LaFonda Roberts

• ● Resolve $200K wire fraud and account takeover and assisted customers with billing errors and payment disputes. Ensured all aspects of dispute process were handled following payment networks' terms and conditions, regulations, and internal guidelines.
• Assist with analyzing fraud alerts, determining the actions required to protect the bank's assets while communicating with customers, merchants, financial institutions, and other personnel, and managing disputes on multiple payment networks and case management systems.
• Utilize third-party systems to substantiate the validity of customer disputes and review, research, and resolve customer disputes by obtaining appropriate information from the customer.
• Ensure excellent customer service by reviewing customer orders for fraudulent activity, and attending daily team meetings, individual treatment teams, and other communication meetings.
• Analyzed financial statements to identify discrepancies, irregularities and fraudulent activity.

• Front desk is responsible for managing approximately 60-100 incoming calls, emails and faxes per day from customers and accepting live checks, electronic transfers, credit card lock boxes, co payments, and in-person payments. Goal is to ensure accuracy by reviewing all payments and creating, maintaining, and following all protocols according to specific client. Participate in particular tasks, reviewing all cost and following fee schedules when available. This ensures that all payments received with modifiers and multiple frequencies are paid correctly.
• Providing medical payment research and clearing misapplied accounts in collaboration with AR, Charge Posting, Insurance, and Intake (receptionist) departments to ensure that payments are processed efficiently and correctly. Requesting refunds, receiving answers to questions regarding CPT codes containing modifiers and multiple frequency settings are paid correctly, processing refund requests, answering incoming calls, communicating with patients about account balances and returning phone calls promptly.
• Kept detailed records of daily activities through online customer database with meeting collection quotas set forth by management, processing patient monthly statements and verifying insurance billing accuracy

Software: JP Morgan E-Connect, Citrix, My Hub, Sharepoint, HVGM Receipts, AWM Daily Letters

• Provided beneficiaries of deceased clients with distributions from retail brokerage accounts and CWM retirement accounts in cooperation with legal entities, personal representatives, beneficiaries, and licensed representatives & requested all liquidations, calculated payments according to beneficiary entitlements, distributed payments on behalf of beneficiaries, and generated reports and data.
• Assured that authorized individual handling decedent's account met the firm's requirements by reviewing client documents, such as death certificates, court appointments, small estate affidavits, trust documents, affidavits of domicile and debt, tax waivers, and payment distribution forms expertise, to ensure 100% compliance and accuracy in overall reporting. Requested all liquidations, calculated payments based on beneficiary entitlements, completed payment distributions on behalf of beneficiaries, reporting and data analysis.
• 2nd Assignment - Client Operations Specialist- Prepared HVGM mail receipt before start of day and processed CWM Smart-form mailbox that contained internal emails that got forwarded to AWM Daily Letters folder at 3 pm, I was in charge of processing FIW Estate Mailbox and producing Excel spreadsheet to be uploaded to AWM Daily Letters that completed FIW Estate Mailbox. I worked on CWM Smart-form mailbox for remainder of day. Daily goal was to work on it for at least one day and no more than two days.

Software: Intergy, Emdeon, Remit Data, Acuity, GreenWay, Good days

• Provided an exceptional customer service experience to 100 patients and family members every day at four medical clinics through outstanding relationship-building and collaborative methods. Utilizing exceptional technical expertise, systematically operated a multi-line phone system, emails, and patient messages via the clinic's online portal.
• Resolved insurance issues for 60 patients a week, using comprehensive research and resolution techniques, resulting in maximum patient coverage and reimbursement. I got referrals and charges using CPT/ICD-10 codes using my medical billing skills, ensuring all reports were accurate and up to date.
• Maintain HIPAA guidelines while collecting all necessary patient data, documentation, and financial payments. I use advanced medical software systems daily, including scheduling, registration, medical record documentation, billing, and collections, to ensure compliance with reporting requirements. I have used exceptional data mining skills while maintaining HIPAA guidelines, ensuring accuracy and compliance with comprehensive reporting.

Software: Vista, Salesforce, HCM Provider Center

• Managed approximately 30 outgoing call, emails and faxes per day from customers
• Effectively communicated specific changes that were negotiated to Magellan provider and explained fee-for-service in concise, straightforward way, ensuring complete understanding and accountability
• Researched/developed relationships with non-contracted providers and verified credentials, implemented outstanding interpersonal and collaborative efforts, maintained compliance in overall reporting, and gathered all provider demographics for contract submission using data retrieval and organizational initiatives.

Software: Claims GUI, ECM, HCM Provider Center

• Partnered with #8 team members, #2 Program Managers, and #3 Clinical Nurses regarding special projects, using exceptional communication and consultative efforts, meeting all productivity/attendance standards.
• Manage and maintain Medical records repository and implement activities supporting accurate and timely document management, adherence to tight project timelines, and protection of PHI.
• Provide support to clinical team and provider groups when obtaining, retrieving, or storing records, and ensure adherence to challenging project timelines by communicating effectively with team members and external providers. Request, retrieve, process, track, and organize incoming Medical Records that will be reviewed by clinical team and/or coding team as part of clinical team's support.
• Providers of access to medical records via fax, mail, remote electronic access or on-site visits. Be sure to upload medical records accurately and on time, follow processes to protect PHI, and track records and record requests