Regina Davis
Alliance HealthCare Services
Louisburg,NC
14
years of professional experience
Dynamic Sr. Claims Analyst at Alliance HealthCare Services with expertise in claims analysis and process improvement. Proven track record in enhancing operational efficiency and ensuring regulatory compliance. Skilled in data evaluation and training development, fostering cross-department collaboration to resolve complex issues and drive performance excellence.
Work History
Interim Director of Claims System Processing
3 Months- Developed and implemented policies to align with organizational goals and industry standards.
- Oversaw budgeting processes, ensuring resource allocation met departmental needs effectively.
- Fostered collaboration among interdisciplinary teams to improve healthcare delivery outcomes.
- Led strategic initiatives to enhance patient care services and operational efficiency.
- Analyzed performance metrics to identify areas for improvement and drive quality enhancements.
- Facilitated cross-functional collaboration for improved decision-making processes within the organization.
- Improved project efficiency with strategic planning, resource allocation, and time management practices.
- Implemented innovative solutions to solve complex problems, resulting in increased productivity and streamlined operations.
Sr. Claims Analyst
7 Years 6 Months- Executed comprehensive claims analysis, improving payment processing efficiency.
- Analyzed claims data to identify system issues and errors, providing consultative resolutions.
- Tracked trends to identify irregularities in claims submissions and chronic QA issues.
- Developed tracking mechanisms for chronic issues, monitoring effectiveness and resolution timeframes.
- Partnered with IT to develop tools enhancing claims system functionality.
- Evaluated data, authored reports, and presented findings with actionable recommendations.
- Tracked trends to identify irregularities in claims submissions and chronic QA issues, enhancing overall claims accuracy.
- Delivered training and technical assistance to network providers on claims processes.
- Resolved issues related to finance system claim crossover, provider payment discrepancies, RA discrepancies, and claim-to-payment mappings.
- Responsible for balancing Medicare and state weekly RAs to report to the Finance Department.
Claims Supervisor
5 Years 7 Months- Compiled performance reports and monitored operational measures to identify needs and optimize work level requirements.
- Supported claims analysts in reviewing claim errors and ensured staff followed resolution protocols, including appropriate escalations.
- Organized workflows and ensured staff were well-trained in organizational policies, providing necessary tools and resources for success.
- Ensure staff are trained and proficient in their day-to-day responsibilities to be successful.
- Set goals for performance and deadlines, with organizational goals and vision.
- Review and analyze daily and weekly reports to help track progress and monitor staff in achieving department standards.
- Compiled performance reports and monitored operational measures to evaluate needs and work level requirements.
Claims Auditor
5 Months- Reviewed paid claims for compliance with Alliance procedures, ensuring accuracy in payments and settlements.
- Identified and reported overpayments, underpayments, and irregularities in claims processing to maintain financial integrity.
- Collaborated with senior management and legal counsel on claims requiring litigation to support strategic decision-making.
AR Director
1 Month- Supervised claims processing, accounts payables, provider enrollment, and claims denial department to enhance operational efficiency and accuracy.
- Generated weekly reports and managed monthly financial closings, delivering comprehensive financial updates to CFO and company accountant.
- Generated weekly reports and managed monthly financial closings to provide comprehensive financial updates to CFO and company accountant.
AR Manager
9 Months- Supervised team of 4 AR specialists in billing, posting, and denial roles, ensuring compliance with funding regulations and MCO software requirements.
- Trained staff on diverse funding sources, improving compliance with regulations and proficiency in MCO software.
- Closed monthly financials and communicated effectively with Medicaid, Medicare, third-party payers, LMEs, and MCOs.
Education
Associate of Arts
High School Diploma
Skills
Claims analysis
Data evaluation
Process improvement
Regulatory compliance
Financial reporting
Training development
Problem solving
Communication skills
Critical thinking
Cross-department collaboration
Trend analysis
Quality assurance
Advanced data analytics
Claims analysis expertise
Error resolution
Performance monitoring
Multitasking
Teamwork skills
Teamwork and collaboration
Claim investigation
Claims trend analysis
Data interpretation
Problem-solving abilities
Multitasking Abilities
Self motivation
Trend identification
Training delivery
Computer skills
Time management
Customer service
Education and Training
other,other
Timeline
Interim Director of Claims System Processing
Alliance Health
04.2026 - CurrentRead More
Sr. Claims Analyst
Alliance HealthCare Services
01.2019 - CurrentRead More
Claims Supervisor
Alliance HealthCare Services
06.2013 - 01.2019Read More
Claims Auditor
Alliance HealthCare Services
01.2013 - 06.2013Read More
AR Director
Saguaro
12.2012 - 01.2013Read More
AR Manager
Saguaro
03.2012 - 12.2012Read More
Cary High Scholle
High School Diploma
Read More
University of Phoenix
Associate of Arts
Read More