Medical Information Security
Resume:
Latonya Washington
Program Coordinator I
Harker Heights, TX 76548
**********@*****.***
Motivated and dependable US Army Veteran who is very adaptable in the workplace with changes in daily routines, as well as, a team player who enjoys working with others! Work Experience
Program Coordinator I
HealthCare Support Staffing - Austin, TX
January 2019 to March 2019
Assist in activities related to the medical and psycho-social aspects of utilization and coordinated care. Initiated authorization requests for output or input services in keeping with the prior authorization list. Researched claims inquiry specific to the department and responsibility.
Performed tasks necessary to promote member compliance such as verifying appointments, obtaining lab results.
Assessed and monitored inpatient census.
Screened for eligibility and benefits.
Identified members without a PCP and referred to Member Services.
Screened members by priority for case management (CM) assessment.
Performed transition of care duties to include but not limited to, contacted the member's attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.
Coordinated services with community based organizations.
Attended marketing and outreach meetings as directed to represent the plan.
Produced and mailed routine CM letters and program educational material.
Data entered assessments and authorizations into the system. Default Service Specialist
Assurant Field Assets Services - Austin, TX
December 2017 to June 2018
Default Service Specialist
Assurant Field Assets Services - Austin, TX
December 2017 to June 2018
Utilized AFAS' order and tracking system to update job progress on the following: Initial Services
Recurring Services
Documented notes in the system
Handled client needs and manage day-to-day client interfacing to include: Direct communication with the client via phone and email Prepared review history
Interacted cross-departmentally
Maintained knowledge of departments' duties and what they could do to help
Understood clients' processes to be able to take action accordingly Had full understanding of client SLAs and expectations
Escalated any advanced issue to Senior DSS and/or Supervisor as needed
Some reporting duties as directed
Initial bids as necessary
Reviewed reports
Identified and reported process gaps
Medical Claims General Clerk II
VAFSC - Austin, TX
September 2015 to November 2017
78744 40Hrs+/Week ($14.52/Hour)
Utilize the VA-FSC medical claims processing system which incorporates an Internet authorization application, document processing functionality, optical character recognition (OCR) scanning capability and Plexis Claims Manager (PCM) claims processing software.
Input and validate medical claims data into the PCM application.
Review documentation authorizing benefits and payments.
Determine appropriate amount due to recipient and process all necessary payment transactions; analyze rejected claims.
Analyze and audit any overpayments of claims
Analyze bulk claims and determine appropriate payment amounts.
Ensure appropriate diagnostic and procedural coding for all HCFA-1500 and UB-1450
Professional and effective communicates leadership; federal, contractors, or civilians
Verify clams, process and create CHOICE Authorizations; complete cycle for payment
Utilizes VISTA, TRIWEST, Health Net Portals, VCL (Veterans CHOICE List)
Ability to apply laws and regulations on the confidentiality of health information (e.g., Privacy Act, Freedom of Information Act, and Health Insurance Portability and Accountability Act (HIPAA), Information Security Awareness and Rules of Behavior, Prevention of Workplace Harassment, and Enforce The essentials of Government/Civilian Work Ethics) Tech
Billing and Follow - Temple, TX
June 2013 to February 2014
76508 40Hrs+/Week ($10.00/Hour)
Accurately adjust patients' claims according to Scott and White policies and procedures
Submit claims to appropriate department for review and correction when needed
Provide additional information when needed on claims
Review and correct any errors on claims in order for them to be processed Education
High School Diploma
Central Texas College - Killeen, TX
2012 to 2014
Noxapater High School - Noxapater, MS
August 1988 to May 1992
Skills
Excel, Microsoft office, Time management, Prior Authorization Additional Information
Skills
Microsoft Office, Excel, Power Point, Access, One Note (10+ years) Project Management Skills: Time Management - Proficient July 2019
Prioritizing and allocating time to effectively achieve project deliverables. Full results: https://share.indeedassessments.com/share_assignment/ayhket-gmfid4vrg Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued
development in any professional field.
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