Latonya-Resume

Latonya Ahanon

** ***** *****

Brockton, MA. 02301

508-***-**** (Home)

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

EXPERIENCE

Good Samaritan Hospital

Brockton, MA. November 5, 2007 – Present

Central Scheduler – Responsible for but not limited to: Processing and verification of all data entries into the Citrix Software System. Ensuring the accuracy of test scheduled with diagnosis. Using my knowledge of ICD-9, HCPCS, and CPT-4 in checking for medical necessity to minimize denials. Entering outpatient demographic and insurance information received by phone from physician offices and other hospitals. Verifying patient insurance claims via WebMD, MassRevs websites and NIA (Network Insurance Agent) or MedSolutions. Answering, screening and processing a high volume of incoming calls to provide customer service to patients and staff through written and verbal communication.

Neighborhood Health Plan

Boston, MA. July 2, 2007 – August 17, 2007

Claims Reviewer – Responsible for the adjudication of claims adhering to NHP current administrative policies and procedures, clinical guidelines, unbundling software and other system edits. Evaluated claim edits such as referral authorization (205 edits), healthcare insurance verification (918 edits), and evaluation for eligible patients over 65 (COB Claims). Also verified payment of claims by reviewing hospital and/or physician contracts and current payment practice. Using my knowledge of ICD-9, HCPCS, CPT-4, and Revenue Codes, I was able to review both electronic and paper claims to determine which course of action to take in resolving the issues involved on the claim, thereby allowing me to either pay the claim or to deny the claim.

PCG Consulting/Public Partnerships, LLC

Chelsea, MA. March 1, 2007 - June 15, 2007

Payroll Clerk - Maintains detailed files and record-keeping systems to assure accurate and complete documentation of payroll/personnel transactions. Inputting data regarding payroll, timekeeping and personnel information into an automated or manual system. Prepared a variety of payroll related forms such as reimbursement and invoices. Providing clerical support to the staff; analyzing and interpreting employee payroll problems and discrepancies in a timely fashion. Provides courteous, flexible and satisfactory customer service by responding to routine inquiries, making changes to employees information, resolving discrepancies and/or clarifying procedures for employees, supervisors, managers and others.

Brockton Hospital/Primarycare Health Affiliates

Brockton, MA September 25, 2006 - February 23, 2007

Medical Office Coordinator - Performs administrative duties in a medical clinical office at the front desk. Third Party Billing using MediTech as apart of insurance verification process. Schedules all appointments: check in and check out. Answering phones in a polite manner; filing of medical records and assisting medical staff. Maintaining and adhering to HIPPA regulations and patient confidentiality.

South End Community Health Center

Boston, MA May 8, 2006 - September 22, 2006

Patient Billing Specialist - Commercial Denial Insurance: Working in the fiscal department. Perform all required patient billing activities for the Health Center. Monitor all the encounter forms coming from direct care departments. Submit and follow-up of claims with third party payers. Perform adjustments and transfer of payments within the Meditech billing system.

Childrens Hospital

Boston, MA. June 2004 – March 2006

Cardiology – Client Services Coordinator: Currently validated the data values of electronic claims on various systems, patient accounts and health care claims and their demographics within an Oracle database system. Performed administrative duties to the department as well as schedule appointment for patients and reschedule appointment for the physicians in an efficient and timely fashion.

AMS Health Care Systems

Boston Massachusetts, January 2004 – June 2004

AMS - Automated Medical Service: Verifying PCP and provider numbers on patient claims and verifying authorization referral process. Cash posting and charge entry. Processing individual customer/patient healthcare data and verifies a variety of data in appropriate formats. Track and verify quality of data entry from all sources. Liaison to physicians and patients. Validated the data values of electronic claims on various systems, patient accounts and health care claims and their demographics within a database system. Worked within the electronic patients information center using their (EPIC) software system to enhance the data software in real time.

IDX Systems Inc.

Boston, Massachusetts October 2002 - August 2003

BAR/MCA Applications - Using their Electronic Data Interchange (EDI), validated customer information with IDX software. Produced healthcare claims electronically based on ANSI X12 837 Claims Implementation Guide. Tested the automated payment and adjustment-posting feature. Received remittance advice based on ANSI X12 835 Remittance Advice Implementation Guide and automatically post payments to the IDXtend for the Web practice management solution. Updated bug fixes using Lotus Notes created and implemented test plan procedures. Provided verification of the status for previously submitted claims. Checked the status of a claims online using IDX framework web server. Submitted claim requests individually or in groupings and verified the responses towards those claims. Created test cases in Mumps language to validate the back-end ensuring claims were processed. Verified the web application user interface, for patient demographics, type of service and payments.

Genuity Internetworking,

Cambridge, Massachusetts June1998 - May 2002

Internet Protocol Telecommunications – A composite of applications within one product offering: IP Fax, VoIP (Voice over IP) and Unified Messaging Systems

Used Java DB API to implement queries via Oracle, to validate the data between SLS and NetCentric. Created query reports using MS SQL Client and verified data within the Oracle finance system.

Performed load tests of area codes, phone numbers based on customer data on the SMS system using Weblogic application server and running bulk load tests using SQL Loader.

Validated data using servers: SMS-Sigma Mgmt. System, LDAP-Logging Data Applet, SLS-Sigma logging server and the NetCentric Hub-service platform. Verified usage data using BAS-Billing aggregation system. Performed regression testing within JDK platform, using Java CGI scripts and created test plans and reports in conjunction with using the defect tracking system.

Custom Hosting Platform – Testing Web Solution products within a Unix environment

Tested products including Real Networks-Real server and Aquas toolkit using "Jumpstart", a server installation tool. Validated package and patch installs across Solaris, Unix and Web servers. Performed installations and de-installations packages on different operating systems such as AIX, IRIX and HP-UX. Validated UNIX OS products for multi-platform builds and builds releases.

Performed smoke tests and functional testing in certain areas based on the bug fixes implemented. Performed end to end tests on applications using MS-Access and Oracle.

Quote-to-Geno – A billing order and purchasing web based application tool. Performed functional, system and configuration testing. Performed navigational and global link testing. Performed GUI front-end testing of content and the look and feel of the application. Performed all UAT testing using Weblogic Application Server.

Circuit Tracking System – Custom built financial software billing application system. Created and executed oracle SQL queries as apart of functional and regression tests within a JDK environment. Updated Perl/CGI scripts to test the file transfer process of SAP. Performed automated tests, using SQL Loader, system analysis, and performed unit tests. Performed function regression tests of Windows OS products

Validated and performed testing using a tractability matrix based on business and technical requirements.

Customer Portal System – Product line software and online documentation web siteValidated the customer service extranet, as access to resources and services provided. Implemented a functional specification for content validation. UAT tested the front-end client application user interface.Worked with developers to validate the content for the GUI application front-end. Tested web based black boxes such as Voip DID and VPN for accessibility to customer-centric information.

Training: Certification:

M for Analysis/Mumps Programming - IDX Institute of Technology

Fundamentals of Solaris 2.x and Unix C Shell programming - Sun

Oracle SQL and PL/SQL - Oracle education

Java Programming Language for Non-Programmers- Sun Microsystems

Microsoft and Oracle Databases- Sun Microsystems

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