Hali Davies
West Blocton,AL
Summary
Dedicated and certified AAPC CPC professional with eight years of experience in medical billing and coding, along with three years of specialized expertise in audit recovery for commercial insurance and CMS/Medicare. Thrives in challenging environments with a strong passion for continuous learning, driving excellence in all aspects of the healthcare system. Collaborative by nature and effective in independent roles, committed to enhancing revenue cycle processes to achieve positive patient outcomes. Emphasizes the critical role of meticulous documentation in healthcare, employing a proactive approach to ensure compliance and maximize efficiency within the industry.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Medical Auditor
Performant Healthcare
Livermore, CA
08.2022 - Current
- Conducted thorough reviews of medical documentation for both outpatient and inpatient settings to ensure recoupment.
- Commercial insurance companies (BCBS, PriorityHealth, United Healthcare, etc)
- Dedicated to ensuring accurate payment processes for CMS/Medicare by recovering overpayments and correcting underpayments.
- Outpatient, Inpatient, ProFee, APC surgical audits.
- Adhering to performance metrics of 95% accuracy or better
- Adhering to strict productivity metrics determined by audit concepts
- Testing new audit workflows and software and providing timely feedback for the purposes of full team implantation
Certified Medical Coder
DCH HEALTH SYSTEM
Tuscaloosa, AL
03.2021 - 08.2022
- CPT and PCS coding
- Coding and billing for Neurosurgeon (surgical procedures and office visits)
- Coding and billing for Cardiac Electrophysiology (office visits, hospital rounds, and surgical procedures)
- Coding and billing for Trauma (surgeries, hospital visits, and clinic)
- Coding and billing Cardiothoracic Surgery (procedures and clinic)
- Coding and billing for Oncology (office visits and hospital services)
- Facilitated swift resolution of insurance claims.
- Takes part in auditing activities.
- Meditech expanse EMR experience
- Cerner/Promed experience
- Sulucro payment system experience
- Quadax Expeditor
- Trizetto Clearinghouse
Medical Billing Specialist
MedHelp Clinics
Birmingham, AL
12.2020 - 03.2021
- Applying ICD-10-CM codes, CPT, and HCPCS codes to encounters.
- Managed preparation of claims for insurance billing.
- Insurance follow-up
- Provided clear explanations of billing statements to patients.
- Ensured timely posting of patient payments.
- Experience Coding and billing claims for MEDICARE AND MEDICAID.
- Experience with BCBS, UHC, CIGNA, HUMANA, and other miscellaneous commercial insurance companies.
- Training new incumbents in Athena EMR.
- Lab billing experience. Office has an in-house lab.
Medical Billing Specialist
Cahaba Medical Care
Centreville, AL
02.2019 - 11.2020
- Prepare and submit claims for FQHC family practice facility
- Prepare physician side claims for inpatient services at Princeton Baptist, UAB Medical West, and Bibb Medical Center.
- Tenured as 1 of 3 on-boarding trainers for the billing department at CMC.
- Experience in billing Medicare, Medicaid, and commercial insurance.
- Claim denial resolution.
- Coding and billing Pro fee wound care.
- Experienced in Athena Healthcare EMR/Practice management software.
- Experience with Meditech.
- Regularly explain patient bills to patients.
Substitute teacher
Kelly Educational Staffing
12.2018 - 02.2019
- Adapt to changing circumstances quickly
- Implement lesson plans
- Prepare backup lesson plans
- Conflict resolution
Professional Hairstylist
Supercuts
09.2009 - 05.2010
- 2 years of customer service
- 2 years of scheduling
- 2 years of telephone communication
- Met deadlines to reach target service percentages.
Education
Certificate - Medical Billing & Coding
Career Step
09.2018
High school diploma or GED - Standard Technical Diploma
West Blocton High School
West Blocton, AL05.2010
Skills
- HIPAA (7 years)
- Microsoft Office (7 years)
- Medical collection (3 years)
- Anatomy Knowledge (4 years)
- Medical Office Experience (4 years)
- Medical Insurance
- Athenahealth (2 years)
- Insurance Verification (3 years)
- Medical Terminology (4 years)
- Documentation review (4 years)
- Medical Scheduling (1 year)
- Medical Records
- Medical Billing
- ICD 10 Coding (4 years)
- CPT Coding (4 years)
- Account Reconciliation (4 years)
- EMR Systems (4 years)
- Phone Etiquette (7 years)
- Data Entry (3 years)
- Physiology Knowledge (4 years)
- Employee evaluation (3 years)
Certification
- CPC
- December 2018 to Present
- AAPC #01678570
Languages
Spanish - Beginner
English - Expert
Affiliations
- American Academy of Professional Coders
- Present
- Certification organization for coding professionals
- Provides continuing education opportunities
- Updates members when new AMA coding guidelines are created
Additional Information
- SKILLS
- Outpatient and Inpatient medical record audits for the purpose of financial recovery
- Outpatient and Inpatient Coding
- ICD-10-CM, ICD-10-PCS
- CPT/HCPCS Level II
- Health Information Management
- CMS 1500 and UB-04 Claim Forms
- Healthcare Reimbursement
- Medical Terminology & Anatomy
- Pharmacology & Pathophysiology
- 3M Encoder / 3M Reference Software
- Fraud, Waste, and Abuse training
- Knowledge of HIPAA and Patient Confidentiality
- Patient Check-in/out, Patient Scheduling/Triage
- Detailed Knowledge of Coding Guidelines
- APC and MS-DRG Assignments
- Posting Charges/Payments
- Filing Medical Records
- Clinical Data Analysis and Abstraction
- Time Management
- Professional and Compassionate
- Good Communication and Telephone Mannerism
Timeline
Medical Auditor
Performant Healthcare
08.2022 - Current
Certified Medical Coder
DCH HEALTH SYSTEM
03.2021 - 08.2022
Medical Billing Specialist
MedHelp Clinics
12.2020 - 03.2021
Medical Billing Specialist
Cahaba Medical Care
02.2019 - 11.2020
Substitute teacher
Kelly Educational Staffing
12.2018 - 02.2019
Professional Hairstylist
Supercuts
09.2009 - 05.2010
High school diploma or GED - Standard Technical Diploma
West Blocton High School
Certificate - Medical Billing & Coding
Career Step