Latosha Harrison

Data Entry CSR

***** ******* **** ******, ********** 91316

310-***-**** adtbk4@r.postjobfree.com

OBJECTIVE

To apply over 20 years of healthcare experience to a position that will utilize my organizational expertise along with recognized strengths in process improvement, problem-solving, consulting, coaching, training, development, and planning; accustomed to a fast-paced environment and handling several duties at once; able to get things done efficiently and profitably; a team player who can effectively interact with customers, staff and upper management.

PROFESSIONAL EMPLOYMENT

Anthem Blue Cross and Blue Shield, Encino, California

Medical Management Specialist 2020 present

Provides non-clinical support to medical management operations, including handling more complex file reviews and inquiries from members and providers.

Primary duties include gathering clinical information regarding cases and determining the appropriate area to refer to or assign cases (utilization management, case management, QI, medical review).

Conducting an initial review of files to determine appropriate action required.

Acts as liaison between medical management operations and other internal departments to support ease of administration of medical benefits.

For California Children Services: request medical records from providers, complete and submit CCS referral to local CCS program on the same date of identifying potential CCS eligible condition.

Proficient in the usage of Citrix, Facets, Macess, ACMP GDP and Medicare, all Microsoft Office automation software, including Office Teams.

Track referrals according to specified timelines and notify providers and families of CCS eligibility determinations and BCC authorizations and deferrals.

Collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager.

Maintain and update tracking databases.

Anthem Blue Cross and Blue Shield, Midland, Georgia

Utilization Management Lead Supervisor

2018 2020

Motivates and encourages UM Reps while providing technical guidance.

Provides quality control services such as call monitoring and conducts UMR level I, II, and III audits for subsequent performance under NMIS and MTM standards.

Monitors daily phone activities to exceed NMIS standards and improve customer service levels.

Provides direction and guidance to less experienced team members relating to medical and IngenioRx pharmacy products.

Assists manager with PTO scheduling and monitoring attendance.

Obtains, analyzes, and presents statistical information related to units of work, productivity, FTEs at work, and time off.

Handles complex situations and ensures UM Reps are directed to the appropriate resources to resolve issues. Assisting UMRs with outpatient, inpatient, DME, and directly admit pre-authorizations. Ensure the authorizations are error-free and referred to the proper clinical team.

Assists management by identifying areas of improvement and recommends solutions.

Interview applicants for FTE hire as well as assist with performance appraisals.

Temporary Vendor support, EXL training and coaching, and Legato initiatives.

Partner with WFM to ensure ASA goals, AHT and adherence is met.

Anthem Blue Cross and Blue Shield, Midland, Georgia

CSR I-ACA Small/Large Group /UMR I-National/Local/NE Accounts 2016 2018

Responsible for handling multiple lines of business, including Central ACA, NE ACA, Small Groups, Local Groups, GA National/GA Local, CA Local/CA National, CR National, and CR Local accounts.

Proficient in the use of Pharmacy/ESI, FIMP-First Impressions, CCB/WGS Legacy, QCARE/Mainframe Clarity, Solutions Central, WCF, Microsoft Suite, Citrix, Right fax, Intradiem, CCPulse, Genesys, Verint, Medallia, NetworXPricer, On-Demand, Blue squared, Sharepoint, NASCO, Transcentra, EOC, software.

Assist members, providers, and facilities with pharmacy benefits, processing approvals and pre-authorizations for oral medications through ESI software, and one time exception and limitation overrides.

Performed administrative support in a variety of functions to a department head, team, department or another group in the organization.

Collects, reviews, analyzes complex and/or confidential data and prepares reports, charts, budgets, and other presentation materials.

Responds to or routes non-routine or confidential inquiries from external or internal sources with correspondence or other messaging.

Schedules and coordinates meetings, travel, and other group activities. Has advanced word processing, spreadsheet, and graphics software skills.

EDUCATION

Current- Bachelor of Arts in Health Care Management, August 2022

Post University Westbury, Connecticut

Certificate Medical Assistant- Phlebotomist- 2003-2004

Sanford Brown Institute New York, New York

High School Diploma, Daegu American School, June 2008

Daegu, Korea (Formerly Taegu American School Dodds)

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