Summary
Overview
Work History
Education
Skills
Affiliations
Accomplishments
Certification
Timeline
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TAMICA DAVIS

Redford,MI

Summary

Dynamic Payment Resolution Specialist at Trinity Health with a proven track record in resolving complex billing disputes and initiating successful appeals. Expert in Claims Billing and Customer Service, I excel in client relations and team leadership, consistently enhancing operational efficiency and ensuring compliance with regulatory standards.

Overview

19
19
years of professional experience
1
1
Certification

Work History

Payment Resolution Denial Team II

Trinity Health
Farmington, MI
01.2019 - Current
  • Payment resolution Specialist focus on resolving payment issues, coding related denials, ensure accurate coding practices, and appeals for Professional Medical Group Services
  • Working Clerical WQ, Appeals WQ and resolving over 45 cases including High Dollar Amount Cases per day with resolution via Dispute Letters, Provider Portals, and Appropriate Forms for Adjudication
  • Focused on Blue Cross Blue Shield of New York Albany and Syracuse claims for determinations and payment for claims
  • Handling post-billed denials, including clinical denials, to ensure proper reimbursement,
  • Analyze denials, identify root causes, and work to minimize payment delays and variances
  • Handling post-billed denials reviewing and appealing rejections and focusing on medical necessity
  • Identifying the reasons for denials and presenting a case for payment resolution by sending to appropriate teams to complete, example Technical WQ, Cash Team, and other Health Ministries as needed
  • Understanding and determining root cause as to why claims were denied preventing future issues, appealing timely filing, medical records formal appeals, duplicate denials, coding errors, credentialing, and reaching out to payors to understand reasons for denials and present supporting documentation for appeals
  • Understanding State and Federal Laws related to contracts and appeals
  • Maintained updated knowledge through continuing education and advanced training.

Medical Billing Customer Service Rep II

Trinity Health
Farmington, MI
01.2019 - Current
  • Assisted with a high volume of calls regarding patients accounts for billing insurance
  • Helping health care providers to resolve complex billing inquiries and discrepancies, resulting in improve communication, customer satisfaction addressing payments, billing concerns, eligibility, benefits, coding issues for both Hospital and Provider Billing
  • Research claim rejections, EOB remark codes, identifying and rectifying coding errors, billing insurance payors, verifying insurance, taking corrective actions, and/or referring claims to appropriate colleagues to ensure timely and accurate claims resolution via Epic Activity Work Queue or IN Basket Review Teams, and conducting billing and follow-up resolutions.
  • Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
  • Manage and Oversee Enterprise Patient Financial Services Escalations for all States, Preside Over Patient Portals per VP Administrator Assistant, resolving over 1000 escalated accounts, billing concerns, and responding within a 24-hour turnaround time
  • Worked disputed balance work ques, escalated emails per weekly report excel spread sheet, and brought to completion over 900 accounts regarding charge capture entry, credentialing, explanation of benefits denials, and payment posting concerns and credits
  • Completed, Monitored, and Resolved, our Quality-of-Care Team (QOC Complaints) investigating HIPPA, Compliance, and Risk Management Claims to bring to completion and making decisions if accounts was deemed as necessary, patient responsibility, or provider malpractice.
  • Reviewed charts, including nursing notes, physician orders, progress notes, and surgical or specialty notes thoroughly to interpret and validate and/or extract all charges
  • Handles self-pay billing-related functions, cash posting payments, distributes and undistributed payments to the correct HAR (Hospital Account Record), and has acquired knowledge of accounts receivable and specialty billing.
  • Process patient payments and refunds and be responsible for balancing charges and writing off adjustments.
  • Collaborated with healthcare providers to resolve billing discrepancies.
  • Processed payments and applied adjustments to patient accounts accurately.

Emergency Room Patient Access Representative II

Detroit Medical Center Harper Hospital
Detroit, MI
01.2014 - 01.2019
  • Registered over 60 patients as they entered the Emergency Room before being Triage, and completing the flow of the Discharge Process and In Patient Admission Process
  • Conducted interviews with patients to gather demographic, Insurance, and financial clearance data to complete the registration process perfectly and competently, Verifying HIPPA and uploading information into the patient Medical Record while creating invoices to process accurate registration into the System, correctly with no supervision
  • Monitored, Trained and Evaluated Staff by measuring Employee Production, Performance, and Productivity
  • Served as a primary source of communication with staff members, employees and patients and resolved menial problems arising from patients and staff
  • Dealt with numerous coordination issues and overcame them by exhibiting and exercising exceptional telephone etiquette
  • Skillfully used clinical and medical insurance knowledge to assist obtaining medical overrides, developing cost estimates as well as coordinating the predetermination processes
  • Processed, tracked, and documented patient care throughout the patient’s experience using an optimistic, kind, and helpful attitude
  • Professionally handled the healthcare department not only by pre-registering patients to avoid any mismanagement but also by providing financial counseling and assistance
  • Facilitated patient check-in processes and verified insurance information.
  • Maintained confidentiality of patient records and sensitive information.
  • Trained new staff on hospital policies and patient access procedures.
  • Applied HIPAA privacy and security regulations while handling patient information.
  • Collected co-pays and other payments from patients at time of service.
  • Scanned documents into electronic medical records system.
  • Obtained necessary signatures for privacy laws and consent for treatment.
  • Created new patient accounts in EMR system as needed.

