Cherie Latham
Houston,TX
Summary
Accomplished Appeals and Grievance Coordinator with substantial experience in healthcare billing and collections. Skilled at analyzing claims issues, ensuring compliance with Medicare and Medicaid, and enhancing reimbursement processes. Recognized for maintaining accurate records and fostering effective communication across departments.
Overview
25
25
years of professional experience
Work History
Accounts Receivable Specialist
Addison Group-employment agency Oakbend Medical Center
03.2025 - 03.2026
- Executed timely and accurate collections, resolutions, and processing of accounts to maintain cash flow.
- Pursued all available payment avenues to maximize reimbursement for each account.
- Managed accounts for third party and government payers to ensure timely payments.
- Documented account details accurately to facilitate tracking and follow-up.
Appeals and Grievance Coordinator
Dean's Professional Services-Smith & Dean, Inc Cigna Healthcare
Houston, Remote
07.2024 - 01.2025
- Analyzed and resolved claims issues related to medical services, durable medical equipment, and medications by processing provider authorization appeals and addressing member grievances. Maintained comprehensive records of all appeals and grievances, ensuring data integrity.
- Maintained comprehensive records of appeals and grievances in company databases, supporting accurate Healthcare Effectiveness Data and Information Set (HEDIS) reporting.
- Coordinated appeals process to ensure timely responses and resolutions.
- Reviewed grievance claims for accuracy and compliance with regulations.
- Collaborated with internal teams to address customer concerns effectively.
Appeals and Grievance Coordinator I
Dean's Professional Services-Smith & Dean, Inc. Centene Corporation-Superior Health Plan
, Remote
04.2023 - 06.2024
- Analyzed and resolved claims issues involving medical services, durable medical equipment, and medications by processing authorization appeals from providers and addressing formal grievances from members.
- Prepared and distributed outcome notification letters to members and providers, clarifying appeal and grievance resolutions.
- Maintained detailed records of all appeals and grievances in company databases, supporting accurate Healthcare Effectiveness Data and Information Set (HEDIS) reporting.
Medicare Reimbursement Analyst Team Lead; Medicaid, Medicare, Managed Care Billing and Collections, AR APPEALS AND DENIAL SPECIALIST
Sava Senior Care Administrative & Consulting, LLC-Corporate Office
11.2004 - 12.2022
- Tracked and facilitated appeal process of Medicare claims, monitored claims through FISS, and utilized DDE for effective billing reconciliation and report generation.
- Demonstrated expertise in Medicare and Medicaid billing guidelines, adapting to changes and ensuring accurate support for cost reports.
- Managed medical billing and collections operations, ensuring compliance with government regulations and timely submissions of UB-04 (CMS 1450) claims.
- Analyzed and verified Reimbursable Bad Debt documentation for adherence to policies and state regulations, ensuring completeness and compliance.
- Reconciled Bad Debt accounts with General Ledger, confirming accuracy of adjustments and collaborating with external auditors during desk reviews.
Billing and Collections Specialist
Memorial Hermann Hospital-Corporate Office
03.2004 - 11.2004
- Resolved billing inquiries and collaborated with departments to clear outstanding account balances, identifying denials from EOB reviews to ensure accurate rebilling with necessary documentation.
- Streamlined resolution of open claims by efficiently utilizing resources for timely filing and payment, managing assigned correspondence to achieve Accounts Receivable objectives.
- Managed patient accounts and billing inquiries with precision and care.
- Reviewed medical claims for accuracy and compliance with regulatory standards.
- Processed payments and reconciled accounts to ensure timely collections.
Billing and Collections Specialist
HCA Houston Healthcare - Business Office
09.2001 - 03.2004
- Executed reviews of medical records to validate medical necessity for procedures, ensuring compliance with insurance carrier requirements and securing necessary authorizations.
- Analyzed and reconciled patient accounts by posting payments, addressing insurance denials, and managing billing discrepancies to uphold financial integrity and accuracy in revenue cycle operations.
- Managed billing processes for patient accounts at a major healthcare provider.
- Coordinated collections efforts with insurance companies and patients.
- Reviewed claims for accuracy and compliance with hospital policies.
Education
Office Occupations/Health Information Coding Technology Certification -
Houston Community College
02-1997
Medical Assisting - Registry of the American Medical Technologists (RMA)
National Education Center-Bryman Campus South
01-1989
Skills
- ICD-10cm
- CPT-4
- HCPCS Coding
- Claim verification
- Pre-certification
- Appeals
- Denials
- Grievance management
- Claims status monitoring
- Billing
- Collections
- EOB analysis
- Over and Underpayments
- FQHC experience
- Knowledge of Electronic Health Records (EHR)
- Process Improvement
- Microsoft Office
- Data Entry
- Accounting Software
- Analytical Skills
- Collaboration Techniques
- Client Communication
- Customer service expertise
- Self-motivation
- Adaptability
Timeline
Accounts Receivable Specialist
Addison Group-employment agency Oakbend Medical Center
03.2025 - 03.2026
Appeals and Grievance Coordinator
Dean's Professional Services-Smith & Dean, Inc Cigna Healthcare
07.2024 - 01.2025
Appeals and Grievance Coordinator I
Dean's Professional Services-Smith & Dean, Inc. Centene Corporation-Superior Health Plan
04.2023 - 06.2024
Medicare Reimbursement Analyst Team Lead; Medicaid, Medicare, Managed Care Billing and Collections, AR APPEALS AND DENIAL SPECIALIST
Sava Senior Care Administrative & Consulting, LLC-Corporate Office
11.2004 - 12.2022
Billing and Collections Specialist
Memorial Hermann Hospital-Corporate Office
03.2004 - 11.2004
Billing and Collections Specialist
HCA Houston Healthcare - Business Office
09.2001 - 03.2004
Office Occupations/Health Information Coding Technology Certification -
Houston Community College
Medical Assisting - Registry of the American Medical Technologists (RMA)
National Education Center-Bryman Campus South