Quality & Compliance Paralegal Track

LATOYIA OWTEN

**** ******** *****, ***********, ** 37406 423-***-**** ************@*****.***

EDUCATION

Pursuing Paralegal Certification Chattanooga State Community College

EXPERIENCE

BlueCross BlueShield TN

July 2014- Present

Quality Examiner Expert Shared Health

Identify error trends in efforts to improve overall divisional quality using multiple audit modalities

Responsible for disseminating quality audit scores to staff

Ability to recognize and identify when policy or procedures should be developed and/or updated

Work with staff 1:1 for coaching as needed to ensure that staff are maintain compliance and function at the top of their skill set

Maintain accurate and timely documentation for all staff

Participate in collaboration meetings with Leadership staff to define quality issues and determine best practice and methodology for addressing issues and streamlining processes

Manage various ad hoc focus audits when specific areas of need are identified

Serve as a resource for staff

Achieved “Frequently exceeds expectations” on most recent performance review

Consumer Adviser Expert BlueCross BlueShield TN

Provide first contact resolution for member service inquiries, including benefit explanations and claims research

Investigate and resolve member concerns and escalate when necessary.

Educate consumers on health insurance plan

Assist members with resources

Handle incoming calls professionally and efficiently

Maintain accurate records and process incoming files

Provide pre-certification and authorizations request to medical staff

Verida/Southeastrans, Inc

January 2009 - July 2014

Compliance Coordinator/Quality Specialist

Ensure that company adheres to all relevant regulations and safety standards, including FMCSA and DOT.

Responsible for receiving, investigating, and compiling reports for complaints

Complete attestations for State regulation approval

Maintain contact with transportation providers to ensure compliance with state regulatory requirements

SKILLS

Microsoft 360

Quality improvement

State & federal CMS regulations

Strong Analytical skills

Organizational skills

Ability to multi-task

Auditing

Reporting

Exceptional communication

Coordinating inspections

Medical Record Reviews

Job Coaching

Collaboration

Compliance

Dynamic and detail-oriented accountant with expertise in GAAP and comprehensive public accounting experience. Known for delivering top-notch strategic solutions and fostering business growth through effective collaboration and ownership mentality. Skilled in updating information changes, issuing identification cards, and giving provider information. Processed client paperwork, pre-certification ns authorizations for procedures. Investigate and resolve client concerns.

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