Insurance Verification Specialist

American Community Insurance Company
Livonia, MI
01.2010 - 01.2013
  • Assisted medical offices by verifying insurance policies, advising of eligibility benefits and insurance coverage, by providing details of deductibles, copays, coinsurance, max benefits per family and out of pocket expense
  • Responsible for delivering excellent customer service to clients while resolving customer issues and complaints
  • Exhibited excellent problem resolution skills by reviewing and resolving claims in a timely manner and following up with the medical office and patients regarding billing and confirming that the patient has coverage for the services provided
  • Communicated with Medicaid, Medicare, Blue Cross Blue Shield, Aetna, all Commercial and State Government plans regarding Appeals, Claims Status, Coordination of Benefit (COB) and Patient Benefits, generating Invoices and processing payments
  • Assisted clients in understanding their insurance benefits and coverage options.
  • Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
  • Updated patient and insurance data and input changes into company computer system.
  • Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
  • Communicated with insurance carrier, patient and third party or employer to verify patient insurance benefits.
  • Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
  • Contacted patients to confirm demographic information and communicate financial responsibilities.
  • Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
  • Evaluated policies and procedures related to Insurance Verification activities.
  • Contacted patients to arrange payment arrangements for deductible and out-of-pocket liability.
  • Responded promptly to customer inquiries regarding their benefits and eligibility status.
  • Assisted in resolving claim issues related to billing and reimbursement inquiries.
  • Maintained confidentiality of patient information in accordance with HIPAA regulations.
  • Managed multiple tasks and priorities in a high-volume, fast-paced environment.
  • Conducted follow-ups with insurance companies to expedite verification processes.
  • Developed and maintained professional relationships with insurance representatives.
  • Resolved insurance-related issues and discrepancies to prevent claim denials.
  • Educated patients on their insurance benefits and coverage limitations.
  • Adhered to HIPAA requirements to safeguard patient confidentiality.
  • Communicated with patients with compassion while keeping medical information private.

Campus Manager, Cosmetologist, Master Instructor

P&A Cosmetology School
Redford, MI
01.2007 - 11.2010
  • Strive to provide great service and communication to students, staff, and guests, I hold responsibility for the whole campus from the staff schedules and training to the student’s enrollment to their attendance, and State Board Academics Daily
  • Educated students in new techniques and communications skills. Giving students the opportunity to live a life as a cosmetologist
  • Coordinated new enrollee presentations
  • Network at industry events such as wedding shows and hair shows to promote business Motivate and coach employees to improve performance
  • Managed daily operations of cosmetology programs and training schedules.
  • Coordinated student enrollment processes and maintained accurate records.
  • Oversaw compliance with state regulations and accreditation standards.
  • Facilitated communication between staff, students, and external partners.
  • Developed training materials to enhance instructional quality for educators.
  • Organized campus events to promote student engagement and community involvement.
  • Led staff meetings to address challenges and improve team collaboration.
  • Coordinated with state inspectors to handle campus inspections.
  • Engaged closely with students to help each coordinate continuing education and career plans.
  • Developed and maintained relationships with faculty members to ensure successful academic programs.
  • Organized and facilitated campus events, including lectures, conferences, student activities, and orientations.
  • Maintained records of student attendance and performance data.
  • Implemented policies related to safety and security of students, faculty and staff.
  • Monitored student progress and assisted students and teachers with resolving problems.
  • Reviewed and evaluated programs for compliance with state, local and federal regulations.
  • Recruited, trained and evaluated staff and recommended personnel actions for programs and services.
  • Planned, directed and monitored instructional methods and content of educational and vocational programs.
  • Maintained cleanliness and organization of workstations throughout the day.
  • Assisted in training new cosmetology students on practical techniques.
  • Ensured proper sanitation practices were followed at all times.
  • Maintained accurate records of customer services provided.
  • Attended continuing education classes to stay up to date with trends in the industry.
  • Maintained cleanliness of salon equipment and tools.
  • Washed, colored, cut and styled hair for high volume of clients daily.
  • Stayed up to date on current and emerging trends to increase professional value and meet diverse client needs.
  • Collaborated with other professionals in the beauty industry.
  • Trained new staff members on salon policies and procedures.
  • Developed new styles and techniques.

Education

Master of Arts - Cosmetology Instructor

P&A Beauty College
Ferndale, MI
01-2012

Associate of Arts - Cosmetologist

Michigan College of Beauty
Troy, MI
01.2010

Some College (No Degree) - Business Management Training Certificate

Oakland Community College
Royal Oak, MI

Skills

  • Excellent Writing & Communication Skills
  • Expert in Client Relations
  • Problem Solving
  • Initiating Appeals
  • Team Leadership/Trainer
  • Efficient in the Epic System
  • Knowledgeable of CPT Codes, ICD-10, HCPCS Codes, CMS-1500 for Physicians, and UB04 for Hospital and Outpatient Clinics
  • Able to Operate Under Pressure
  • Methodical Problem Solver
  • Patient Escalations Specialist
  • Excellent Customer Service
  • Claim processing
  • Insurance verification
  • Billing disputes
  • Customer relationship management
  • Regulatory compliance
  • Attention to detail
  • Conflict resolution
  • Quality assurance
  • Team building
  • Flexible and adaptable
  • Time management
  • Critical thinking

Affiliations

Perfect Attendance Award

Accomplishments

  • Recognized for Customer Service Best Award

Certification

  • License Cosmetologist
  • License Instructor

Timeline

Payment Resolution Denial Team II

Trinity Health
01.2019 - Current

Medical Billing Customer Service Rep II

Trinity Health
01.2019 - Current

Emergency Room Patient Access Representative II

Detroit Medical Center Harper Hospital
01.2014 - 01.2019

Insurance Verification Specialist

American Community Insurance Company
01.2010 - 01.2013

Campus Manager, Cosmetologist, Master Instructor

P&A Cosmetology School
01.2007 - 11.2010

Master of Arts - Cosmetology Instructor

P&A Beauty College

Associate of Arts - Cosmetologist

Michigan College of Beauty

Some College (No Degree) - Business Management Training Certificate

Oakland Community College

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TAMICA DAVIS