Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Renee Davis

Elgin,SC

Summary

Seasoned Epic Analyst with proficiency in healthcare software solutions. Demonstrated capability in improving operational efficiency by implementing and maintaining Epic Systems. Strengths include strong analytical skills, problem-solving abilities, and knowledge of medical terminology. Previous work has resulted in streamlined workflows, improved data management and enhanced patient care.

Overview

41
41
years of professional experience
1
1
Certification

Work History

Clinical Assistant II/Revenue Claims Specialist

Natera
Austin, TX
09.2024 - Current
  • Communicates directly with prior authorization, claims and appeals, and lab teams to troubleshoot issues, verify samples, streamline processes, and serve as a liaison between these teams and the genetic counselors.
  • Assist with data collection for internal projects, product development, and operations related to reimbursement.
  • Tracks outcomes of payment resolution, appeals, and negotiated claims to ensure goals are met.
  • Reviews and monitors billing and coding changes, researches, evaluates, and interprets guidance from a variety of sources to determine departmental actions.
  • Participates in team meetings.
  • In addition to the above, the following clinical assistant duties would also be performed.
  • Review incoming referrals and claim denials, and request additional documentation or clarification when needed.
  • Update internal databases regarding test development progress, and make notes in LIMS case notes for each patient or provider contact.
  • Assist genetic counselors in answering questions from clinics and customer support.
  • Works with PHI on a regular basis, both in paper and electronic form, and has access to various technologies to access PHI (paper and electronic) in order to perform the job.

Administration Manager

There Is Hope Foundation
Columbia, SC
04.2008 - 02.2019
  • Managed the operation of large multi-dimensional data sets
  • Provided lead direction in project management and prioritized tasks to meet deadlines
  • Translated technical information into non-technical communication for diverse audiences
  • Conducted research and analysis on complex issues, delivering clear and concise recommendations
  • Utilized data analytics to extract valuable insights and make data-driven recommendations
  • Conducted data cleansing and validation to ensure data accuracy
  • Produced reports and visualizations to present findings to the management team
  • Worked collaboratively with stakeholders to define data requirements
  • Developed and maintained data collection and reporting processes
  • Leveraged advanced Excel and data analysis tools for data manipulation and reporting
  • Contributed to the optimization of data storage and retrieval systems
  • Coordinated office, calendar, and administrative duties for the VP and Manager
  • Coordinated community engagement activities for Midstream Operations.

Medical Coordinator

Carolina Medical Review
Columbia , SC
01.1990 - 08.1995
  • Developed processes and procedures for appealing denied claims that improved efficiency and effectiveness.
  • Compiled data from various sources in order to analyze trends associated with denials, or other claim issues.
  • Maintained up-to-date knowledge of applicable laws, regulations, policies, and procedures related to appeals processing.
  • Reviewed appeals submitted by patients and providers to ensure accuracy and compliance with policies.
  • Conducted quality assurance reviews of other Appeals Specialists' work products.
  • Worked closely with internal teams, such as Medical Directors, Customer Service Representatives, and Provider Relations staff, in order to facilitate the successful resolution of appealed claims.
  • Organized information by using spreadsheets, databases, or word processing applications.

Medical Claims Processor

Blue Cross Blue Shield of South Carolina
Columbia, SC
01.1985 - 08.1990
  • Performed Quality Assurance checks on processed claims ensuring all edits were resolved prior to submitting them for adjudication and payment.
  • Investigated discrepancies in medical billing information such as incorrect codes or amounts due.
  • Researched claim denials and appeals to determine appropriate resolution.
  • Calculated payments due based on allowed charges compared to billed charges according to contract terms with payers, insurers, third parties.
  • Ensured compliance with insurance company policies and procedures related to the processing of claims.
  • Worked collaboratively with providers' offices to ensure timely reimbursement on submitted claims by providing missing documentation or correcting errors that caused delays in payment processing.
  • Prepared documents for submission to insurance companies for review and approval for payment of claims.
  • Experience with CPT/HCPCS. ICD-10, modifier selection, and UB revenue codes.

Education

Some College (No Degree) - Information Technology

Midlands Technical College
Columbia
08-2002

High School Diploma -

WJ Keenan High School
Columbia, SC
06-1985

Skills

  • 5 years experience and understanding in healthcare billing, coding, claims processing, and reimbursement
  • Understanding of payer rules, denial management and revenue cycle
  • Epic professional billing and claims experience, 5 years
  • Experience in healthcare and claims in a clinical setting
  • Ability to analyze population health data and implementation of care strategies
  • Strong knowledge of EPIC operations, workflows, and regulatory requirements
  • Healthcare IT
  • Issue resolution
  • Epic module expertise
  • Time management abilities
  • Excellent communication
  • Medical coding
  • Project management
  • Data analysis
  • Attention to detail
  • Effective communication
  • Problem solving
  • Quality assurance
  • Stakeholder engagement practices
  • Clinical workflow analysis
  • Software troubleshooting
  • HIPAA compliance

Certification

  • Good Documentation Practices (GDP) Guidelines
  • HIPPA PHI

Timeline

Clinical Assistant II/Revenue Claims Specialist

Natera
09.2024 - Current

Administration Manager

There Is Hope Foundation
04.2008 - 02.2019

Medical Coordinator

Carolina Medical Review
01.1990 - 08.1995

Medical Claims Processor

Blue Cross Blue Shield of South Carolina
01.1985 - 08.1990

Some College (No Degree) - Information Technology

Midlands Technical College

High School Diploma -

WJ Keenan High School

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