Summary
Overview
Work History
Education
Timeline
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Lorie Davis

Hendersonville,TN

Summary

Certified Medical Office Administrator with over Twenty Five (25) years in the Healthcare Industry. Seeking career advancement in a business industry where my experience as well as my personal qualifications are used to the advantage of the company’s continued success and allows me the opportunity to advance. Expertise in client, customer service, claims, eligibility, benefits, enrollment and provider domain experience.

Overview

21
21
years of professional experience

Work History

Stop Loss Coordinator/Stop Loss Analyst

Lucent Healthcare/ Wellpath (HCS)
Nashville, TN
01.2019 - 01.2023
  • Process Claims within production requirements as well as split claims for stop loss purposes
  • Stop loss claims filing
  • Review of Reinsurance contracts, Summary Plan Descriptions, Coordination of Benefits, Pre-authorizations
  • Maintaining Turnaround Time (TAT) guidelines and accuracy with Aggregate and Specific stop loss claims
  • Run monthly and renewal reports
  • Aggregate deductible audits
  • Root cause analysis completion to develop process improvement
  • Accurate and timely notifications of Trigger Diagnosis and 50% of specific deductible to stop loss carriers
  • Distribution of checks to clients, maintenance of financial spreadsheet.

Reimbursement Analyst/Operations Support Specialist (PRN)

Wellpath/Correct Care Solutions
Nashville, TN
01.2014 - 01.2018
  • Review of Care Management inpatient stays.
  • Medicaid enrollment for inpatient admissions for all Arkansas state prisoners, along with multiple counties in the U.S.
  • Direct contact with providers and Care Management staff of enrollment status.
  • Claims and insurance assignment billing processes.
  • Initiation of medical review as needed.
  • Assistance and support to Regional Managers.
  • Assistant to the Operations department providing new site administrative training and support for the state of Massachusetts including orientation, material distribution and education including Electronic Health Record System and Care Management (ERMA CM), policies and procedures and Medicaid enrollment process.

Medical Receptionist

Dickson Medical Associates
Dickson, TN
01.2009 - 01.2014
  • Receptionist for busy Internal Medicine/Pediatrics practice including high volume call intake and patient appointment scheduling
  • Medical record maintenance
  • Assistant to clinical staff with call returns, referrals to specialists and exam room prep, as needed.

Patient Service Representative/Medical Records Clerk/Referral Coordinator

Wellstar Physicians Group
Smyrna, Mableton and Austell, GA
01.2002 - 01.2007
  • Performed several duties at three (3) locations within the Wellstar Physicians Group practice
  • Medical records maintenance
  • Patient check in/out, ordering office supplies, appointment scheduling, patient accounts collections, claims filing, insurance verification, ICD 9 coding
  • Specialist referral processing for group of 10 physicians.

Education

Medical Office Administration Certificate -

Medix School
Smyrna, GA
01.1993

High School Diploma -

Atlanta West Christian Academy
Lithia Springs, GA
01.1988

Timeline

Stop Loss Coordinator/Stop Loss Analyst

Lucent Healthcare/ Wellpath (HCS)
01.2019 - 01.2023

Reimbursement Analyst/Operations Support Specialist (PRN)

Wellpath/Correct Care Solutions
01.2014 - 01.2018

Medical Receptionist

Dickson Medical Associates
01.2009 - 01.2014

Patient Service Representative/Medical Records Clerk/Referral Coordinator

Wellstar Physicians Group
01.2002 - 01.2007

Medical Office Administration Certificate -

Medix School

High School Diploma -

Atlanta West Christian Academy

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Lorie Davis