La-Tonya Thomas
Columbus,OH
Summary
Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
13
13
years of professional experience
Work History
Workers Compensation Medical Bill Reviewer
Sedgwick CMS
Dublin , OH
10.2014 - 04.2024
- Ensured medical claim accuracy and validity
- Processed payments for hospitals and physicians' offices in accordance with policy coverage.
- Implemented procedures to adhere to state guidelines for bill processing
- Conducted audits of medical records to identify missing or incorrect documentation that could affect accurate coding and billing.
- Researched denied claims to determine the cause of denial and corrected errors as needed.
- Assigned appropriate codes using ICD-10-CM for diagnosis, CPT for procedures, HCPCS for supplies and modifiers as required by payers.
- Trained new employees on medical coding practices.
- Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
- Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
- Maintained positive working relationship with fellow staff and management.
Claims Services Representative
Nationwide
Dublin, OH
10.2011 - 10.2014
- Enhanced the handling of initial notice of loss by promptly liaising with policyholders, claimants, relatives and Attorneys.
- Acquired proficiency in Gateway, Claims Center, and Horizon systems to gather information on active claims.
- Collaborated effectively with other departments at Nationwide, such as Claims Adjusters and medical providers, to facilitate seamless claims processing.
- Offered in-depth insights into the claims process, policy coverage, state laws and regulations.
- Facilitated partnerships between Claimants and third-party vendors including Safelite Auto Glass, Enterprise Car Rental, and Nationwide approved auto mechanics and body shops.
Education
High School Diploma -
Independence High
Columbus, OH06-2001
Medical Assistant Certification - Medical Assisting
Fort Hayes Career Center
Columbus, OH06-2001
Skills
- Analytical
- Accuracy and attention to details
- Communication
- Fact-checking
- Critical Thinking
- Self Motivation
- Adaptability
- Multitasking
- Deadline-oriented
Timeline
Workers Compensation Medical Bill Reviewer
Sedgwick CMS
10.2014 - 04.2024
Claims Services Representative
Nationwide
10.2011 - 10.2014
High School Diploma -
Independence High
Medical Assistant Certification - Medical Assisting
Fort Hayes Career Center
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