LaSonya White

• Queried databases for information needed for claim processing.
• Verified patient and provider information by analyzing and verifying information on provider claims.
• Utilized excellent analytical and problem-solving skills to quickly and accurately process claims.
• Checked documentation for accuracy and validity on updated systems.
• Utilizing Facets and CWS to meet and exceed daily production of 100-130 claims.

• ● Analyze data determining if claims processing guidelines were followed correctly by researching plans, eligibility verification, patient authorization, and provider contract rates.
• ● Assisting with claim status, payments, 835/837 Electronic Remittance Advice, Accounts Receivable, payer denials, rejections, reconsiderations, grievances & appeals, de-escalate complaints, provider contract education, credentialing assistance, along with other complex issues.
• ● Strong knowledge and experience of CMS 1500 and UB04 forms, Medical Terminology, and usage of HCPCS/Rev Codes, ICD-9, CPT, DX Codes, compiling denial letters, and identifying billing trends.
• ● Utilizing systems such as; Availity, to meet and exceed meeting hourly production.

● Served as Team Lead for a team of 12 FTEs researching and analyzing Workers Compensation state laws.
● Ability to identify, resolve and independently produce quality work within a timely manner with limited to no supervision.
● Solid knowledge of Worker’s Compensation & HealthCare basics, Claims terminology, and HIPAA.
● Responsible for timely follow-up in regard to client grievances.
● Ability to adapt to changes in the work environment, while dealing with and conquering demands, and other delays and unexpected events.
● Research, resolve, and adjudication of clients’ high dollar claims based upon Worker’s Compensation laws along with client contract education.

● Handling customer inquiries via telephone, fax, or email regarding patient results, inquiries of tests and services, concerns of service failures, and other duties that may require supervisory attention.
● Troubleshoot inquiries and follow up with customers on issues that cannot be resolved immediately.
● Detailed Documentation of calls to maintain complete and accurate records of patient and client disputes.
● Possess great composure skills that are utilized daily in stressful situations dealing with irate customers and clients.
● Advanced to Interim Team Lead, Leading a team of 15 FTEs accepting multiple responsibilities but not limited to; Kronos, coaching, quality control, along with other managerial duties.