LAKESHA HAGGINS
Hampton,GA
Summary
- Detail-oriented, focused professional with a 10+ year history in medical insurance billing, data entry, and customer service. Experience working at highly respected companies is testament to commitment and ability. Conveys a positive attitude when interacting with clients, staff, and the public.
- Establishes and maintains credibility with the public, partners, customers, and co-workers.
- Works with customers to assess their needs to meet and exceed expectations.
- Maintains high degree of confidentiality on all patient information.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Legal Administrative Claims Benefits Rep
Department of Veterans Affairs
05.2023 - Current
- Coordinates counseling sessions with Veterans, their dependents, and their beneficiaries face to face, regarding all benefits available through the VA, as well as non-VA benefits available through other agencies
- This is accomplished through in-person or telephone interviews, and correspondence
- Explains in detail, VBA rating decisions and provides explanations for the decisions using extensive knowledge of VA benefits and services, claim and appeal processing procedures and benefit determination information and all pertinent information available in system of record
- Assists with programs include, but are not limited to, compensation and pension benefits, home loan eligibility, education, health care, life insurance, burial benefits, vocational rehabilitation services, general Social Security Administration benefit programs, other federal, state, and local domestic relations, and assistance programs
- Prepares technical correspondence to veterans and their dependents providing benefit information, representation rights and response to miscellaneous inquiries
- Explains pertinent legal provisions, regulations, and related administrative practices and their application to specific cases
- Initiates inquiries to resolve errors, delays, or other problems in obtaining benefits
- Completes claim and appeal related work
Advanced MSA Radiology Specialist
Department of Veterans Affairs
Tampa, FL
05.2019 - 04.2023
- Coordinates timely care for the Veteran based on the priority indicated on the consult, receive RTC order through GUI system and call to schedule all patients
- Monitoring Vet Link to assure all patients are checked in as well as insurance has been updated, pulling RTC and Consults for PCP, Pharmacy, and MH patients
- Manages appointments in Vista (no shows, cancellations, rescheduled appointments), Clinic Cancellations, Manages workload on spreadsheets
- Immediately notifies the medical staff when potentially serious medical symptoms or complaints are identified for walk-in patients
- Coordinates timely care for the Veteran based on the priority indicated on the consult, ensuring accurate and timely scheduling of appointments, organizing the work structure of his/her assigned areas (spreadsheets)
- Providing on the job training for new and current employees
- Organize work, priorities, and delegate tasks to other AMSA, meet deadlines when given
- Communicate with peers and upper management to obtain the compliance with established policies and regulation, experience using VISTA and CPRS
- Making decision towards benefit sought to include questions relating to adequacy of military service, medical evidence
- Ensuring accurate and timely scheduling of appointments
- Organizing the work structure of his/her assigned areas
- Schedule between 5 to 25 complex appointments ranging from 1-18 hours in length per veteran
- Completes Reminder Calls each Day
- Utilizes numerous Excel Spreadsheets daily
- Schedule patient appointments
- Interview veterans for VA benefits
- Knowledge of the technical health care process as it relates to access to care, and advance knowledge of clinic management
- Independently utilizing reference sources, decision making, and allow the team to collaborate and resolve problems within a complex systems environment
- Advanced knowledge of policies and procedures associated with operational activities that affect the patient flow, patient care, and the revenue process to include co-pays and preauthorization requirements for specific coverage
- Maintains patient's confidential records, copies, and file documentation
- Scans and enters information into Veteran information Systems and Technology (VISTA), Computerized Patient Record Systems (CPRS)
- Scheduling, canceling, re-scheduling patient's appointments and/or consults; monitoring the electronic wait list; preparing for clinic visits
- Monitoring inpatient and outpatient appointments for areas of responsibility; verifying and updating demographics and insurance information
- Coordinates and maintains overall patient flow
- Receives patients and visitors in person or telephonically
- Initiates, completes, and verifies patient eligibility for benefits
- Updates and verifies demographic information
- Provides information regarding clinic and hospital policies, procedures, and locations to patients, family members, and staff
- Maintains and monitors patient appointment schedules for the clinic and communicates delays to the appropriate staff and patients
- Coordinates and schedules patient appointments with other clinics, specialties, and inter-facility as appropriate
- Duties include but not limited to: Assigning codes to documented patient care encounters inpatient and outpatient covering the full range of health care services provided by the VAMC
- Patient encounters are often complicated and complex, requiring extensive coding expertise
