Ladaisha Stallworth
Sacramento,CA
Summary
Detail-oriented claims processor with proven skills in HIPAA compliance and medical coding. Committed to enhancing operational efficiency through effective collaboration with healthcare providers.
Overview
5
5
years of professional experience
Work History
Claims Processor
UnitedHealth Group
03.2024 - 01.2026
- Processed insurance claims efficiently, ensuring compliance with company policies and state regulations.
- Conducted thorough reviews of claim submissions, identifying discrepancies and correcting errors promptly.
- Collaborated with healthcare providers to gather necessary documentation for claim approval.
- Utilized claims processing software to track and manage workflow, enhancing operational efficiency.
- Collaborated with cross-functional teams to resolve discrepancies in claims processing.
- Processed and reviewed billing invoices for accuracy and compliance with company policies.
Customer Service Representative
U.S. Bank
02.2023 - 02.2024
- Resolved customer inquiries through effective communication and problem-solving techniques.
- Processed orders and managed returns efficiently to enhance customer satisfaction.
- Maintained accurate records of customer interactions in CRM software.
- Collaborated with team members to streamline service processes and improve response times.
- Assisted in training new staff on customer service protocols and best practices.
- Handled escalated issues with professionalism, ensuring timely resolutions for customers.
Prior Authorization Representative
CVScaremark
01.2021 - 01.2023
- Processed prior authorization requests efficiently to ensure timely medication access for patients.
- Reviewed clinical documentation thoroughly to determine eligibility for prescription coverage.
- Collaborated with healthcare providers to clarify patient needs and expedite approval processes.
- Utilized electronic health records (EHR) systems to track authorization requests and outcomes accurately.
- Monitored performance metrics to identify areas for improvement and achieve operational goals.
Education
High School Diploma -
Loma Vista Education
Concord, CA06-2018
Skills
- Claims analysis
- Attention to detail
- Reconciliation of transactions
- Claims management
- HIPAA compliance
- Professionalism and integrity
- Medical coding expertise
- Critical thinking capacity
- CMS guidelines
- Medical terminology mastery
- ICD-10
- Data entry
Timeline
Claims Processor
UnitedHealth Group
03.2024 - 01.2026
Customer Service Representative
U.S. Bank
02.2023 - 02.2024
Prior Authorization Representative
CVScaremark
01.2021 - 01.2023
High School Diploma -
Loma Vista Education