Nakiyah Davis
Newark,NJ
Summary
Dynamic Revenue Cycle Analyst with extensive expertise in analysis and problem-solving, dedicated to enhancing operational performance through strategic solutions. Proven track record in identifying inefficiencies and implementing data-driven improvements demonstrates a commitment to excellence. Strong communication skills complement a collaborative approach, fostering teamwork to achieve results while adapting to evolving business needs. Proactive in addressing potential issues in operations, workflow, and production by uncovering critical trends that impact overall business success.
Overview
14
14
years of professional experience
Work History
Third Party Follow-Up Analyst
HackensackUMC
Hackensack, NJ
02.2020 - Current
- Worked closely with delinquent account holders to collect and reconcile accounts through approved channels.
- Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
- Wrote appeal letters to insurance companies for denial of claims.
- Meets bi-weekly and monthly with various vendors and outsource agencies to discuss bottlenecks in revenue flow and discusses solutions. Acts as liaison between agencies and Follow-Up department to prevent accounts receivable aging and ensures timely flow of communication.
- Performs reimbursement management and tracks and reports on high volume discrepancies which will be used as escalation to Managed Care, the payer, or IT. Monitors denials and initiates CPT or DRG analysis to determine reason for denial.
- Improved internal knowledge sharing by developing comprehensive documentation outlining standard operating procedures for various tasks.
- Conducts accounts receivable audits as defined by SVP, Sr Revenue Officer and Patient Financial Services Managers.
Medical Insurance Biller
Care Station Medical Group
Linden, NJ
07.2019 - 01.2020
- Filed and submitted an approximate number of 45 insurance claims daily.
- Reviewed medical records to meet insurance company requirements.
- Handled third-party insurance processing tasks to assist patients.
- Reviewed received payments for accuracy and applied to intended patient accounts.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
- Completed and submitted appeals for denied claims.
- Submitted appeals using provider portals and phone communication.
- Reviewed claims for coding accuracy.
- Distributed or posted financial data to appropriate accounts and prepare simple reconciliations.
- Monitored reimbursement from managed care networks and insurance carriers to verify consistency with contract rates.
- Contributed to company growth by accurately analyzing trends in denial rates, payer mix, and other key performance indicators relevant to revenue cycle management.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
Claims Adjuster
Horizon BCBSNJ
Newark, NJ
07.2011 - 03.2019
- Reviewed data to verify validity of claims and determine case management actions.
- Drafted statement of loss to summarize damages, payments and underlying policy coverage.
- Analyzed and audited open claims to calculate additional payments owed.
- Accurately processed large volume of medical claims every shift.
- Input data into the system, maintaining accuracy of provider coding information and reported services.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Used contract notes and processing manual to correctly apply group-specific classifications to claims.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
Education
Certification - Medical Billing And Coding
DeVry University
Naperville, IL12.2022
High School Diploma -
Technology High School
Newark, NJ06.2003
Skills
- Healthcare Claim Coding
- Medical Terminology
- ICD-9 Coding
- Critical Thinking
- Problem Resolution
- DRGs Patient Assignments
- Medical Billing Processing
- Epic Systems
- Insurance Billing
- Attention to Detail
- Patient Data Abstracts
- Analytical thinking
- Root-cause analysis
- Critical thinking
- Evidence-based decision making
Timeline
Third Party Follow-Up Analyst
HackensackUMC
02.2020 - Current
Medical Insurance Biller
Care Station Medical Group
07.2019 - 01.2020
Claims Adjuster
Horizon BCBSNJ
07.2011 - 03.2019
High School Diploma -
Technology High School
Certification - Medical Billing And Coding
DeVry University