Summary
Overview
Work History
Education
Skills
Certification
Assessments
Timeline
Generic
Tamika Berry

Tamika Berry

Parkville,MD

Summary

To Pursue a Highly rewarding Career, Maintaining a healthy and Safe work environment. To utilize my Skills for organizational Growth.

Overview

15
15
years of professional experience
1
1

CPR & First Aid AED

1
1

90 Hrs Child Care Certification

1
1

Child Care Directors Certification

1
1

45 Hrs School Age Certification

1
1

ADA Certification

Work History

Claims Specialist

Mercy Health Services
09.2018 - 12.2023
  • Investigate suspicious insurance claims, including those that are suspected to have stemmed from fraud, criminal activity, arson, falsified documents, or unnecessary medical procedures.
  • Consult police and hospital records.
  • Consult with accountants, architects, construction workers, engineers, lawyers, and physicians to get expert evaluations.
  • Examine photographs and statements.
  • Listen to or Watch audio or video surveillance.
  • Record data and statements in report.
  • Obtain background information on claimants and witnesses using a universal database.
  • Access personal information and identify Social Security numbers aliases, drivers license numbers, addresses, phone numbers, criminal records, and past claims histories.
  • Search for previous cases of fraud.
  • Visit claimants to obtain oral statements.
  • Inspect facilities and determine if a claimant is performing rigorous activity that would rule out injuries in workers' compensation claim.
  • Take photos and document suspicious activity.
  • Report all activity to insurance company for final determination.
  • Testify in court cases when claimant is accused of fraud.
  • Resolved complex claims issues with thorough investigation, resulting in fair settlements for all parties involved.
  • Enhanced team productivity by providing ongoing training and mentorship to claims adjusters.
  • Reduced claim processing time by implementing efficient workflow improvements and streamlining processes.
  • Achieved high customer satisfaction ratings by maintaining open lines of communication and addressing concerns promptly.
  • Increased accuracy in claim evaluations through comprehensive documentation and attention to detail.

Payment Poster

Mobile X
11.2017 - 08.2018
  • Prepare, edit and submit account billing in accordance with the client contract or payer guidelines
  • Ensure all invoices are submitted accurately and timely per policy guidelines
  • Submit system contract/fee schedule changes when required to supervisor
  • Submit all required documentation with the invoice
  • Update facility daily census changes and performs required rebilling
  • Request necessary documentations when missing from client, physician or patient as appropriate
  • Access client flies if necessary to verify information
  • Respond to verbal and written client or responsible party inquiries regarding account status within the policy and procedure timeline
  • Research accounts and document follow up appropriately
  • Resolve account discrepancies adjustments and refunds for approval necessary
  • Maintain accurate and complete record concerning billing activity on all accounts
  • Documents in the system records
  • Address problems s they occur
  • Keep supervisor advised of area compliance issues which may lead to untimely or inaccurate completion of invoice or claim submission
  • Complete all reports according to schedule.
  • Enhanced payment processing efficiency by implementing a streamlined posting system.
  • Reduced payment discrepancies through meticulous attention to detail in data entry and reconciliation.
  • Collaborated with billing team to resolve outstanding invoices and improve cash flow.
  • Optimized payment allocation processes, resulting in decreased time spent on manual adjustments.
  • Increased accuracy of patient account balances by diligently applying payments according to insurance guidelines.
  • Assisted in the development of training materials for new Payment Poster hires, improving onboarding success rates.

Financial Coordinator/MMA

Sinai Hospital
08.2016 - 10.2017
  • Coordinates the daily billing activities of assigned department, works independently to maintain consistent workflow of all billing activities, and serves as a liaison between the Professional Billing Office, physicians and third party payers
  • Entering adjustments into Oracle Utilities Customer Care and Billing (CC&B) system
  • Improving and redesigning processes
  • Maintaining records and documentation
  • Maintaining confidentiality of information
  • Checking patients in at the front desk
  • Answering the phone
  • Scheduling patients for appointments
  • Compiling medical records and charts
  • Transferring lab results to the appropriate clinician.
  • Improved financial reporting accuracy by streamlining data entry processes and implementing automated systems.
  • Reduced budget discrepancies with thorough analysis of expense reports and timely resolution of any issues.
  • Enhanced cash flow management by optimizing payment schedules and negotiating favorable terms with vendors.
  • Increased departmental efficiency, implementing standardized procedures for all financial coordinator tasks.
  • Strengthened internal controls to mitigate risk, conducting regular audits and tightening approval processes.
  • Facilitated the annual budget planning process, collaborating closely with various departments to ensure accurate input.
  • Developed comprehensive financial reports for senior management, providing actionable insights on company performance.

Family and Physician / Provider Satisfaction with Access Services

University of Maryland Medical Center
12.2015 - 07.2016
  • Provides system wide oversight for access services provided at Facility, overseeing the delivery of services that facilitate patient access to the Medical Center
  • Financially securing patient care prior to or at time of care, avoid bad debt related to unauthorized hospitalizations or procedures, un-sponsored care or incorrect patient payer or demographic data, and enhance patient / family and physician / provider satisfaction with access services
  • Provides information to insurance companies to assist with billing
  • Assist patient during checkout, and ensure they have post treatment instruction
  • Refers individuals to outside agency when unable to meet their needs
  • Prioritizes the order of care so that the most critical patients can be seen first.

