Revenue Cycle & Payer Enablement Leader

LaToya Tharrington

Richmond, VA 919-***-****

*****************@*****.***

Core Competencies

Revenue Cycle Management & Reimbursement Operations: Manage end-to-end revenue cycle activities, including claims submission, AR optimization, cash flow acceleration, and revenue integrity.

Prior Authorization, Denials & Appeals: Research payer requirements, audit submissions, monitor trends, and implement strategies to reduce denials and expedite approvals.

Payer Setup & Compliance: Gather and validate payer IDs, claim/appeal addresses, and medical record submission details; maintain accurate configurations and compliance with regulatory updates.

System Configuration & Workflow Optimization: Translate insurance plan requirements into system setups, optimize workflows, and support automation initiatives to improve operational efficiency.

EMR / RCM Systems Expertise: Configure and maintain insurance plans in platforms such as Cerner, Credible, Epic, NextGen, AdvanceMD, Power BI, and Salesforce; manage payer portal registrations and user access.

Productivity & Data Analysis Tools: Proficient in Microsoft Office (Word, Excel, PowerPoint, Outlook), Google Suite (Docs, Sheets, Slides), and advanced Excel functions including PivotTables, VLOOKUP, INDEX/MATCH, and data analysis tools for reporting, dashboards, and workflow optimization.

Cross-Functional Collaboration & Leadership: Partner with IT, Market Access, and operational teams to ensure system accuracy, implement process improvements, and drive change management initiatives, including UAT and software upgrades.

Documentation & Process Standardization: Develop and maintain detailed system configuration documentation, workflow guides, and integrations to support compliance, audits, and staff training.

Offshore Vendor & Project Management: Oversee vendor performance, track KPIs, and ensure quality, timely deliverables; lead ad hoc tasks and cross-functional projects to meet departmental goals.

Performance Monitoring & Reporting: Track departmental KPIs, quality metrics, and system performance; identify opportunities for improvement and deliver executive-ready status reports.

Professional Experience Natera Inc. (Remote) Revenue Cycle Analyst / Project Manager April 2025-Feb 2026

Oversee and track prior authorization submissions to ensure accuracy, timeliness, and compliance with payer guidelines while minimizing denials and rework.

Drove consistent achievement of departmental SLAs and quality benchmarks while independently managing priority and ad hoc assignments.

Supported system enhancements through active participation in UAT, change management, and performance monitoring to strengthen adoption, accuracy, and operational efficiency.

Partnered cross-functionally to optimize workflows, maintain configuration documentation, oversee payer portal access, and identify automation opportunities that improved overall revenue cycle performance.

Audit authorization requests (portal, fax, electronic) and pre-build submission packets to validate complete patient demographics, CPT, and DX coding integrity.

Lead automation and portal migration initiatives, transitioning payers from manual fax workflows to electronic platforms to improve efficiency and turnaround times.

Investigate denials and submission errors, conduct root cause analysis, and implement sustainable process improvements to reduce repeat issues.

Manage offshore vendor partnerships, conducting weekly KPI and metrics review meetings to ensure productivity, quality standards, and project milestones are met.

Drive cross-functional projects and process improvement initiatives, ensuring timelines, deliverables, and execution remain on track.

Build and maintain performance trackers and dashboards to monitor current-state operations and future-state goals, enhancing visibility and accountability.

Provide regular status updates and executive-level reporting on project progress, risks, automation efforts, and operational performance

Provide executive-ready status reports highlighting project progress, automation advancements, risk mitigation, and performance metrics.

Standardize workflows through SOP development and partner with business analyst and analytics teams to enhance reporting tools and support scalable, data-driven revenue cycle operations.

Denials & Appeals Specialist (RCM)

May 2024 – April 2025

Conducted in-depth research on new and existing payer requirements for prior authorizations, claim submission, and appeals to ensure regulatory compliance and optimize reimbursement outcomes.

