High School Health
Resume:
Latasha Swain
Valrico, FL *3594
Email: *******@*****.***
Objective: To maintain a position where I can maximize my claim processing skills and quality of provider relations.
Work History:
WellCare Health Plans 08/2012-05/2017 Tampa, FL
Provider Resolution Specialist Sr. 10/2014-05/2017
*Worked high escalated projects
*AHCA/State complaints from provider
*Provider and member grievances
*Worked out of provider escalated claim appeal and dispute queue
*Adjusted Professional and institutional Medicare and Medicaid claims
*Worked high escalated emails
*Trained and cross trained new hires
*Made some outbound calls to providers on complaint review outcome
*Worked monthly MMA Report
Cost containment Coordinator (CCU) 08/2012-10/2014
*Post refund checks, solicited and unsolicited for professional and institutional claims
*Calculate and enter refund amounts in Database
*Work with the Wells Fargo check imaging system
*Contact provider with refund issues
*Made adjustments to Medicare and Medicaid claims for all lob.
*Worked monthly MMA report
Amerigroup 10/2007-10/2011
Claims Analyst Senior/Adjustment Team
*Work with TX, NV, and NM markets, Made adjustments to incorrectly processed claims
*Create, assign and worked campettes, complete camp projects
*Work with the health plan on claim problems and issues
*Contact person for high profile hospital-Children Medical Center (CMC)
*Process Medicaid and Medicare intermediate and complex claims
*Work in the correspondence, EOB queues for TX, NV and NM
*Perform research and process high dollar claims including authorization review
United Health Care-08/2002-10/2007-Tampa, FL
Claims processor for commercial and Medicare claims
08/2004-08/2006
Provider Relations Rep
*Provider relations rep for CT, NJ and NY markets, provided credentialing process for all markets
*Received inbound calls from providers
*Reviewed contracts with providers and put in request, for correction/review if needed
*Updated and or adjustment if need of provider profile
*Assist provider with any and all claim issues
08/2006-10/2007-Claims Trainer
*Claims Trainer for new hire class 15-20 people
*Taught how to use the claims processing system Yoda, policies and procedures
*Kept attendance and course records
Education/Achievements
Graduated from Chamberlin High school 1994
Attended International Academy of Marketing and Design College 1999-2000.
Completed classes of Dealing with Difficult people, Time management and Team Building.
References available upon request
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