Claims Specialist

BD Diagnostics
11.2013 - 03.2015
  • In-depth knowledge in claim processing and specialty billing
  • Processed appeals for rejected medical claims
  • Review claims payment inquiries from providers and members and adjust for additional payment or retract overpayments in Facets System
  • Execute all regular transaction processes necessary to maintain operations records and databases
  • Perform extracting, importing, and exporting of data in various database applications
  • Assist in implementation, testing, and validating data and software systems
  • Perform data analysis of key problem areas to assist in root cause analysis
  • Audit data on a regular basis to ensure data integrity and quality.
  • Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
  • Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
  • Collaborated with cross-functional teams to optimize claims handling procedures, resulting in improved productivity.
  • Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
  • Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
  • Identified fraudulent claims through diligent investigation and collaboration with law enforcement agencies when necessary.

Inventory/Warehouse Coordinator

ThyssenKrupp Elevator Company
10.2011 - 08.2013
  • Pick up product by monitoring production; loading and moving product
  • Stores product by designating storage areas: adjusting storage areas to production and shipping requirements; updating location database
  • Prepares product for shipment by verifying location; directing movement to staging area; resolving problems
  • Ordering/Receiving elevator parts using AS400 and Oracle
  • Verifies product inventory reports by comparing logs, and reports; adjusting entries
  • Documents actions by completing forms, reports, logs, and records; maintain databases
  • Monitors inventory by completing counts as required
  • Accomplishes distribution and organization mission by completing related results as needed.

Front Desk Receptionist

Agora Publishing
01.2010 - 09.2011
  • Operated multi-line phone system
  • Keying and Batching invoices using ACCPAC for accounts payable
  • Check writing and distribution for company employees
  • Verifying customers account information before warm transferring customer to appropriate department using advantage software.

Intake Coordinator

Optum United Health Group
07.2008 - 07.2009
  • Positions in this function include those responsible for initial triage of members, administrative intake of members
  • Provides clinical and billing support, prior authorization and other related services
  • Processed inpatient and outpatient authorization requests
  • Managing the admission discharge information post notification, working with hospital and clinical team
  • Includes managing incoming calls, request for services from providers and members
  • Providing information on available network services and transferring members to appropriate clinical staff
  • Manages the referrals process, processing incoming and outgoing referrals and prior authorizations
  • Intake notification and census roles.

Education

Certification in CNA -

Sojourner Douglass College
01.2007

High school diploma -

W.E.B Dubois High School
Baltimore, MD
01.2005

No Degree - Child Care

Dave Johnson Enterprises
Baltimore, MD
2015.07 - 2015.11

Skills

  • Coordination
  • Organization
  • Time management
  • Supervision
  • Data Entry
  • Excel
  • Oracle/Orion Excel
  • Epic
  • Power point
  • SAP
  • AS400
  • ACCPAC
  • Citrix
  • Everest
  • Data Analysis
  • Help Desk
  • Process Improvement
  • Operating Systems
  • Qualitative Analysis
  • Supply Chain
  • Quantitative Analysis
  • Analytics
  • Accident Investigations
  • Compliance Management
  • Coverage Assessments
  • Settlement Determinations
  • Documentation Review
  • Claims
  • Claims Analysis
  • Verbal Communication
  • Microsoft Office
  • Case Management
  • Fraud Detection
  • Critical Thinking
  • Multitasking Abilities

Certification

  • Child Care Director
  • HIPPA
  • 90 Hrs Child Care
  • 45 Hrs School Age
  • ADA

Assessments

  • Medical receptionist skills, Proficient, 05/2023, Managing physician schedules and maintaining accurate patient records
  • Call center customer service, Proficient, 07/2021, Demonstrating customer service skills in a call center setting
  • Customer service, Proficient, 07/2021, Identifying and resolving common customer issues

Timeline

Claims Specialist

Mercy Health Services
09.2018 - 12.2023

Payment Poster

Mobile X
11.2017 - 08.2018

Financial Coordinator/MMA

Sinai Hospital
08.2016 - 10.2017

Family and Physician / Provider Satisfaction with Access Services

University of Maryland Medical Center
12.2015 - 07.2016

No Degree - Child Care

Dave Johnson Enterprises
2015.07 - 2015.11

Claims Specialist

BD Diagnostics
11.2013 - 03.2015

Inventory/Warehouse Coordinator

ThyssenKrupp Elevator Company
10.2011 - 08.2013

Front Desk Receptionist

Agora Publishing
01.2010 - 09.2011

Intake Coordinator

Optum United Health Group
07.2008 - 07.2009

Certification in CNA -

Sojourner Douglass College

High school diploma -

W.E.B Dubois High School

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Tamika Berry