LA CHE A. WILLIAMS

**** **** ******, **, **********, DC 20018

**** * *** ********** ****, Coward, SC 29530

202-***-****

abidm5@r.postjobfree.com

EDUCATION

**** - ******* ******* **********, Minneapolis, MN

Master's of Science Healthcare Administration

2007 - 2008 Grand Canyon University Phoenix, AZ

Master's of Science Healthcare Administration

1998 - 2002 North Carolina Wesleyan College Rocky Mount, NC

Bachelor's of Science Business Administration

1994 - 1998 Archbishop Carroll High School, Washington, DC

High School Diploma

TRAINING

.Lotus Notes 123, Microsoft Office Suite (Access,

Outlook, Excel, Word, PowerPoint,), Epic Healthcare

applications, Diamond (claim and benefit verification

application); Typing 63 WPM.

PROFESSIONAL

SUMMARY

.Trained in the research, preparation and disbursement

of medical information (written and verbal

correspondence) to the requesting person(s) with all

release being in compliance according to HIPAA rules and

regulations; provide effective leadership (and teamwork)

by coordinating and integrating services within

department, with other departments and with the

organization's primary functions; continuously working

to assess and improve the department's performance by

designing operational processes, monitoring performance

through data, analyzing the data, implementing

sustainable performance improvement, and participating

in multi-disciplinary inter-departmental activities;

managing information by providing information systems

and data management for department operations and

performance improvement.

Qualifications:

.Expertise skills working with Claims and Claims

Processing.

.Excellent experience with Microsoft Access.

.Good organizational skills, competent in research and

compilation of reports, program support, scheduling, and

document handling.

.Possess strong communication skills from working on a

daily basis on the phone with members, providers,

brokers and prospective enrollees. Possess strong

interpersonal skills.

.Fast and eager learner, have been trained to handle a

majority of the departments' functions (such as

membership accounting (individual and group

enrollments), claims processing inquiries (detailed

knowledge of general claims processing principles, HCFA

claims coding and UB-92-04 claims coding, based on at

least 3 years experience in claims processing, customer

service, preferably in a managed care environment);

ability to analyze complex claims problems and

accurately resolve payment issues);

.Ability to work well with management and team members

to contribute to the achievement of departmental goals,

patient account inquiries (Copay/deductible inquiries),

and benefit inquiries (members, providers and brokers).

.Currently seeking a mid-level position for a long term

career in the healthcare (mental health included) or

business administration for a company with the mission

of implementing new products and ideas in making

healthcare affordable.

.Conflict Resolution; Defense mechanism/tactics;

Investigative reporting (including writing reports,

interviewing parties and drafting documents for senior

level management).

.Assist in coordinating care for patients with provider

staff in developing effective treatment plans.

.Maintained food handler's license for in order to

prepare meals (breakfast, lunch, dinner and snacks) for

residents in MR/DD residential group home settings.

EXPERIENCE

August 2009- Department of Veterans Affairs (GS-7)

Present Columbia, SC ($45000.00)

Veterans Service Representative

.Working within a team environment and serves as (1) a

counselor or advocate for VA claimants providing

information about a broad range of benefits and

assisting with applications for VA benefits and

services, (2) a legal technician conducting interviews

and gathering requisite evidence from medical, military,

community, and other sources to support benefit

determinations, (3) a decision maker weighing the

evidence and applying the controlling laws and

regulations, and (4) a computer systems user who enters

appropriate data to generate accurate benefits payments,

controls pending issues or schedules future actions, and

releases complete, correct notifications of benefits

determinations. The VSR must not only be competent in

interpretation and application of law and procedures,

but must be well-versed in medical principles and

terminology and in public relations skills.

Veterans Claims Examiner

.Make determinations pertaining to such matters as

entitlement to medical or dental treatment, eligibility

for vocational rehabilitation and education benefits,

funeral expenses, civil service preference certificates,

and entitlement to certificates for State and local

bonuses, licenses, or privileges. The adjudication of

such claims normally requires determinations relating to

the application of appropriate regulations to a

particular situation as opposed to the making of

judgments (which is characteristic of higher levels) in

those areas where regulations apply only in a very

general sense; GS-7 examiners are expected to develop,

with little or no supervision, the necessary information

or evidence required to properly adjudicate the claims

assigned to them. This involves the authority to contact

various hospitals, doctors, State and local police

authorities, officials of military departments and the

claimants themselves.

.Processing Chapter 33 Educational claims for the

veterans, spouses or other dependents determined

eligible to receive benefits.

June 2009 - District Department of the Environment

August 2009 Washington, DC ($11/hr)

Team Leader

.Act as primary supervisor for up to 15 youth ages 14-

21. Oversee the daily projects such as community

outreach, trash clean-up/removal, graffiti removal,

environmental surveys, distributing information on

idling regulations and DC Green Agenda, and interacting

with the community and responding to requests for

assistance. Train youth on how to perform project

tasks. Process youth time and attendance using the Air-

Click-time and manual attendance. Serve as first

responders in the event of an emergency. Handle on-site

project logistics. Hold morning and afternoon meetings

with youth.

August 2005 - Kaiser Permanente

April 2009 Silver Spring, MD ($52500.00)

Member Services Representative (Claims,

Eligibility/Benefits, Enrollment, Customer Service,

Billing/Payment Collections - Call Center)

.Research and respond to all Member Services Department

calls in accordance with compliance guidelines (handling

heavy inbound calls), providing information and general

assistance to existing and prospective members and those

interested in a group and non-group enrollment;

assisting providers with eligibility and claims

questions/concerns.

