ASIA LAWSON
Colorado Springs,CO
Summary
Detail-oriented healthcare specialist skilled in processing medical claims and maintaining regulatory compliance. Expertise in Medicaid and Medicare policies, with a strong focus on resolving claims issues through thorough analysis. Dedicated to clear communication and improving service outcomes for members and providers.
Overview
9
9
years of professional experience
Work History
Health Claims Specialist
Gainwell Technologies
Jacksonville, FL
02.2025 - Current
- Reviewed and processed medical claims, ensuring accuracy and compliance with healthcare regulations to support timely reimbursements.
- Adjudicated claims per Medicaid and Medicare policies, company procedures, and contractual obligations.
- Verified member eligibility and benefits prior to claim adjudication, maintaining adherence to coverage standards and reducing claim rejections.
- Communicated claim decisions and status updates to providers, members, and internal teams, enhancing transparency and collaboration throughout the claims process.
- Requested additional documentation from providers to enhance accuracy of claim determinations.
- Researched complex or denied claims by analyzing medical documentation and claim history.
- Identified discrepancies, billing errors, and potential fraud, by escalating issues to relevant departments.
Choices Program Specialist
Automated Health Systems Inc.
Tallahassee, FL
01.2023 - 02.2025
- Guided potential and current SMMC enrollees in selecting tailored health plans to meet individual needs.
- Provided unbiased information to Florida Medicaid enrollees regarding long-term care and managed medical assistance plans.
- Addressed enrollee questions, complaints, and grievances, ensuring high levels of customer satisfaction.
- Managed high-volume inbound calls while ensuring professionalism, accuracy, and program compliance.
- Maintained confidentiality of personal and health information in line with privacy regulations.
- Documented interactions, enrollment decisions, and case notes in company CRM systems.
- Partnered with team members to refine counseling processes and meet performance objectives.
QMAP/Caregiver Attendant
The Retreat at Sunny Vista
Colorado Springs, CO
12.2017 - 08.2018
- Administered medications accurately while adhering to state regulations and protocols.
- Monitored resident health, promptly reporting changes in condition to nursing staff and supervisors.
- Assisted residents with activities of daily living to promote dignity and independence.
- Supported residents with meals, hydration, laundry, and daily routines to promote well-being and enhance daily living.
- Identified resident needs, providing hygiene supplies and mobility equipment to enhance personal comfort and independence.
- Communicated effectively with residents and families to address care needs and enhance living conditions.
- Documented care activities and medication refusals to maintain compliance with care standards.
- Maintained a clean, safe environment by following safety protocols and participating in team meetings.
Education
Master of Science - Health Services Administration
Strayer University
09-2029
Bachelor of Science - Psychology
Colorado Technical University
Colorado Springs, CO11-2024
Associate of Science - Health Administration
Colorado Technical University
Colorado Springs, CO10-2022
Skills
- Insurance claims processing
- Claims investigation
- Claim adjudication
- Medical record review
- EHR management
- Claims data management
- Data analysis
- HIPAA compliance
- Healthcare regulations
- Regulatory updates
- Healthcare industry knowledge
- Medical terminology
- Microsoft Office Suite
- Customer service
- Patient communication
- Patient interaction
- Ethical compliance
Timeline
Health Claims Specialist
Gainwell Technologies
02.2025 - Current
Choices Program Specialist
Automated Health Systems Inc.
01.2023 - 02.2025
QMAP/Caregiver Attendant
The Retreat at Sunny Vista
12.2017 - 08.2018
Master of Science - Health Services Administration
Strayer University
Bachelor of Science - Psychology
Colorado Technical University
Associate of Science - Health Administration
Colorado Technical University