Regina Davis
Louisburg
Summary
Dynamic Sr. Claims Analyst at Alliance HealthCare Services with expertise in claims analysis and process improvement. Proven track record in enhancing operational efficiency and ensuring regulatory compliance. Skilled in data evaluation and training development, fostering cross-department collaboration to resolve complex issues and drive performance excellence.
Overview
13
13
years of professional experience
Work History
Sr. Claims Analyst
Alliance HealthCare Services
Morrisville
01.2019 - Current
- Executed comprehensive claims analysis, implementing process improvements in payment processing.
- Analyzed claims data to identify system issues and errors, providing consultative resolutions.
- Collaborated with cross-departmental teams to ensure compliance with NC Medicaid guidelines.
- Delivered training and technical assistance to network providers on claims processes.
- Partnered with IT to develop tools enhancing claims system functionality.
- Evaluated data, authored reports, and presented findings with actionable recommendations.
- Tracked trends to identify irregularities in claims submissions and chronic QA issues.
- Developed tracking mechanisms for chronic issues, monitoring effectiveness and resolution timeframes.
- Handle issues related to finance system claim crossover provider payment discrepancies, RA discrepancies, and claim-to-payment mappings.
- Ensure providers are paid by the prompt pay guidelines.
- Participate in multiple cross-departmental meetings and committees to ensure the Alliance's integrity.
- Responsible for balancing Medicare and state weekly RA's to report to the Finance Department.
Claims Supervisor
Alliance HealthCare Services
Morrisville
06.2013 - 01.2019
- Compiled performance reports and monitored operational measures to evaluate needs and work level requirements.
- Assisted claims analysts in reviewing claim errors and ensured staff took appropriate steps for resolution, including escalation.
- Organized workflows and ensured staff were well-trained in organizational policies, providing necessary tools and resources for success.
- Ensure staff are trained and proficient in their day-to-day responsibilities to be successful.
- Set goals for performance and deadlines, with organizational goals and vision.
- Identify and support the resolution of internal issues creating claim barriers for providers.
- Review and analyze daily and weekly reports to help track progress and monitor staff in achieving department standards.
Claims Auditor
Alliance HealthCare Services
Morrisville
01.2013 - 06.2013
- Reviewed paid claims to ensure payments and settlements complied with Alliance procedures.
- Reported overpayments, underpayments, and other irregularities in claims processing.
- Conferred with senior management and legal counsel on claims requiring litigation.
AR Director
Saguaro Materials Research
Raleigh
12.2012 - 01.2013
- Supervised claims processing, accounts payables, provider enrollment, and claims denial department, ensuring operational efficiency and accuracy.
- Reported to CFO on aging balances and cash flow issues, providing strategic insights for financial management.
- Generated weekly reports and managed monthly financial closings, delivering comprehensive financial updates to CFO and company accountant.
AR Manager
Saguaro
Raleigh
03.2012 - 12.2012
- Supervised a team of 4 AR specialists, including billing, posting, and denial roles, ensuring compliance with funding regulations and MCO software.
- Trained staff on diverse funding sources, enhancing their understanding of regulations and MCO software requirements.
- Closed monthly financials and communicated effectively with Medicaid, Medicare, third-party payers, LME's, and MCO's.
Education
Associate of Arts -
University of Phoenix
Tempe, AZ01-2010
High School Diploma -
Cary High Scholle
Cary, NC06-1981
Skills
- Claims analysis
- Data evaluation
- Process improvement
- Regulatory compliance
- Financial reporting
- Training development
- Problem solving
- Communication skills
- Critical thinking
- Cross-department collaboration
- Trend analysis
- Quality assurance
- Advanced data analytics
- Claims analysis expertise
- Error resolution
- Performance monitoring
- Multitasking
- Teamwork skills
- Teamwork and collaboration
- Claim investigation
- Claims trend analysis
- Data interpretation
- Problem-solving abilities
- Multitasking Abilities
- Self motivation
- Trend identification
- Training delivery
- Computer skills
- Time management
- Customer service
Timeline
Sr. Claims Analyst
Alliance HealthCare Services
01.2019 - Current
Claims Supervisor
Alliance HealthCare Services
06.2013 - 01.2019
Claims Auditor
Alliance HealthCare Services
01.2013 - 06.2013
AR Director
Saguaro Materials Research
12.2012 - 01.2013
AR Manager
Saguaro
03.2012 - 12.2012
Associate of Arts -
University of Phoenix
High School Diploma -
Cary High Scholle
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