REBECCA DAVIS
Summary
Highly motivated and experienced professional seeking a position in medical billing/coding, accounts payable/receivable, or dental billing/coding. Proficient in insurance verification, prior authorization, and pre-determination, with a strong knowledge of various insurance types including IHS, Medicaid, Medicare, and government insurances. Demonstrated expertise in CDT, CPT, and ICD-10 codes. Exceptional critical thinking skills and the ability to maintain accurate financial records in challenging environments. Skilled medical office professional adept at correcting and resubmitting claims, reviewing patient charts, and identifying proper diagnosis codes for billing. Experienced in managing medical record information to obtain prior authorizations and ensure payment from insurance companies. Knowledgeable in invoice preparation, payment processing, and pursuing past-due balances. Detail-oriented with a strong focus on accurate coding for clear recordkeeping. Team-oriented and dependable individual with a proven track record of delivering results.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Senior Patient Account Representative
OU Health Center
09.2024 - Current
- Reconciled account discrepancies to maintain accurate records of payments received from both patients and insurance companies.
- Improved collections rate by proactively identifying trends within outstanding accounts and developing targeted solutions.
- Participated actively in cross-functional team efforts geared towards improving overall organizational performance within the healthcare facility.
- Strengthened relationships between patients, providers, and insurers through open communication channels promoting transparency in financial matters.
- Maintained strict confidentiality while handling sensitive patient information in accordance with HIPAA regulations.
- Streamlined the revenue cycle process for increased efficiency and timely reimbursements.
- Provided exceptional customer service, addressing patient concerns and explaining complex billing processes in a clear manner.
Billing Specialist
Absentee Shawnee Tribal Health
06.2024 - 09.2024
- Researched and resolved billing discrepancies to enable accurate billing.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Worked with multiple departments to check proper billing information.
- Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
- Improved customer satisfaction with prompt and clear communication regarding their billing inquiries.
- Negotiated with insurance companies to resolve disputed claims, securing rightful payments.
- Collaborated with healthcare team to ensure billing codes were accurately applied, optimizing reimbursement from insurance companies.
- Fostered strong relationships with healthcare providers and insurance representatives to facilitate efficient resolution of billing issues.
- Made denial letters when a patient failed to notified contract health of doctor appointments and/or ER visits.
Pharmacy Prior Authorization Specialist
Absentee Shawnee Tribe Little Axe Health Center/Shawnee Clinic
04.2023 - 06.2024
- Responsible for sending in Prior Authorization to insurance for Pharmacy medication
- This included sending Priors Authorization through CMM (Cover My Meds) or having to call insurance to get a Prior Authorization started for a patient
- Once I received an approval or denial I would let pharmacy know the progress of the PA
- I also would log the outcome on my spreadsheet for the end of month report
- When not doing prior authorization I would help close out referrals for CHS/PRC
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms
- Communicated with people from various cultures and backgrounds on application process
- Continually updated knowledge on industry developments, ensuring adherence to best practices and relevant regulatory changes impacting the prior authorization process
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
Dental Coder/biller
Absentee Shawnee Tribe Little Axe Health Center/Shawnee Clinic
04.2021 - 04.2023
- Responsible for coding and billing of dental claims that are produced, processed, and sent in a prompt matter
- Verify insurance eligibility for all insurance types, send claims on dental Xchange and/or dental websites and/or mail claims
- Claim follow up of review of denials, calling insurances if no payment has been made within 90 days of DOS
- Resubmission of corrected claims
- AR responsibilities of reading EOB and posting payment to patients claim/chart, sending appeals if needed, and pulling reports of outstanding balances from insurances and/or patients
Medical Coder
Absentee Shawnee Tribe Little Axe Health Center/Shawnee Clinic
04.2021 - 04.2023
- Responsible for coding outpatient medical claims correctly according to progress notes of DOS
- Coded for 20-30 Medical providers, ranging from primary Care to specialty providers (I.E cardio, Behavior health, etc.)
