Darineisha E. Davis, CBCS
Powder Springs,GA
Summary
Knowledgeable medical office professional talented at correcting and resubmitting claims, preparing patient charts and reviewing health records to identify proper diagnosis codes for billing. Offers background in reviewing, analyzing and managing the patients' to obtain prior authorizations from insurance companies and ensure payment.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Precertification Specialist
Wellstar Heath System
06.2023 - Current
- Input all patient data regarding claims and prior authorizations into system accurately.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Completed 30 or more patients accounts per day
Unit Secretary
WellStar Paulding Hospital
01.2023 - Current
- Assisted in development and implementation of policies, procedures, and regulations for unit operations.
- Managed incoming calls and directed to appropriate department.
- Provided information for patient admissions and discharges to foster timely processing.
- Processed patient charge capture, double checking information for accuracy.
- Placed new supply orders, managed inventory and restocked clerical spaces.
- Organized and coordinated huddle and monthly meetings.
Secretary/Scheduler
Northside Hospital
12.2021 - 01.2023
- Answered multi-line phone system and greeted callers enthusiastically.
- Scheduled appointments and conducted follow-up calls to clients.
- Responded to emails and other correspondence to facilitate communication and enhance business processes.
- Handled daily scheduling tasks and provided administrative support for entire department.
- Kept information confidential and followed HIPAA guidelines to maintain patient trust.
- Corrected data entry errors to prevent later issues such as duplication or data degradation.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Posted payments and collections on regular basis.
Medical Biller and Coder
Murray Medical Center
01.2021 - 01.2022
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
- Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Reviewed patient charts to better understand health histories, diagnoses and treatments.
- Resourcefully used various coding books, procedure manuals and on-line encoders.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Accurately selected proper descriptive code when more than one anatomical location was indicated.
- Verified signatures and checked medical charts for accuracy and completion.
Referral Coordinator, Front Office Lead
Wellstar Hospital
01.2014 - 05.2021
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
- Scheduled appointments with specialists on behalf of clients.
- Called insurance companies to get precertification and other benefits information on behalf of patients.
- Weighed patient need, provider availability and insurance coverage to determine optimal scheduling.
- Followed up with clients and specialists to inquire about experience and collect reports.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
Administrative Assistant
Patterson Services
08.2012 - 11.2020
- Operated weigh scales and issued tickets when necessary.
- Complied with safety regulations to avoid potential injuries and support company goals.
- Directed dispatching, routing and tracking of 10 fleet vehicles.
- Evaluated success of training programs and recommended improvements to upper management to enhance effectiveness.
- Compiled training handbook and related course materials.
- Managed administrative logistics of events planning, event booking and event promotions.
- Prepared vendor invoices and processed incoming payments.
- Applied proper codes to invoices, files and receipts to keep records organized and easily searchable.
- Maintained good working relationships with vendors and resolved disputes.
Education
Associate of Science - Medical Billing & Coding
Gwinnett College
Marietta, GA05.2022
High School Diploma -
South Cobb High School
Austell, GA2022
Skills
- CPT Code Modifiers
- Reviewing Patient Information
- Operational Requirements
- Medical Billing Processing
- Emergency Room Services
- Claim Processing
- Billing and Collections Procedures
- Office Management
- Expenditure Authorization
- Financial Reporting Coordination
- Patient Data Abstracts
Certification
- Certified Medical Billing and Coding Association, National Healthcare - 2022 to 2024
- CPC & CPB, AAPC- Pending
Additional Information
- ICD-10/CPT Coding, Cerner/Epic, Expert Microsoft Office, Patient Scheduling, EOB/Superbills, Remittance Advice, HCPCS Coding, Posting Payments, Insurance Verification, Claims Processing
Timeline
Precertification Specialist
Wellstar Heath System
06.2023 - Current
Unit Secretary
WellStar Paulding Hospital
01.2023 - Current
Secretary/Scheduler
Northside Hospital
12.2021 - 01.2023
Medical Biller and Coder
Murray Medical Center
01.2021 - 01.2022
Referral Coordinator, Front Office Lead
Wellstar Hospital
01.2014 - 05.2021
Administrative Assistant
Patterson Services
08.2012 - 11.2020
Associate of Science - Medical Billing & Coding
Gwinnett College
High School Diploma -
South Cobb High School
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