LaTarsha Williams

***** ****** ***. ****. * Apt. 447

Euclid, Ohio 44117

216-***-**** acel83@r.postjobfree.com

Functional Skills: *Typing *Organizational Skills

*Alphabetical/Numerical filing *Faxing and Photocopying *Ten

Key *Cash Register *Excellent Spelling

*Loan Setups *Customer Service *Switchboard

Operator *Check Encoder *Microfiche *Patent

Machine Setups *Postal Meter

Computer Skills: Operating Systems - Windows 3.1, Windows 95, Windows 98,

Windows 2000 and DOS

Word Processing (Word) - Mail Merge

Excel (Spreadsheets) - Absolute cell referencing, creating

spreadsheets

PowerPoint - Presentation creation

Access (Database) - Tables, Queries, Forms, and Reports

Software Integration - Using each application or file with

the other MS Office Application.

Education: *Professional Bartending Schools of America

Cleveland, Ohio

Mixologist

Bartender / Mixologist Certification Received

(2006)

*Meadowmark Computers Inc. *Cleveland Works, Inc.

*Lincoln West

Cleveland, Ohio (1997) Cleveland, Ohio

(1995) Cleveland, Ohio (1994) Computer

Business Business Enhancement College Prepatory

Achievements Honor and Merit Roll, Perfect Attendance Awards,

Member of English

and Awards: Honorary Society, Member of Magic Enrichment Programs,

Graduated

Top 15% of senior class.

Work Experience: Buckeye Community Health Plan

Independence, Ohio

Provider Relations Specialist

October 2011 - Present (Prn)

Responsible for maintaining working relationships within

the existing network. Assist in the recruitment and

credentialing of new providers. Maintain accurate and

current provider databases relating to provider facilities

and physician information. Assist with policy and procedure

interpretation. Assists with the development and monitoring

of provider contracts as well as negotiating, reviewing,

and preparing enrollment agreements with facilities,

laboratories, and group physician practices. Researches and

coordinates the resolution of provider's claims and

capitation issues.

Cleveland Clinic Foundation

Cleveland, Ohio

Account Representative II

(2008 -Present)

Providing customer service under the financial unit within

Patient Financial Services Division via phone and/or

internally by usage of such systems as Epic, ADTR Rumba,

Shamrock, SMS Signature, HBO as well as the Regional

Hospital operating systems to patients, insurance, doctors

and attorneys, insurance processing, medicare processing

and follow up, insurance verification, cash application,

hospital and physician billing, and pricing utilizing

knowledge of cpt4/icd code applications

Litigation Management

Mayfield Heights, Ohio

Record Acquisition Support II

(2007 - 2008)

Generate records request for litigation purposes, contact

providers for the status of the records' request, answer

questions from providers' and Counsel, locate and assign

Notary services, identify, investigate and research

potential providers, update the client website of the

status of the records request

1-888-OHIOCOMP

Cleveland, Ohio

Assistant Office Manager

(2001-2007)

Providing assistance to the office manager overseeing a

staff of 20 employees in three areas of the workman's

compensation; first report of injury, managed care

specialist, and billing department. Reviewing medical

documentation that is received electronically from the

medical repository department via scanner at Ohio Bureau

Workers Compensation, entering injury reports into a

Physicians' Billing System database which is electronically

sent to BWC for a claim number, medically managed all

medical only claims for one of the manage care

organization's largest clients, displaying customer service

for billing inquiries received from injured workers,

providers and/or the third party administrator, providing

the employers and providers with training sessions to help

them understand how maintaining cost control and assurance

that the system is being utilized and managed properly in

the administration of the Health Partnership Program

Managed Care Specialist Supervisor (2000-

2007)

Overseeing staff of 12 employees upon printing BWC faxes

received via Scanner system; separating faxes from medical,

C9's, change of physician forms, vocational rehabilitation;

distribute medical to correct nurse case manager; retrieve

signed C9's from nurse case manager and fax information to

all parties on cover sheet; enter into system notes per C9

faxed; handling all change of physician forms: make sure

injured worker belongs to 1-888-OHIOCOMP, making sure

injured worker signed form, checking to see if provider is

BWC certified, mail or fax signed form to all parties

Intake Supervisor (1999-

2000)

Responsible for overseeing / training four intake

technicians on the Physicians Billing System for employees

with injuries that are covered under the MCO; Displaying

customer service by providing a 3 point contact for each

claim with the injured worker, provider, and employer to

obtain valid medical documentation, certification, and

personal information on each claim with the intent to

successfully get each injured worker back to work; after 3

point contact is complete processing information from a

First Report Of Injury form into the Physicians Billing

System in order to have the claim electronically sent to

Ohio Bureau Workman's Compensation for a claim number

Qualified Health Plan (Managed Health Care Services)

Cleveland, Ohio

Medical Technician

(1999)

Data entry consisting of self insured accident reports

that are medical only; forwarding all lost time reports to

case manager in QHP office in Columbus; sending a copy of

accident reports to the Third Party Administrator for

determination of compensability and claim status; gathering

of medical and return to work information from injured

worker, provider and / or employer; updating PerDatum

Prognos system to reflect all information gathered.

Managed Health Care Services Cleveland,

Ohio

Administrative Office Manager (1999)

Manage administrative functions for Director of local MCO

office as well as financial statements, reports, and the

providers' trust fund to successfully pass BWC audits;

Proficient in cross-functional and interdepartmental

coordination of information; back up for Columbus MCO

office

Customer Service/Billing Supervisor (1998-

1999)

Liaison between medical, claim and rehabilitation personnel

to provide medical management to internal and external

customers; actively pursued alternative methods on

training customer service staff on how to utilize systems

affiliated with workers' compensation i.e. PBM System,

Employer Risk Data System, Rumba 95 NT and many others;

data entry consisting of injured worker's medical

information

Administrative Assistant (1997-1998)

Administrative support to MCO Director and department,

research billing issues, focused importance to customer

service staff on promoting a positive corporate image of

company; Coordinate all aspects of claims management

involving rehabilitation, medical and fraud; Oversee the

mail distribution and collection process

Third Federal Savings and Loans

Cleveland, Ohio

Customer Service Representative (1996 -

1997)

Processing savings/checking deposits and withdrawals,

updating, recreating, and closing accounts, filing,

typing, check-encoding, faxing, customer service phone

operator, and loan setups

Cuyahoga Savings and Loans

Cleveland, Ohio

Customer Service Representative

(1995)

Processing savings/checking deposits and withdrawals,

safe deposit boxes, filing, typing, check encoding, faxing,

and photocopying

Kelly Services

Cleveland, Ohio

Clerical / Customer Service

(1994-1995)

Typing, filing, light industrial, faxing, telephone

operator, customer service / sales, photocopying,

switchboard operator, retrieve and discharge elderly

patient files

References Available Upon Request

Contact this candidate