Analyzed insurance plan policies and translated complex payer guidelines into accurate system configurations and standardized workflows within the billing platform.

Led payer setup and maintenance initiatives by gathering and validating payer IDs, claim addresses, appeal addresses, and medical record submission details to ensure clean claim submission and minimize denials.

Configured and optimized insurance plans within the billing system to support accurate claims adjudication, efficient appeals processing, and revenue integrity.

Served as Subject Matter Expert (SME) performing detailed denial trend analysis to identify root causes, mitigate revenue leakage, and reduce repeat denials.

Conducted comprehensive denial analysis across Medicare, Medicaid, and commercial payers, presenting data-driven insights and corrective action plans to leadership to improve AR performance and cash flow

Developed performance dashboards and reporting tools to monitor KPIs including denial rates, appeal success rates, reimbursement accuracy, and recovery metrics.

Authored and implemented Standard Operating Procedures (SOPs) and job aids to standardize denial management workflows and enhance operational efficiency.

Collaborated cross-functionally with Revenue Cycle Operations and Market Access teams to implement systemic improvements that increased clean claim rates and ensured timely, compliant reimbursement

Partnered directly with payers to resolve recurring billing issues, strengthening payer relationships and improving overall claim acceptance and reimbursement accuracy

Trained and mentored team members on denial management best practices, payer policy interpretation, and regulatory compliance to maintain high-quality revenue cycle operations.

Centene (Envolve Dental) (Remote)

Claims Team Lead

May 2022 – May 2024

Supervised a team overseeing Medicaid and Medicare claims operations, ensuring timely resolution of complex accounts and minimizing denials through proactive oversight and escalation management.

Directed quarterly AR and claims performance audits, identifying key trends and implementing targeted process improvements that reduced claim aging by 10% and strengthened overall cash flow.

Coached, trained, and developed staff to enhance productivity, accuracy, and accountability, elevating overall team performance and service quality.

Partnered with senior leadership to identify and resolve systemic claims processing issues, implementing sustainable solutions that improved accuracy and reduced denial rates.

Led cross-functional meetings to align Revenue Cycle, Market Access, and operational teams, accelerating claim resolution timelines and improving stakeholder and client satisfaction

ATI Physical Therapy (Remote)

Medical Claims Auditor (RCM – Part-Time)

April 2022 – August 2024

Led audits of billing, coding, and reimbursement processes, identifying discrepancies and implementing corrective actions that reduced claim denials by 15%

Provided training, coaching, and ongoing support to internal billing teams and offshore vendors, enhancing understanding of coding compliance, claims adjudication, and operational standards

Partnered with Finance and leadership teams to develop detailed reports on audit findings, highlighting trends and key areas for process improvement.

Collaborated cross-functionally with leadership to strengthen billing and coding practices, ensuring compliance with industry regulations, payer requirements, and organizational standards.

Oversaw offshore vendor performance and workflow alignment, ensuring timely and accurate claims processing while maintaining quality and compliance metrics.

Azalea Healthcare (Remote)

Enterprise Account Coordinator (RCM)

April 2019 – May 2022

Managed a portfolio of 8–12 clients, overseeing end-to-end revenue cycle operations, including billing, coding, claims resolution, and AR management.

Led client calls and regular check-ins, addressing payer issues, providing guidance, and identifying opportunities for process improvement.

Analyzed AR reports and trends, implementing strategies that reduced claims aging by 12% and improved client cash flow.

Collaborated with internal teams—Billing, Reimbursement, Credentialing—and clients to streamline workflows, enhance operational efficiency, and reduce denials.

Served as Subject Matter Expert (SME) for assigned clients, offering expertise on claims resolution, payer issues, and revenue cycle best practices.

Education

Bachelor of Science in Accounting

Elizabeth City State University, Elizabeth City, NC

Graduation: May 2010

Pharmacy Certification

April 2018

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