- Once all coding is complete and corrected, claim is sent for payment to insurance through eCW system and/or uploaded on Medicaid site
- Worked with all types of insurances commercial, Sooner care, Medicare, and IHS (Indian Health)
Billing Specialist
Absentee Shawnee Tribe Little Axe Health Center/Shawnee Clinic
06.2020 - 04.2021
- Responsible for sending claims that are produced, processed, and sent for payment accurately and promptly
- Complete claims follow up on rejected claims that have been processed wrong and/or uploaded to secondary insurance
- Once all corrected information is obtained, resubmission of claim for correct payment on accounts
- This process includes paper and/or electronic claim forms (HCFA or UB)
Billing Tech
Citizen Potawatomi Nation
01.2019 - 06.2020
- Responsible for patients' claims that are produced, processed, and sent for payment accurately and promptly
- I also complete claim follow up on rejected and returned claims that have been processed wrong
- Once all corrected information is obtained, I will resubmit the claim for prompt, correct payment on accounts
- This process includes paper and/or electronic claim forms (HCFA or UB)
- I am also responsible for Workman Comp claims
- I receive information about a case via email, fax, and/or phone I will begin the process of getting all documentation ready to be sent
- This information includes medical records, pharmacy, and physical therapy
- Once the information is ready, I will bill for a single visit claim and print off claim to be sent via fax and/or secure email to our Work comp company
Commitment Register Clerk (Accounts Receivable/Payable)
Citizen Potawatomi Nation
01.2017 - 01.2019
- Responsible for making payment to all approved accounts for CHS (Contract Health Services)
- Counsel's providers and/or patients about approved and denied services
- Updated status of claims with outside providers and/or billing companies once an EOB was received
- Repriced all incoming claims that had no primary insurance on file
- The repricing would come from the CMS website for MLR (Medicare Like Rates)
- Posted payments once corresponding approved referral and PO was found
- Aided with the determination of eligibility of CHS
- Updated vendors on claim status as asked, verify patient's insurance eligibility and coverage type (PPO, HMO, Sooner Care, Medicare, and/or Indian Health)
- Reconciles end of the year accounts, as well did weekly DCR reports to make sure all claims and balance even out for the week
CHS Receptionist
Citizen Potawatomi Nation
11.2016 - 01.2017
- Responsible for greeting patients and/or providers who come in daily
- Answered a multi-line phone, took messages, transferred calls to the proper personnel, and logged all CHS calls
- Did a report of all CHS referrals that were done the day before by the schedulers
- Took ER call in notifications from patients that are in our district
- Passed out incoming mail daily
Medical Records
Absentee Shawnee Tribe Little Axe Health Center/Shawnee Clinic
02.2016 - 05.2016
- Responsible for requesting all records for the providers and/or patients
- Scanned all documentation that came in daily of records, patient request, etc
- Logged all information that came in including counting pages to make sure of correct count
- Had a monthly report to show all the work that was done
Registration Clerk LAC
Absentee Shawnee Tribe Little Axe Health Center/Shawnee Clinic
04.2013 - 11.2015
- Responsible for greeting patients that come into the clinic
- Obtain all required/requested documentation for each patient at each visit
- Answered a multi-line phone, scheduled patients for future visits and/or same day visits
- Verification of all types of insurance and took co-payment if needed
- When a patient couldn't make their co-payment at time of services a payment plan was set up
- Helped build providers schedules and/or blocked schedules when the provider would be out
- Was backup lead Registration Clerk when the lead would be out
- All questions/patient concerns came to me when needed
Transportation Driver