- Applies advanced knowledge of medical terminology anatomy and physiology, disease processes treatment modalities diagnostic tests medications procedures as well as the principles and practices of health services and the organizational structure to ensure proper code selection
- Selects and assigns codes from the current version of several coding systems to include the International Classification of Diseases-Clinical Modification ICD-9-CM Current Procedural Terminology CPT and HCPCS
- Adheres to accepted coding practices guidelines and conventions when choosing the most appropriate diagnosis operation procedure ancillary or Evaluation and Management code to ensure ethical, accurate, and complete coding
- Also applies codes based on guidelines specific to certain diagnoses, procedures, and other criteria in inpatient and outpatient settings used to classify patients under the Veterans Equitable Resource Allocation (VERA) program that categorizes all VA patients into specific classes representing their clinical conditions and resource needs
- Corrects any identified data errors or inconsistencies in a timely manner to ensure acceptance in the national VA database within established timeliness
- Identifies the principal diagnosis and principal procedure for every inpatient discharge; also identifies significant complications and/or co-morbidities treated or impacting treatment to correctly determine the proper DRG
- Codes inpatient professional fee services for identified inpatient admissions
- Code selection is based upon strict compliance with regulatory fraud and abuse guidelines and VA specific guidance for optimum allowable reimbursement
- Codes all Operating Room procedures reported in the Surgical Package of the Vista hospital system; applies ICD-9-CM and CPT coding guidelines and selects proper codes using the QuadraMed encoder software; ensures all procedures file to the appropriate Patient Care Encounter (PCE); adds Anesthesia and Pathology codes to the PCE encounter for all billable surgical cases
Patient Access Specialist/Medical Records Supervisor
Tampa General Hospital
Tampa, FL
11.2014 - 05.2019
- Scan patient medical records into patients’ charts
- Schedule appointments
- Answer Phones & Fax Medical Records to providers
- Ability to Multitask, work closely with patients and also assist patients with all their needs
- Process disability paperwork for providers, process work comp claims
- Process authorizations and referrals for patients
- Process FMLA paperwork for Providers
- Supervisory
- Process patient Medical Records
- Process patient case load
- Codes all Operating Room procedures reported in the Surgical Package
- Serving as the liaison between the Medical Center, patients and employees of the facility, and the community it serves regarding patients' rights and advocacy
- Working with health care providers and administrative support staff throughout the Medical Center in preventing and resolving patient complaints
- Interpreting the Medical Center mission, policies, procedures, and available resources/services to the patient and presenting the patient's problems, opinions, and needs to appropriate staff and management
- Assisting patients in understanding their rights in addition to their responsibilities
- Representing the Director in safeguarding and ensuring ethical, statutory, and constitutional rights of patients
- Applied ICD-9-CM and CPT coding guidelines and selects proper codes using the QuadraMed encoder software; ensures all procedures file to the appropriate Patient Care Encounter (PCE); adds Anesthesia and Pathology
- Assisting patients, families and advocates, and facility staff members in recognizing and removing institutional barriers to the provision of optimum health care to Veterans
- Identifying and analyzing existing or potential problem areas to suggest solutions or alternatives to eliminate the existence of procedures or practices which contribute to the problem
- Maintaining a strong relationship with Veterans Service Organizations, clinic staff, and others whose interests are in helping and protecting veterans, their families, and their representatives
Senior Collector Claims Representive
RX Development
Tampa, FL
03.2014 - 01.2016
- Customer Service & Call Center
- Process and Collect Workers Compensation Payments and Claims for Physicians
- Contact Lawyers and Adjusters to assure patient’s claims are being paid
- Processed Appeals and mail them out to the client’s
- Receive Claims for Workman’s Compensation Claims & PIP
- Fax, mail & post payments to patient’s accounts
- Process payments in Medisoft, Rx Billing & Rx Development system
Utilization Review Coordinator/Medical Records Team Lead - Call Center
Care Centrix
Tampa, FL
03.2013 - 03.2014
- Received inbound calls, identified patient needs, and determined appropriate actions
- Created authorizations for patients in need of Durable Medical Equipment (DME)
- Contacted health plans to gather policy information, completed eligibility and benefits verification, and documented all communications in the computer
- Identified payer sources, verified benefits, and obtained initial authorization
- Assisted employees, organized team members, and ensured goals and objectives were met
- Medical Records processor
- Case Management Coordinator
Medical Clinical Lab Assistant Externship
Kids First Pediatrics
Tampa, FL
03.2013 - 05.2013
- Took and recorded vital signs and medical history
- Administered injections, EKGs, and drew blood
- Provided clerical and medical support for clinical staff for front and back office
