Tia Barker
Chesterfield,VA
Summary
Detail-oriented Healthcare Compliance and Audit professional with 10 years of experience in Medicare and Medicaid operations, regulatory compliance, and quality assurance. Conducts compliance reviews, identifies operational risks, evaluates documentation accuracy, and interprets regulatory requirements. Collaborates with cross-functional teams to enhance compliance programs and drive continuous process improvement.
Overview
11
11
years of professional experience
Work History
Audit and Compliance Analyst
Accessia Health
Midlothian, Virginia
05.2026 - Current
- Perform comprehensive compliance audits to evaluate adherence to federal regulations, state requirements, organizational policies, and program guidelines.
- Conduct multiple audit types, including state audits, eligibility audits, anomaly report audits, PEX card transaction audits, PSR approval audits, finance audits, and quality assurance reviews.
- Identify documentation deficiencies, compliance risks, operational trends, and process gaps while recommending corrective actions to leadership.
- Analyze audit findings, prepare detailed reports, and communicate results to management to support compliance initiatives and continuous quality improvement.
- Collaborate with operations, finance, eligibility, and cross-functional teams to resolve compliance issues and improve audit readiness.
- Participate in the development, transition, and standardization of enterprise audit processes to improve consistency, accountability, and operational efficiency.
- Support leadership with audit planning, workflow prioritization, and process improvement initiatives designed to strengthen compliance oversight.
Medical Management Specialist II
Anthem
Richmond, VA
03.2022 - 05.2026
- Facilitated communication between providers and stakeholders to resolve complex billing and payment issues, ensuring alignment and timely resolutions.
- Liaised with internal teams to ensure regulatory compliance and timely responses to provider inquiries, identifying process optimization opportunities to support cost-efficiency initiatives.
- Participated in strategic planning initiatives to enhance compliance and streamline Medicaid authorization process, contributing to operational efficiency.
- Drafted and reviewed written communication (e.g., determinations/denial language and guidance to providers) to ensure clarity, compliance, and accuracy.
- Reviewed and ensured quality of denial letters sent to members and providers for accuracy and compliance.
- Led training sessions and mentored new team members to enhance onboarding and integration.
- Entered authorizations for Medicaid and Medicare personal and respite care.
Performance Quality Analyst I
Anthem
Richmond, VA
10.2018 - 09.2021
- Supported discrepancy reviews and guideline interpretation as SME; facilitated implementation reviews to ensure consistent, accurate processing.
- Audited calls and correspondence for quality and compliance; summarized findings and recommended corrective actions to address trends.
- Prepared detailed reports for internal audits and compliance reviews, supporting regulatory documentation efforts.
- Updated policies and created training materials to align with evolving compliance standards.
- Mentored auditors and supported discrepancy reviews to enhance overall team expertise.
Medical Management Specialist I
Anthem
Richmond, VA
09.2017 - 10.2018
- Coordinated care for Medicaid members, optimizing case manager assignments to improve member support outcomes.
- Supported DMAS assessments and reporting, collaborating with internal partners to effectively resolve case-related issues.
- Supported DMAS assessments and reporting, collaborating with internal partners to resolve case-related issues effectively.
- Liaised between departments to ensure accurate reporting and compliance with program standards.
Operations Expert
Anthem
Richmond, VA
04.2017 - 09.2017
- Spearheaded initiatives to improve operational workflows, resulting in reduced turnaround times, and increased accuracy.
- Coached team on procedural updates, tracked opportunities and reported on inquiries using Excel to enhance information flow.
- Processed claims to facilitate timely reimbursements and maintain provider relationships., ensuring accurate outcomes and minimizing provider abrasion.
- Researched benefit and claims escalations, created work items/tickets (Rational Team Concert) to facilitate reconciliation and special processing.
- Conducted interviews and designed onboarding plans to integrate new hires effectively.
Customer Care Associate I/II/III
Anthem
Richmond, VA
08.2015 - 04.2017
- Functioned as Open Enrollment Ambassador at Anthem Health Plans, delivering essential information to clients during crucial enrollment periods.
- Addressed inquiries on benefits, claims, and eligibility, fostering client understanding and satisfaction with services.
- Led team huddles and updated performance dashboards to synchronize team goals and monitor progress effectively.
Education
Bachelor of Science - Psychology
Liberty University
Lynchburg, VAHigh School Diploma -
Hermitage High School
Richmond, VASkills
- Compliance Auditing
- Healthcare Compliance
- Regulatory Compliance
- Medicare regulations
- HIPAA Compliance
- Documentation Review
- Audit Reporting
- Risk Assessment
- Internal Auditing
- Process Improvement
- Root Cause Analysis
- Corrective Action Recommendations
- Cross-Functional Collaboration
- Operational Compliance
- Policy analysis
Timeline
Audit and Compliance Analyst
Accessia Health
05.2026 - Current
Medical Management Specialist II
Anthem
03.2022 - 05.2026
Performance Quality Analyst I
Anthem
10.2018 - 09.2021
Medical Management Specialist I
Anthem
09.2017 - 10.2018
Operations Expert
Anthem
04.2017 - 09.2017
Customer Care Associate I/II/III
Anthem
08.2015 - 04.2017
Bachelor of Science - Psychology
Liberty University
High School Diploma -
Hermitage High School