.Assist the Health Plan by responding to general and

complex inquiries from existing members, prospective

members and groups (typing, filing and emailing; data

entry).

.Independently analyze, resolve and respond to various

inquiries providing definitive answers; Bill and Claim

Submission (helping customers with their claims),

medical claims processing; communicating with

clients/vendors in regards to their claims;

administrative and analytical review of billing and

activities (3 years prior medical claims experience);

Knowledge of medical terminology, HCFA & UB04 claims

(Exposure to ICD-9 and CPT coding procedures); providing

expertise or general claims support to teams in

reviewing, researching, investigating, negotiating,

processing and adjusting claims; Cashiering, Refunds and

Adjustments, Customer Service; Denial Prevention and

Management; Third Party and Guarantor Follow-Up; Analyze

reimbursement trends; generate appeals and report on

progress; review EOBs for accuracy; review denial

reports; identify payor trends; research claims and

communicate with insurance companies.

.Coordinates and assist requesters with access to and

release of medical information.

Analyze reimbursement trends; generate appeals and

report on progress; review EOBs for accuracy; review

denial reports; identify payor trends; research claims

and communicates with insurance companies.

January 2005 - Temporary Solutions

August 2005 Vienna, VA ($11/hr)

Temporary Employee

Client: NAHMA

(06/05 - 08/05)

Alexandria, VA

Administrative Assistant

.Assist the organization with preparing for their annual

summer meeting held in San Francisco, CA.

.Duties include Xeroxing, updating spreadsheets in

Microsoft Access and Microsoft Excel; preparing signs

and putting together information packets for the various

committees and NAHMA members.

January 2005 - Long & Foster Realtors

May 2005 Headquarters Fairfax, VA

PC Technician Assistant

.Assist the Information Services Department with

upgrading the hardware and software at each of their

branch locations in the Washington, DC Metro area.

.Perform light clerical duties such as updating

spreadsheets in Microsoft Excel.

May 2004 - Community Residences

September 2004 Vienna, VA ($27,500.00)

Residential Counselor

.Assist/instruct consumers with activities of daily

living. Counsel consumers in learning to, establish and

maintain effective interpersonal relationships.

.Teach consumers how to define problems and learn

problem solving skills. Assess the extent and nature of

the consumer's strengths and needs.

.Maintain documentation in compliance with all state of

Virginia and federal regulations and policies.

.Assist consumers in developing/implementing service

plans and individual goals.

.Maintain a safe and positive environment by cleaning

the home and developing and implementing group

activities for the consumers to participate in.

.Maintain contact with consumer's family members, case

managers and appropriate community contacts by updating

consumer personal information and scheduling visitation.

.Assist/monitor consumers' medications and mental

health. Assist/monitor consumers' finances.

.Maintained food Handler's license to prepare daily

meals for consumers (breakfast, lunch, dinner and

snacks).

Medication administration to residents.

October 2003 - Fitness Image Results (Marriott Hotels)

May 2004 Washington, DC ($8/hr)

Front Desk Associate (Fitness Room)

.Maintain an orderly and neat appearance for the Health

Club. Process paperwork for massage contracts and new

membership/renewal contracts.

.Document pool and whirlpool chlorine and pH readings

every 2 hours.

August 2002 - Careco, Inc.

October 2003 Silver Spring, MD ($27,500.00)

Residential Counselor

(08/02 - 10/03)

.Assist mentally ill/retarded male consumers with the

activities of daily living such as household chores and

personal hygiene.

.Improve social skills and abilities through constant

interaction such games, dancing to music, or engaging in

general conversation.

.Trained in defensive mechanisms and conflict

resolution.

.Maintained food Handler's license to prepare daily

meals for consumers (breakfast, lunch, dinner and

snacks).

Medication administration to consumers.

One to One Residential Counselor

(10/02 - 10/03)

.Consumer is a blind-deaf mute. The consumer is unable

to walk without assistance and has to have range of

motion therapy on a daily basis. Perform the consumer's

ADL's which include washing clothes, feeding, personal

hygiene, and maintain a daily log of activities which

includes eating, waste disposal, and hygiene.

June 2002 - K-Mart

October 2002 Hyattsville, MD ($6.50/hr)

Team Member

(06/02 - 08/02)

.Cashier and personal greeter for store guests. Assist

guests with purchase and offered advice/assistance when

guest made inquiries on various items within the store;

warehouse receiver/stocker.

Assistant Up-Front Manager

(06/02 - 10/02)

.Up-Front assistant manager over cashiers.

Responsibilities include providing change orders and

dispersing money to the cahiers when drawers were low or

at the beginning of the cashier's shift.

December 2001 - Unity Hair Salon

January 2002 Washington, DC (Non-Paid Internship)

Intern

.Purchase and kept running inventory of beauty supplies,

equipment, and services.

.Prepared manual payroll for ten employees, which

includes using the tax table to determine the correct

amount of federal and state taxes that would be removed

from each employee's pay check.

January 1996 - Friendship Baptist Church

Present Washington, DC

Musician (Drummer)

.Drummer for the Senior and Youth Choirs. Assist with

services on the first and second Sunday of every month

and the fourth Sunday in November. Assist other choirs

in Church sponsored programs.

.Musical styles: Gospel (Traditional, Contemporary,

Classical), Hip-Hop Christian, Reggae Christian, Rock

Christian.

Extracurricular Activities

.2005 - Catholic University & US Naval Academy

Basketball Camp Coach

.1998-2000 - Women's Basketball Team for North Carolina

Wesleyan College

.1994-1998 - Women's Basketball Varsity Basketball Team

for Archbishop Carroll High School

Contact this candidate