denials specialist

TAMICA DAVIS

Redford, MI *****

***********@*******.*** / 313-***-****

SUMMARY

Accomplished professional with significant experience at Trinity Health, excelling in claims processing and appeals initiation. Proven expertise in swiftly resolving over 100 daily accounts while ensuring adherence to regulatory standards. Exceptional problem-solving capabilities and outstanding communication skills enhance client relations and improve team dynamics.

SKILLS

Writing and communication skills

Client relations

Problem solving

Appeals initiation

Team leadership

Epic software proficiency

Medical coding knowledge

Pressure management

Patient escalation management

Customer service excellence

Claims processing

Insurance verification

Billing dispute resolution

Regulatory compliance expertise

Attention to detail

Conflict resolution

Quality assurance practices

Team building strategies

Flexibility and adaptability

Time management

Critical thinking

EXPERIENCE

Payment Resolution Denial Team II / Trinity Health - Farmington, MI 01/2019 - Current

Resolved payment issues and coding denials for Professional Medical Group Services.

Managed clerical and appeals work queues, addressing over 75 cases daily.

Focused on Blue Cross Blue Shield of New York, Albany, and Syracuse claims for timely determination and payment.

Evaluated denial causes to eliminate payment delays and discrepancies.

Analyzed and disputed rejections and grievances, guaranteeing alignment with medical necessity criteria.

Partnered with Technical Team and Cash Teams to achieve effective case resolutions.

Addressed post-billed clinical denials to uphold proper reimbursement protocols.

Maintained up-to-date knowledge of state and federal laws governing contracts and appeals.

Medical Billing Customer Service Rep II / Trinity Health - Farmington, MI 01/2019 - Current

Successfully resolved over 100 enterprise patient financial services escalations within 24 hours.

Handled billing inquiries as VP administrator assistant for patient portals proficiently.

Processed payments accurately while balancing charges and applying necessary adjustments.

Addressed insurance calls regarding payment issues, eligibility, benefits, coordination of benefit issues, and coding matters.

Worked alongside healthcare providers to resolve billing inquiries and discrepancies.

Utilized Excel spreadsheets to track over 900 disputed balance questions efficiently.

Conducted investigations into HIPAA compliance and risk management claims with Quality-of-Care Team.

Reviewed clinical charts to identify relevant charges from nursing notes and physician orders.

Emergency Room Patient Access Representative II / Detroit Medical Center Harper Hospital - Detroit, MI 01/2014 - 01/2019

Streamlined registration process for over seventy-five Emergency Room patients, guaranteeing accurate data collection pre-triage.

Conducted comprehensive interviews to gather demographic, insurance, and financial information from patients.

Ensured HIPAA compliance during data uploads to medical records and invoice preparation.

Enhanced staff productivity by monitoring performance and implementing targeted training programs.

Functioned as key communication link among staff and patients, effectively addressing operational issues.

Assisted in securing medical overrides while creating detailed clinical cost estimates.

Upheld confidentiality of patient records and sensitive information at all times.

Collected co-pays and facilitated treatment consent signature acquisition during patient interactions.

Insurance Verification Specialist / American Community Insurance Company - Livonia, MI 01/2010 - 01/2013

Reviewed claims and coordinated follow-ups with medical offices to resolve customer issues efficiently.

Verified insurance policies and communicated coverage details, including deductibles and copays.

Educated clients on their insurance benefits while managing appeals with various carriers.

Ensured accurate verification prior to procedure scheduling, enhancing operational efficiency.

Maintained strict confidentiality of patient information in compliance with HIPAA regulations.

Identified discrepancies in coverage and ensured accurate data entry into systems.

Interacted effectively with clients to explain their coverage options clearly.

Resolved issues promptly while adhering to high service quality standards.

Campus Manager, Cosmetologist, Master Instructor / P&A Cosmetology School - Redford, MI 01/2007 - 11/2010

Provided exceptional service and communication to students, staff, and guests.

Managed campus operations, including staff schedules, training, enrollment, and attendance.

Educated students on advanced techniques and effective communication skills.

Ensured compliance with state regulations and accreditation standards.

Facilitated effective communication among staff, students, and external partners.

Developed instructional materials to enhance educator effectiveness.

Coordinated student enrollment processes while maintaining accurate records.

Monitored student progress and addressed challenges through collaboration.

EDUCATION

Associate of Applied Science: Cosmetology Instructor 01/2012

P&A Beauty College - Ferndale, MI

Associate of Applied Science: License Cosmetologist 01/2010

Michigan College of Beauty - Troy, MI

Associate of Arts: Business Management Training 2000

Oakland Community College - Royal Oak, MI

ACTIVITIES AND HONORS

Perfect Attendance Honor Award

ACCOMPLISHMENTS

Recognized for Excellent Customer Service

CERTIFICATIONS

License Cosmetologist

License Instructor

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