Baton Rouge Patient Access
Resume:
Takisha K Wells
Baton Rouge, LA
All positions are relevant to the position which I have applied Education
• Associate's, Major: Business, University of Phoenix Gainwell Technologies-Baton Rouge, LA
April 08, 2024-present
Provider Enrollment Specialist
Receives calls from Providers regarding Lamedicaid portal enrollment status, claims issues, Providers enrollment and Medicaid updates
MMC Group – Client – Cencora Baton Rouge, LA September 11, 2023 - present Patient Access Specialist – Document Review
• Research, review, and carefully PSQA all documents received by utilizing all job aids and Tawans Workbook our Patient Assistance Program (PAP)
• Create cases (ACR, and Benefit Verifications) by services requested from patients and providers
• Create, review, work, and accurately complete Prior Authorization Cases/Appeals/Denials
• Research and Review any missing information (MI Cases)
• Insurance drug and prescription information is updated
• All HCP/Provider's information is accurate, all Enrollment Forms are received
• All Patient information is accurate, all Enrollment Forms are received
• Label documents by the correspondence received
AmeriHealth Caritas - Baton Rouge, LA January 11, 2021 – March 17, 2021 Appeals and Grievances Representative
• Research, review, and work faxed appeals and Grievances for the state of Pennsylvania regarding Personal Assistant Services (PAS)
• Schedule review meetings
• Review medical documents.
• Send acknowledgement letters, grievance decision letters, and other correspondence to members.
• Work and complete appeals and grievances according to the applicable time frame of the appeal
• Utilized heavy MACESS EXP, FACETS, and JIVA
UnitedHealth Care March 2016 to September 2017
Appeals Rep
• Processed LA claims.
• Pulled all cases correspondence from MACESS database inventory.
• Researched, reviewed, and worked appeals for the state of Delaware, Mississippi, New York, Texas, Tennessee, and Iowa, such as Claim Denials, Provider Disputes, and Authorizations
• Made determinations to Overturn or Upheld nonclinical appeals.
• Received Overturn or Upheld status from clinical team and staff regarding clinical appeals.
• Researched, reviewed, triaged, and worked appeals/claim denials regarding ICD and all coding, billing errors, and adjustments.
• Triaged cases
• Heavy FACETS researching, reviewing, notating, and updating billing.
• Processed authorizations requests from providers regarding Dural Medical Equipment (DME), hospital, and other medical facilities services
• Updated and closed cases Communicated with divisions, co-workers, and supervisors in SharePoint, email, and chat
• Stored and updated cases in SharePoint
• Created and edited links and tabs in SharePoint
• Communicated with Supervisor, SME, and team members SharePoint.
• Faxed knowledgement and resolution letters to providers
• Utilized heavy MACESS EXP, FACETS, SharePoint, Excel, MS Word, ICUE, CareOne, and eviCore AmeriHealth Caritas August 2015 to March 2016
Grievances Associate
• Pulled grievances and appeals correspondence from database inventory regarding claims and authorization.
• Communicated with members and providers regarding grievances and appeals by phone and postal mail.
• Triaged and routed to other divisions when needed awaiting review and determination to Overturn or Upheld
• Stored grievances in database
• Researched and reviewed grievances and appeals, communicated with co-workers' and other departments by email, database communication, and in-office.
• Received emails from LDH daily regarding grievances and Appeals reports.
• Communicated with LDH by email and postal mail.
• Communicated with members and providers/medical facilities regarding grievances/complaints resolution, such as provider service and billing, disputes, and authorizations.
• Researched, reviewed, and updated TPL.
• Researched, reviewed, and worked pharmacy cases regarding grievances, claims, billing, complaints, authorizations regarding refills, prescriptions, and medications.
• Communicated with pharmacies by mail, fax, and phone.
• Communicated with members of the health plan regarding their pharmacy complaints and cases.
• Heavy FACETS researching and reviewing regarding billing issues.
• Communicated with other departments, insurance companies, and providers regarding TPL.
• Stored and updated cases regarding 30-day timeframe.
• Created and edited links and tabs in SharePoint regarding acknowledgment and resolution letters
• Communicated cases in SharePoint with Supervisor, Manager, and co-workers.
• Printed acknowledgement from SharePoint letters and mailed to members.
• Stored, updated, and closed cases in SharePoint.
• Processed reimbursement request.
• Researched and reviewed CPT codes for accuracy regarding reimbursement request
• Calculated the Medicaid allowance in Excel.
• Communicated with providers regarding reimbursement.
• Mailed acknowledgement letters to members.
• Mailed denial and approval letters to members.
• Utilized heavy MACESS EXP, FACETS, SharePoint, MS Word, and Excel
• Printed, faxed, and scanned important documents. LA Dept. of Revenue June 2014 to June 2015
Revenue Tax Analyst
• Assisted Louisiana individual and business taxpayers regarding refunds, bills, and notices, also including tax preparers and CPA's regarding their client's account.
• Researched and updated accounts
• Corrected tax returns discrepancies
• Setup payment plans on taxes owed.
• Sent confirmation letters of monthly installments.
• Assisted taxpayers with their online accounts regarding inquiries, such tax forms, tax returns, and payments.
• Coordinated team projects
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