Gwentona Davis
Allen,Texas
Summary
Organized- Manages time, tasks and resources efficiently. Microsoft and Excel have a proven track record. Detailed oriented Building relationships and partnerships to achieve goals. Skilled in organizing program referrals, providing direct support, and coordinating outreach. Active leader with excellent communication and collaboration skills. Successful coordination of community service resources to meet the needs and expectations of vulnerable populations in the community.
Overview
13
13
years of professional experience
Work History
Medical Claims Analyst
United Health Group/Optum
10.2022 - Current
- Consistently meet and establish productivity, schedule adherence and quality standards.
- Review, analyze and research complex health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations and process them for payment.
- Navigate across various computer systems to locate critical information.
- Accurate processing and completion of medical claims.
- Actively participate in quality improvement and meetings.
- Provide expertise and general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims.
- {Remote}
Senior Service Care Coordinator
Village Health Partners
03.2021 - 10.2022
- Kept all company sensitive documents secure.
- Developed a reputation for punctuality and hard work.
- Worked with other team members to identify and achieve agency goals.
- Processed medical and prescription claims.
- Management recognized me for providing outstanding customer service with patients and providers.
- Analyze identified trends and provided reports as necessary.
- Provide insights on claim issues.
- Submitted attestations for proper billing.
- Handled escalated patient issues with appropriate resources.
- Verified insurance and demographics information.
- Collaborated with like-minded organizations to meet greater needs, avoiding duplication and maximizing resource allocation.
- Handled inbound/outbound calls.
- Understood and maintained HIPAA confidentiality and privacy standards when completing assigned work.
- Consistently met established productivity, scheduled adherence and quality standards.
Certified Medical Assistant
Texas Health/Presbyterian
01.2013 - 03.2021
- Implemented care and efficiency improvements to support and improve office operations.
- Gathered information about patient medical history including medication, symptoms, and allergies.
- Scheduled patient appointments over the phone and in person.
- Educated patients by providing medication and diet information, as well as clarifying doctors' orders and thoroughly answering questions.
- Performed preliminary assessments, such as measuring weight, temperature, and blood pressure, and meticulously documented the results.
- Educated patients about procedures, procedures, and treatment plans.
- Conducted monthly and quarterly inventory of supplies using facility cost reporting records.
- Prepared lab specimens of blood, urine, stool, and sputum for diagnostic evaluation.
- Directed patients to exam rooms, answered questions, and helped doctors prepare for exams.
- Called and faxed pharmacies to submit prescriptions and refills.
- Relayed physician orders to patients, offering advice on how to carry them out and answering follow-up questions.
- Assisted with routine checks and diagnostic testing by collecting and processing specimens.
- Helped patients prepare for X-rays, EKGs, suture removal, and dressing changes.
- Updated the inventory, expiration, and vaccine logs to keep the tracking documentation up to date.
- Escorted patients to exam rooms, answered general questions, and explained the process to patients to prepare them for the physician.
Education
Medical Assisting-Certified Medical Assisting -
ATI
Richardson, TexasSkills
- Effective customer communication
- Well-trained in ECW, and Epic
- MS Outlook/Microsoft Word {ability to send/receive emails and calendar invites
- Relationship development
- Project organization
- Customer support and assistance
- Proficiency with computer and Windows PC which includes the ability to learn new and complex computer system applications
Timeline
Medical Claims Analyst
United Health Group/Optum
10.2022 - Current
Senior Service Care Coordinator
Village Health Partners
03.2021 - 10.2022
Certified Medical Assistant
Texas Health/Presbyterian
01.2013 - 03.2021
Medical Assisting-Certified Medical Assisting -
ATI