LETITIA Y. MASON

**** ***** **** ********* #****

Hollywood, Florida 33024

954-***-**** adob5v@r.postjobfree.com

Healthcare, Claims and Case Management Professional Accomplished, goal driven, and result oriented licensed healthcare professional with over twenty years of healthcare, claims, customer service and case management experience. Proven ability to lead and manage high caseloads with exceptional closure rates and rewarded customer service excellence. AREA OF EXPERTISE

Time Management Strategic Planning Employee Relations Quality Interviewing Training & Development Fraud Investigation Microsoft Billing & Coding Medicare& Medicaid Auditing HIPAA Coordinate Benefits Human Resources Communication Excel Reporting Case Management Social Work Unemployment Finance

WORK HISTORY

DEO Customer Service Representative

KFORCE Inc (State Government Project)

July 2020- May 2021

Assisted Florida Department of Economic Opportunity with Unemployment

Provided guidance and information to over 50 callers per day with patience.

Trained as a Subject Matter Expert due to Outstanding Customer Service Skills

Deescalated stressful conversations through understanding and compassion

Solved difficult Financial Cases.

Provided clear verbal and communication to Unemployment applicants. Dental Claims Specialist III

MCNA Dental

June 2019- June 2020

Review and Process all Dental Claims types in assigned Queue.

Refer claim requiring dental review to Clinical Reviewer and follow up to ensure timely processing.

Approve or Deny payment of all claims types within the requirements of MCNA and State guidelines.

Review CPT’s, ICD 9 and 10 codes for accuracy

Consult with State of Florida Dental Providers to assure accuracy in claims billing process. CRC Healthcare Billing and Recovery Outreach Specialist Performant Financial Corporation

Feb 2018- May 2019

Grievance and Appeals Case Manager highly handle importance escalations.

Review and investigate account claim and other documentation to verify payment liability.

Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.

Conduct Quarterly Conferences meetings with Healthcare insurance carriers regarding payment of claims; answer questions and educate Healthcare Insurance carriers on their obligation to pay debt.

Work with CMS and U.S. Department of Treasury to ensure MSP debtors delinquent cases are resolved, Proficient in HIGLAS systems and CMS.gov. FMLA and Medical Leave Coordinator

Aetna

Dec 2010- Dec 2015

Administrator of FMLA medical leave of absence claims.

Responsible appropriate scheduling and tracking of FMLA time and Medical benefits.

Daily communication with Human Recourse Generalist, Employers and Medical Providers.

Coordinate with Human Resource Generalist in regard to Fraud, termination, or benefit continuation.

Successfully applied state Disability statutes within scope of FMLA administration. Claims Auditor and Trainer

HS1

Feb 2007- Oct 2010

Successfully Audit claims to identify Claims Examiners and system errors.

Review and investigate daily audit reports for accuracy and fraudulent activities.

Proficient on Billing claims with accurate CPT's, lcD-9's and lcD-10 codes.

Responsible on training and updating of six Claims Examiners on new policies and procedures.

Accountable for planning and note tracking of Executive meeting with Directors, Managers and Supervisors.

Daily use of Microsoft Excel and PowerPoint to create department reports and memorandums.

Provide customer service and benefit information to Providers and Health plan Members. Eligibility Case Manager

SOF Department of Children and Families Services

2007-2009

Quality Assurance Analyst

Claims Examiner lll

HIP Administrators

1998-2007

Medicare Marketing Rep

Humana

1996-1998

ACADEMICS CREDENTIALS

Florida Licensed Health Agent

Florida Licensed Life Agent

B.A. Healthcare Administration, University of Phoenix Certified Claims Adjustor, Miami Dade Community College

Contact this candidate