Tia Barker
Chesterfield
Summary
Business and operations professional specializing in healthcare operations with expertise in medical management and quality assurance. Proven ability to lead training sessions, mentor team members, and streamline processes, enhancing compliance and operational efficiency across Medicare and Medicaid lines.
Overview
11
11
years of professional experience
Work History
Audit and Compliance Analyst
Accessia Health
Midlothian
05.2026 - Current
- Conduct audits and quality reviews to ensure compliance with organizational policies, regulatory requirements, and program guidelines.
- Review member applications and supporting documentation for accuracy, completeness, and eligibility determination.
- Identify discrepancies, compliance risks, and documentation deficiencies, recommending corrective actions when necessary.
- Monitor adherence to HIPAA, privacy standards, and internal compliance requirements while handling sensitive member information.
- Analyze audit findings and communicate results to leadership and operational teams to support continuous improvement initiatives.
- Collaborate with cross-functional departments to resolve compliance issues and maintain audit readiness.
- Maintain detailed records, reports, and audit documentation to support regulatory and organizational requirements.
- Contribute to process improvement efforts that enhance accuracy, efficiency, and compliance across program operations.
Medical Management Specialist II
Anthem
04.2022 - 05.2026
- Facilitated communication between providers and stakeholders to resolve complex billing and payment issues, ensuring alignment and timely resolutions.
- Acted as a liaison with internal teams to ensure regulatory compliance and timely responses to provider inquiries, while supporting cost-efficiency initiatives by identifying process optimization opportunities.
- Participated in strategic planning initiatives to improve compliance and streamline Medicaid authorization process, contributing to enhanced operational efficiency.
- Led training sessions and mentored new team members to enhance onboarding and integration.
- Reviewed and ensured the quality of denial letters sent to members and providers.
- Drafted and reviewed written communication (e.g., determinations/denial language and guidance to providers) to ensure clarity, compliance, and accuracy.
- Entered authorizations for Medicaid and Medicare personal and respite care.
Performance Quality Analyst I
Anthem
11.2018 - 09.2021
- Provided SME support for discrepancy reviews and guideline interpretation; facilitated implementation reviews to ensure consistent and accurate processing.
- Audited calls and correspondence for quality and compliance; summarized findings and recommended corrective actions to address identified trends.
- Prepared detailed reports for internal audits and compliance reviews, supporting regulatory documentation efforts.
- Contributed to policy updates and training materials to align with evolving compliance standards.
- Mentored auditors and supported discrepancy reviews to enhance overall team expertise.
Medical Management Specialist I
Anthem
10.2017 - 11.2018
- Coordinated care for Medicaid members, optimizing case manager assignments to enhance member support.
- Completed DMAS Health Assessments and verified member data.
- Supported DMAS assessments and reporting, collaborating with internal partners to effectively resolve case-related issues.
- Liaised between departments to ensure accuracy in reporting and compliance with program standards.
Operations Expert
Anthem
05.2017 - 10.2017
- Spearheaded initiatives to improve operational workflows, resulting in reduced turnaround times, and increased accuracy.
- Coached team and communicated procedural updates, using Excel to track opportunities and report on daily inquiries.
- Keyed, processed, and adjusted claims, ensuring accurate outcomes and minimizing provider abrasion.
- Researched benefit and claims escalations, creating work items/tickets (Rational Team Concert) for streamlined reconciliation and special processing.
- Conducted interviews and designed onboarding plans.
Customer Care Associate I/II/III
Anthem
Richmond
09.2015 - 05.2017
- Served as Open Enrollment Ambassador at Anthem Health Plans, providing vital information to clients during critical enrollment periods.
- Handled inquiries on benefits, claims, and eligibility to ensure client understanding and satisfaction.
- Facilitated team huddles and maintained performance dashboards to align team goals and track progress.
Education
Bachelor of Science - Psychology
Liberty University
Lynchburg, VA05-2021
High School Diploma -
Hermitage High School
Richmond, VA06-2005
Skills
- Case management
- Medicaid and Medicare knowledge
- Quality assurance
- HIPAA compliance
- Benefits/eligibility/COB awareness
- Policy documentation
- Risk assessment
- Process optimization
- Facets
- WGS
- NASCO
- ACMP
- AUMI
- Team leadership
- Microsoft Office Suite
- Stakeholder Liaison
Timeline
Audit and Compliance Analyst
Accessia Health
05.2026 - Current
Medical Management Specialist II
Anthem
04.2022 - 05.2026
Performance Quality Analyst I
Anthem
11.2018 - 09.2021
Medical Management Specialist I
Anthem
10.2017 - 11.2018
Operations Expert
Anthem
05.2017 - 10.2017
Customer Care Associate I/II/III
Anthem
09.2015 - 05.2017
Bachelor of Science - Psychology
Liberty University
High School Diploma -
Hermitage High School