Absentee Shawnee Tribe Little Axe Health Center/Shawnee Clinic
05.2012 - 04.2013
- Responsible for taking elders to and from doctor appointment
- Kept a log for mileage and when gas was put into the vehicle on that day of transport
- Checked status of patients that are/were on Sooner Care who got the gas reimbursements for doctor appointments
- If the patient is eligible, we would set them up with Sooner care for Sooner Ride
- Answered multi-line phones and had cellphone for when out of office
Education
CMRS (CERTIFIED REIMBURSEMENT SPECIALIST) - MEDICAL BILLING
AMERICAN MEDICAL BILLING ASSOCIATION
Davis, OK04-2025
Dental Coding/ Billing -
AMERICAN DENTAL ASSOCIATION
St Louis, MO03.2024
Medical Billing/Coding/Insurance -
Gordon Cooper Technology Center
Shawnee, OK01.2017
Medical Terminology -
Moore Norman Technology Center
Norman, OK01.2014
Medical Billing/Coding/Insurance -
Gordon Cooper Technology Center
Shawnee, OK01.2014
Skills
- Heart saver First Aid
- Data Verification
- Workers' Compensation Forms
- Medical Recordkeeping
- Medical Terminology
- Medical billing code accuracy
- Medical claims coding
- Treatment Documentation
- Data Entry
- Billing Procedures
- ICD-10 Coding
- Appointment Scheduling
- Payment Collection
- Customer Service
- Claim submission
- HIPAA compliance
- Prior authorization process
- Claims processing
- Medical appeals handling
Certification
- Dental Coder/Biller
- Medical Billing
- Medical Coding/Insurance
- Medical Terminology
- Human Anatomy and Physiology
- HIPAA
- CPR
Computer Programs
- RPMS
- EHR
- ALL-Scripts
- E-Clinicals
- Dentrix
- Microsoft Office
- Excel
- Net-term
- PAMS
- Epic
Professional References
- Amy Hughes, (405) 448-0533, 15951 Little Axe Dr., Norman, OK, 73026
- Wynona Coon, (405) 447-0300, 15951 Little Axe Dr., Norman, OK, 73026
- Genevieve Foster, (405) 447-0300, 15951 Little Axe Dr., Norman, OK, 73026
Timeline
Senior Patient Account Representative
OU Health Center
09.2024 - Current
Billing Specialist
Absentee Shawnee Tribal Health
06.2024 - 09.2024
Pharmacy Prior Authorization Specialist
Absentee Shawnee Tribe Little Axe Health Center/Shawnee Clinic
04.2023 - 06.2024
Dental Coder/biller
Absentee Shawnee Tribe Little Axe Health Center/Shawnee Clinic
04.2021 - 04.2023
Medical Coder
Absentee Shawnee Tribe Little Axe Health Center/Shawnee Clinic
04.2021 - 04.2023
Billing Specialist
Absentee Shawnee Tribe Little Axe Health Center/Shawnee Clinic
06.2020 - 04.2021
Billing Tech
Citizen Potawatomi Nation
01.2019 - 06.2020
Commitment Register Clerk (Accounts Receivable/Payable)
Citizen Potawatomi Nation
01.2017 - 01.2019
CHS Receptionist
Citizen Potawatomi Nation
11.2016 - 01.2017
Medical Records
Absentee Shawnee Tribe Little Axe Health Center/Shawnee Clinic
02.2016 - 05.2016
Registration Clerk LAC
Absentee Shawnee Tribe Little Axe Health Center/Shawnee Clinic
04.2013 - 11.2015
Transportation Driver
Absentee Shawnee Tribe Little Axe Health Center/Shawnee Clinic
05.2012 - 04.2013
Medical Billing/Coding/Insurance -
Gordon Cooper Technology Center
Medical Terminology -
Moore Norman Technology Center
Medical Billing/Coding/Insurance -
Gordon Cooper Technology Center
CMRS (CERTIFIED REIMBURSEMENT SPECIALIST) - MEDICAL BILLING
AMERICAN MEDICAL BILLING ASSOCIATION
Dental Coding/ Billing -
AMERICAN DENTAL ASSOCIATION
Similar Profiles
BrookLynn MartinBrookLynn Martin
Lab Assistant 3/ Inventory Management at OU Medical Health Science CenterLab Assistant 3/ Inventory Management at OU Medical Health Science Center
Chassidy BoylandChassidy Boyland
Sr. Patient Services Representative at OU Health Sciences CenterSr. Patient Services Representative at OU Health Sciences Center
Angela VenegoniAngela Venegoni
Licensed Practical Nurse at OU Health- Stephenson Cancer CenterLicensed Practical Nurse at OU Health- Stephenson Cancer Center
Marie SmithMarie Smith
Senior Patient Account Representative at Eagleville HospitalSenior Patient Account Representative at Eagleville Hospital
KIM M COZIERKIM M COZIER
Senior Patient Account Representative at NORTHWELL HEALTHSenior Patient Account Representative at NORTHWELL HEALTH