ALI M. HAYWOOD
Denham Springs,LA
Summary
Results-oriented achiever with proven ability to exceed targets and drive success in fast-paced environments. Combines strategic thinking with hands-on experience to deliver impactful solutions and enhance organizational performance.
Overview
14
14
years of professional experience
Work History
Medical Management Specialist II, Remote
Elevance Health
11.2021 - Current
- Manages preauthorization of inpatient admissions and outpatient services
- Acts as liaison between Medical Management and internal departments.
- Maintains and updates tracking databases.
- Prepares and manages all reports for the team.
- Trains all new team members.
- Conducts utilization management review activities which require interpretation of clinical information.
- Maintains privacy and confidentiality.
- Coordinated with internal departments to streamline operations and improve overall company efficiency.
- Managed client relationships effectively by maintaining open lines of communication and promptly addressing concerns or issues as they arose.
MMIS Support Coordinator II, Remote
University of New Orleans (LA Department of Health)
10.2018 - 10.2020
- Maintained an advanced working knowledge of Medicaid policy and eligibility policy to interpret correct billing procedures for providers.
- Performed advanced calculations to decide adequate claim recovery amounts and processed incoming payments.
- Monitored trends and reported financial audit results to management.
- Lead processes to recover funds from recipients and estates of deceased recipients.
- Participated in planning, development, design, testing, and implementation of changes and/or new specifications to the recovery system.
- Maintained privacy and confidentiality.
- Managed high-volume caseloads, ensuring timely completion of tasks and effective communication with clients.
- Maintained detailed documentation of client interactions and progress toward goals, providing a clear record of care provided.
- Ensured compliance with regulatory guidelines by diligently monitoring case documentation and maintaining accurate records for audit purposes.
Pharmacy Rebate Reconciliation Specialist
University of New Orleans (LA Department of Health)
02.2017 - 10.2018
- Received and reconciled pharmacy payments via remittance advice or pharmacy invoices.
- Compiled monthly productivity reports that track current projects, achievements, and future goals.
- Aided with company compliance issues.
- Trained, coordinated, and oversaw student workers.
- Aided with the recruitment, interviewing, and hiring of new student workers
- Maintained privacy and confidentiality.
- Provided training for new team members on department procedures, fostering a supportive work environment and promoting skills development.
- Managed high volumes of transaction data efficiently while maintaining attention-to-detail necessary for accurate reconciliations.
- Collaborated with cross-functional teams to resolve complex account imbalances, ensuring accurate financial reporting.
- Actively participated in team meetings, sharing insights on best practices to enhance overall department performance.
- Maintained account accuracy by reviewing and reconciling checks monthly.
- Tracked financial progress by creating quarterly and yearly balance sheets.
Medicaid Payment Resolution Specialist
Adreima Reimbursements
09.2015 - 02.2017
- Verified eligibility using payer websites, client eligibility systems, or via phone
- Reviewed high dollar claims for coding and billing corrections.
- Communicated with payers via telephone or written correspondence to secure payment
- Obtained authorization information as needed to bill claim and collect reimbursements.
- Maintained privacy and confidentiality.
- Developed tailored strategies for dispute resolution, resulting in successful outcomes and increased client retention rates.
- Streamlined dispute resolution process, cutting down average handle time.
- Simplified escalation process, allowing for quicker resolution of complex cases.
Intake Coordinator/Special Claims Processor
Blue Cross and Blue Shield of LA
10.2011 - 04.2015
- Responded to provider and member requests telephonically and electronically for benefit and eligibility needed for preauthorization of inpatient admissions and outpatient services.
- Initiated procedures to recover funds from providers, subscribers, or beneficiaries where overpayments have occurred to ensure accuracy of claims processed and financial stability.
- Maintained accuracy and updates in CPT and ICD-9 coding procedures.
- Trained new team members.
- Maintained privacy and confidentiality.
- Collaborated with healthcare professionals to ensure patients received appropriate services and resources.
- Collected, verified, recorded and processed client demographics, insurance payments, and referral information.
- Documented patient medical information, case histories, and insurance details to facilitate smooth appointments and payment processing.
Education
Bachelor of Accounting -
Southern A&M University
Baton Rouge12.2025
Skills
- Time and Priority Management
- Communication and Interpersonal skills
- Self-Motivation
- Conflict Resolution
- Leadership experience
- Organizational development
- Customer relations
- Team leadership
- Relationship building
Timeline
Medical Management Specialist II, Remote
Elevance Health
11.2021 - Current
MMIS Support Coordinator II, Remote
University of New Orleans (LA Department of Health)
10.2018 - 10.2020
Pharmacy Rebate Reconciliation Specialist
University of New Orleans (LA Department of Health)
02.2017 - 10.2018
Medicaid Payment Resolution Specialist
Adreima Reimbursements
09.2015 - 02.2017
Intake Coordinator/Special Claims Processor
Blue Cross and Blue Shield of LA
10.2011 - 04.2015
Bachelor of Accounting -
Southern A&M University