Revenue Cycle and Reimbursement Management, Epic Credentialed

LaTasha B. Mack, CRCA

*** ********** ***** **********, ** 29016 803-***-**** *************@******.*** Objective

• To secure a challenging position, utilizing my interpersonal skills to work effectively in a highly interactive and interdependent team environment. I have multiple years of clerical and finance experience with an emphasis in the insurance industry. With excellent ability to multi- task, I am always looking to acquire new skills and sharpen my knowledge. I embrace change. I am a hardworking, dedicated team player.

Education

CRCA MAY 2022 HEALTHCARE FINANCIAL MGMT ASSOCIATION, SC CHAPTER

• Certified Revenue Cycle Associate

DIPLOMA MAY 2002 LOWER RICHLAND HIGH SCHOOL

• HS Diploma

Skills & Abilities

MANAGEMENT

• Previously managed on-site staffing branch at Bose Corporation in Blythewood, SC. Previously supervised team of employees responsible for auditing all underpaid physician and hospital claims within the Lexington Medical Center Network. As a Revenue Cycle Associate, assisted in the training of new employees and was a main department point of contact for claims and billing issues, along with system ‘go live’ updates.

COMMUNICATION

• Excellent written and verbal communication. Was responsible for coordinating and facilitating monthly meetings with contracted payer advocates and their respective leadership to discuss ongoing claims and credentialing issues on behalf of Lexington Medical Center. LEADERSHIP

• Lexington Medical Center Award of Excellence, 2013

• Pace Setter Award recipient 2015, 2017, 2018, 2019 and 2021- Patient Financial Services

• PFS United Way representative 2013- 2017

• UEF Representative 2019

Experience

EDUCATION COORDINATOR LEXINGTON MEDICAL CENTER NOVEMBER 2024-PRESENT

• Responsible for training BSA employees in all patient access front end workflows ( ED, Central, De- Central, LMC Lex & Irmo; HB)

• Responsible for training of new compliance/regulatory standards 2

MANAGED CARE AND PAYER RELATIONS SUPERVISOR LEXINGTON MEDICAL CENTER FEB 2022 – 11-2024

• Interviewed, hired, and trained new employees.

• Was responsible for interpreting complex insurance contracts and fee schedules to ensure that contractual terms of reimbursement are being adhered to, which also includes identifying internal registration and posting errors.

• Ensured accurate identification and timely recovery of hospital and physician practice underpayments by insurance payers, monitored and reported inaccurate claims processing trends.

• Manipulated data to report monthly recovery status.

• Acted as a resource for hospital and practice staff as it relates to questions/concerns regarding Managed Care and government payers.

• Identified and addresses coding denial discrepancies.

• Communicated appropriate data to Manager of Managed Care and Payer Relations for purposes of contract negotiation and re-negotiation of existing contracts.

• Worked with system analysts to identify and resolve rate load inaccuracies.

• Monitored productivity metrics and administer coaching as needed.

• Created and implemented process improvements for account review.

• Updated existing procedures as needed.

• Was responsible for coordinating with various departments to compile a monthly agenda and also facilitated structured monthly meetings with contracted payers on behalf of Lexington Medical Center. REVENUE CYCLE ASSOCIATE LEXINGTON MEDICAL CENTER JAN 2012 – FEB 2022

• Researched and resolved electronic billing rejections. Filed late charge claims. Completed coding/modifier corrections. Verified and loaded applicable insurance coverages.

• Researched and resolved claim denials, to include alerting posting and/or management of applicable adjustments and appeals needed. Applied adjustments up to 10k. Initiated level I appeals. Submitted claim reconsiderations. Disputed processing errors.

• Was responsible for following up on outstanding claims, ensuring all documentation needed for processing is submitted, and alerting patients of additional information needed for processing. Submission of medical records and itemizations.

• Followed government mandates regarding Workers Comp claims filing and follow up procedures. BRANCH ASSISTANT MANAGER RANDSTAD IN-HOUSE MAY 2011- JAN 2012

• Was responsible for administering and analyzing pre-employment screenings and assessments; conducted interviews and new-hire orientations.

• Was responsible for ensuring that all temporary employees were adhering to Bose code of conduct and line productivity metrics.

• Was responsible for administering employee corrective action, random drug testing, and refresher training courses.

VARIOUS BCBSSC MARCH 2003- JAN 2011

• Held several permanent positions during tenure with BCBSSC to include: Claims Associate II ( March 2003- April 2004); Account Administrator II ( April 2004 – May 2005); COBRA Administrator ( May 3

2005- Oct 2006); Accounting Associate II ( July 2007- Dec 2008); Accounting Claims Analyst II ( Dec 2008- July 2010); and Claims Research Analyst ( July 2010 – Jan 2011)

• Was responsible for processing, adjusting, and reviewing medical claims; Keyed 1st pass claims and worked 2nd pass deferral edits.

• Reprocessed any claims that may have rejected or denied due to membership issues.

• Contacted group leaders and/ or members daily via letters, phones, fax, and email; was responsible for resolving all inquiries internally and externally; Maintained and updated complex COBRA as mandated

*Posted COBRA premium payments to the system, voided checks, issued refunds.

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