experience
Work History
Pre-Service Contact Representative
Texas Children's Hospital
Katy, TX
12.2021 - 08.2024
- Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations
- Engage with requesting providers as needed in peer-to-peer discussion
- Knowledgeable in interpreting existing benefit language and polices in the process of clinical coverage reviews
- Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy
- Communicate and collaborate with other internal partners
- Document clinical review findings, actions, and outcomes in accordance with policies and regulatory and accreditation requirements
Senior Advocate
UnitedHealthcare
Sugar Land, TX
05.2016 - 12.2021
- Respond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence
- Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to include managing their health and well-being by selecting the best benefit plan options, maximizing the value of their health plan benefits and choosing a quality care provider
- Maintained up-to-date knowledge of coding and regulatory requirements to accurately assign codes for appropriate reimbursement of healthcare services
- Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues
- Provide education and status on previously submitted pre-authorizations or pre-determination requests
- Reviews and verifies assigned codes and sequences diagnosis and procedures according to regulations (e.g., ICD9CM, CPT, HCPCS, UHDDS, and HIPPA coding guidelines) and abstracts accurate clinical information to obtain the most specific code possible to ensure an accurate health information database
- Verifying charges on accounts as needed and providing detailed and accurate comments for future reference.
- When necessary, create a registration in the appropriate system (EPIC) from documentation provided to accurately record encounter and accurately bill the appropriate stakeholders.
Document Control Specialist
AmerisourceBergen
Sugar Land, TX
06.2017 - 04.2020
- Maintained version control for all documents, ensuring that only the most recent updates were in circulation at any given time.
- Provided assistance with inbound and outbound document processes, document sorting, logging, and work order creation.
- Maintained document control system and updated work instructions, procedures and associated databases.
- Facilitated timely project completion by managing the distribution of essential documentation to project team members.
- Perform final documented review of completed ate batch paperwork prior to shipment and final review of all other GMP documentation
- Documentation responsibilities include the review, filing initiation of SOP changes, processing new and revised SOP’s, and of maintaining Preventive Maintenance, Critical Monitoring Systems, GLP and GMP documentations
- Assist in training of new staff on Good Documentation Practices
Customer Support Specialist
Republic Services
Houston, TX
07.2013 - 10.2016
- Developed strong relationships with clients, resulting in repeat business and positive feedback.
- Delivered exceptional customer service experiences by maintaining a positive attitude, active listening skills, and empathetic responses to customer concerns.
- Managed a high volume of inbound calls while maintaining excellent call quality standards and adhering to established procedures.
- Enhanced customer satisfaction by addressing and resolving complex issues promptly and professionally.
- Following standard credit processes and procedures, assesses the risk of offering credit to new and existing customers for multiple divisions, business units or an area within a determined threshold, approves credit limits.
- Where appropriate performs research to identify misapplied payments and resolve basic and moderately complex issues.
- Retrieved and reviewed billing system reports to identify delinquent accounts.
- Following standard operating procedures, contacts customers via phone or standard letter to bring accounts to a current status.
- Prepares and provides reports reflecting status of credit and collection activity
Education
No Degree - Communications
Texas Southern University
Houston, TXSkills
- Expert in software programs EPIC, MS Office-Word, PowerPoint, Excel, Taleo, Workday, SAP, CRM, Oracle and Infopro
- Demonstrate ability to partner with all levels internal and external customers, lead, administer budgets, and strategic roll out implementations
- Execute strategic planning, market data, and pipelining in the Talent Acquisition process
- Expert in APA/MLA written/verbal communication skills in print, e-mail, person or by telephone Professional
- Ability to work in settings of high confidentially and abide by all rules and regulations of HIPPA
Timeline
Pre-Service Contact Representative
Texas Children's Hospital
12.2021 - 08.2024
Document Control Specialist
AmerisourceBergen
06.2017 - 04.2020
Senior Advocate
UnitedHealthcare
05.2016 - 12.2021
Customer Support Specialist
Republic Services
07.2013 - 10.2016
No Degree - Communications
Texas Southern University