- Answered incoming calls, scheduled and confirmed appointments, pulled charts, handled patient check in and check out, verified insurance coverage, and called in prescriptions
- Entered and posted patient information into the database after office procedures
- Keep all reports and files current in the patient chart
Durable Medical Equipment (DME) Coordinator, Human Resource Coordinator/Benefits
Citrus Health Care
Tampa, FL
03.2007 - 01.2010
- Identifies relevant facts and issues regarding employee benefits
- Responds to questions, complaints, problems, and/or situations within Human Resources in a timely manner
- Created authorizations for patients in need of Durable Medical Equipment (DME)
- Reviewed requests and checked for eligibility/benefits to determine if referral was most cost effective
- Counsel management, employees, and beneficiaries on program coverage, options, variances in coverage, and advantages and disadvantages of benefits
- Gathers and organizes data for special projects
- Maintains and presents up-to-date benefits information
- Medical Records Technician
- Assists the Specialist with the medical facility's Human Resources Management Service and Fiscal Service to identify any employee status changes (for example, marriage, death, divorce, or minor children reaching maturity) that may affect compensation entitlements
- Applied basic laws, regulations, policies, and precedents of Federal employee retirement, group life insurance, health benefits, and thrift savings programs
- Maintained telephone queue and assisted callers appropriately
- Case Manager
- Supports technical review, analysis and collaboration among internal and external stakeholders to ensure accurate processing of WC claims
- Provides guidance and counsel to facility and employees, managers and supervisors regarding their rights, responsibilities and requirements under the Federal Employees' Compensation Act (FECA) immediately following the first report of work-related injury or illness
- Reviews and interprets medical portions of less complex claims based on medical matrices and the level of disability in relationship to the work injury, considering any preexisting medical conditions and subsequent medical conditions of the injured employee
- Worked closely with Nurses to identify members that required case management
- Followed-up with patients to ensure care was received
- Communicated referral/precertification decisions
- Uphold compliance with regulatory time frames
- Stayed in close contact with Medicare and Medicaid to process authorizations
Well Care Health Plans Enrollment & Claims Representative, Cost Containment Department (CCU) Human Resource Coordinator
Adecco Temp Agency
Tampa, FL
02.2006 - 03.2007
- Medicare and Medicaid Authorization processing
- Enrollment Specialists
- Medical Records Clerk
- Gathers and organizes data for special projects
- Maintains and presents up-to-date benefits information
- Researches and reviews laws, regulations, authorities, and agency policies
- Manually processed professional and institutional claims
- Researched payments for accuracy
- Case Management Coordinator
- Responded to Provider requests
- Monitors information systems for actions related to benefits
- Reviews requests for completeness and accuracy for all employees
- Evaluates sensitive personnel issues and counsels employees when needed
- Collected money and settlements, processed refunds, appeals, and grievances
- Processed authorizations and referrals
- Data Entry & Customer Service Representative
Customer Service, Claims and Multi Queue Associate - Call Center
Oxford Health Plans
Tampa, FL
05.2004 - 12.2005
- Worked in Billing, Claims, Medicare, and Enrollment
- Medical Records Coordinator
- Case Worker
- Interfaced with customers via inbound and outbound calls
- Interviewed customers to determine claims and review information
- Managed pending claims to meet quality
Education
Master’s Degree - Health Care Management
University of Phoenix
07.2021
Bachelor’s Degree - Health Care Management
University of Phoenix
08.2018
Associates Degree - Health Information Management
University of Phoenix
11.2014
Medical/Clinical Lab Assistant -
Ultimate Medical Academy
Tampa, FL01.2013
Skills
- Claims
- Authorization & Referrals
- Customer Service
- Benefits
- Management
- ICD 10
- Remote
- Communication
- Utilization Review
Certification
- HIV/AIDS/Blood Borne Pathogens (BBP)
- CPR/BLS/AED
- First Aid
- National CCMA Certification
- National CPT Certification
- Long Term Care Certification
Timeline
Legal Administrative Claims Benefits Rep
Department of Veterans Affairs
05.2023 - Current
Advanced MSA Radiology Specialist
Department of Veterans Affairs
05.2019 - 04.2023
Patient Access Specialist/Medical Records Supervisor
Tampa General Hospital
11.2014 - 05.2019
Senior Collector Claims Representive
RX Development
03.2014 - 01.2016
Utilization Review Coordinator/Medical Records Team Lead - Call Center
Care Centrix
03.2013 - 03.2014
Medical Clinical Lab Assistant Externship
Kids First Pediatrics
03.2013 - 05.2013
Durable Medical Equipment (DME) Coordinator, Human Resource Coordinator/Benefits
Citrus Health Care
03.2007 - 01.2010
Well Care Health Plans Enrollment & Claims Representative, Cost Containment Department (CCU) Human Resource Coordinator
Adecco Temp Agency
02.2006 - 03.2007
Customer Service, Claims and Multi Queue Associate - Call Center
Oxford Health Plans
05.2004 - 12.2005
Master’s Degree - Health Care Management
University of Phoenix
Bachelor’s Degree - Health Care Management
University of Phoenix
Associates Degree - Health Information Management
University of Phoenix
Medical/Clinical Lab Assistant -
Ultimate Medical Academy