ALESIA LAWRENCE-BROWN
Taylor,PA
Summary
Dynamic individual with extensive experience in the healthcare industry, excelling in claims adjudication and provider relations. Proven ability to enhance operational performance through effective data analysis and quality assurance. Skilled in training development and fostering strong interpersonal communication, ensuring compliance and optimal service delivery.
Overview
5
5
years of professional experience
Work History
Provider Claims Representative
Amerihealth Caritas
Philadelphia, USA
04.2023 - 08.2024
- Responding in a timely, professional and courteous manner to all customer needs
- This includes provider phone calls or correspondence regarding benefits, eligibility, and other provider issues
- Reviews and adjudicates claims based on provider and health plan contractual agreements and claims processing guidelines
- Conducts cross-training to staff as required
- Demonstrates solid knowledge of Provider Service/Claim systems, functions and team processes
- Demonstrates superior skill in dealing with provider issues/inquiries, team members, and co-workers
- Suspends claims requiring additional information and/or special handling; initiates action to obtain required information
- Forwards claims requiring external department intervention to the appropriate department or person
- Monitors outstanding inquiries and works with management staff to identify and resolve areas of non-compliance
- Reviews and verifies quality audit reports
- Reconciles audit discrepancies, corrects in system and makes appropriate changes to avoid recurrence
- Maintains thorough knowledge of claims process systems, its databases and subsystems
- Responds to and resolves provider and health plan claim inquiries
- Monitors and tracks aged, pended, and open reports to maintain timeliness in claims processing
- Inputs claims into the system for appropriate tracking and processing
- Documents file, as appropriate, to support payment decisions
- Serves as a Subject Matter Expert and conducts training as required
- Actively participates in user acceptance testing functions, such as test script development, testing and documentation of test results
Administrative Assistant
Community Dental
Biddeford, USA
08.2021 - 08.2022
- Received, recorded, and addressed incoming and outgoing communication via telephone, email, and fax
- Provided first contact resolution for member service inquiries regarding claims, benefit explanation, etc
- Formulated ideas and strategies to improved retention i.e., client education and operational performance
- Assisted in the development and review of policies and procedures related to dental hygiene
- Provided support to dentists and other staff members
- Assisted in financial analysis and risk assessment to estimate outcomes
- Maintained paperwork, verified and update patient’s electronic charts in Dentrix for the provider encounter
- Analyzed patients’ medical records to ensure accuracy before being seen by a dentist or hygienist
- Coordinate patient flow in office
- Arranged travel and accommodations for Director
- Analyzed financial and statistical reports related to cost and healthcare services
- Assisted with developing probability tables based on analysis of statistical data and other relevant data
- Oversaw inventory management, ensuring low supply situations are timely communicated to the manager
- Managed Director calendar strategically scheduled and coordinated virtual and in-person meetings, events, travel and appointments
- Prepared budget and analyzed financial results related to dental office expectations for Director’s review
- Created a more efficient workspace by proactively anticipating department needs
- Handled Human Resource responsibilities, such as Scheduling interviews and new hire onboarding
- Assist with finding grants to support low income family with dental services
Communication Consultant
Inovalon
Bowie, USA
08.2019 - 07.2021
- Conducted outbound/inbound calls to health plan members to schedule in-home assessments by nurse practitioners or other clinical staff
- Provided members with full details of the in-home assessment within guidelines of clients
- Provided friendly customer service with a positive attitude, building rapport and trust with members
- Present, promote, and sell benefits of in-home assessment through active listening skills, empathy, and the ability to overcome objections
- Scheduled appointments for client’s members in a physician’s office
- Maintained compliance with the company’s policies, procedures and mission statement
- Adhered to all confidentiality and HIPAA requirements as outlined within the company’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered
- Exercised independent judgment within policy and procedure guidelines established by the company
- Prioritized tasks to meet deadlines and goals, perform additional duties as directed by management, and meet all business expectations in metrics and quality
Education
Bachelor of Arts -
Shippensburg University
Shippensburg, PASkills
- Claims adjudication
- Provider relations
- Regulatory compliance
- Claims processing
- Data analysis
- Quality assurance
- Interpersonal communication
- Medical terminology
- Analytical thinking
- Effective Work Management
- Audit reconciliation
- Training development
- Microsoft Excel
Timeline
Provider Claims Representative
Amerihealth Caritas
04.2023 - 08.2024
Administrative Assistant
Community Dental
08.2021 - 08.2022
Communication Consultant
Inovalon
08.2019 - 07.2021
Bachelor of Arts -
Shippensburg University
Similar Profiles
Celestina AdewuyiCelestina Adewuyi
Provider Services Representative at AmeriHealth CaritasProvider Services Representative at AmeriHealth Caritas
CHELSEA SAVAGECHELSEA SAVAGE
Claims Examiner at AmeriHealth CaritasClaims Examiner at AmeriHealth Caritas
Takenya JeterTakenya Jeter
Care Connector at AmeriHealth CaritasCare Connector at AmeriHealth Caritas