Customer Service Billing Specialist

VALERIE DAVIS

*** ******* *****, ****** ****, MD 20640

240-***-**** · *******.*********@*****.***

QUALIFICATIONS

Exceptional interpersonal communication, leadership, analytical, and organizational skills. Able to work independently and as an integral part of a team effort. Outstanding networking and customer service skills. An aggressive problem solver and decision maker. The ability to set realistic priorities and initiate viable courses of action to attain objectives from complex problems and escalated issues.

WORK HISTORY

Self-pay Billing Specialist / Coordinator

Kaiser Permanente Rockville, MD

January 2005 – August 2019

Audited bills to ensure accurate internal health plan charges and out of pocket expenses. Team Leader for the self-pay team, which acted as the go between for the specialists and upper-level management. Provided customer service to members regarding bills received. Provided training for all new Specialists.

Member Services Commercial Appeals Analyst

Kaiser Permanente Rockville, MD

January 2000 – January 2005

Provided expert and timely handling of all member appeals to assure program compliance with all external requirements and internal service goals. Communicated with members on all levels. Handled phone calls related to member complaints and wrote letters regarding complaints and concerns. Collected and analyzed data within member services. Prepared accurate and thorough presentation of material for a weekly interdisciplinary appeals committee. Provided accurate case information regarding member appeals and acted as the advocate for members.

Claims Adjudicator / Claims Processor

Kaiser Permanente Rockville, MD

June 1992 - January 2000

Provided expert and timely management and adjudication for all emergency review claims in the Clinical Review Unit. Ensured compliance with Kaiser’s missions, goals, and regulatory requirements. Collaborated with nurses, emergency care management staff, and appeals committee in resolving emergency room claims. Processed and adjudicated member claims according to contract and department guidelines. Troubleshooted problem claims and maintained high production and accuracy of all claims.

Education

Morgan State University August 1978 – May 1979

Baltimore, MD

Communications Major

Mount Vernon College August 1982 – May 1983

Washington, DC

Business Major

Certificates

LeanSigma Fundamentals for Financial Services Summer 2006

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