Summary
Overview
Work History
Education
Skills
References
Timeline
Generic

LaQuana Williams

Houston,TX

Summary

A highly motivated leader with skills in assessment, analytics, and impeccable customer service, committed to optimal service and the company's bottom line. Detail-oriented team player with strong organizational skills.

Overview

21
21
years of professional experience

Work History

Credentialing Specialist

UT Health
06.2024 - Current
  • Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
  • Managed multiple priorities effectively, resulting in on-time completion of credentialing tasks for numerous providers simultaneously.
  • Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
  • Enrolled providers and Medicaid, Medicare, and private insurance plans.
  • Conducted primary source verifications such as background checks and board certifications.
  • Safeguarded confidential provider information by adhering to strict data privacy regulations and company policies.
  • Demonstrated excellent problem-solving skills when confronted with complex issues or discrepancies during the credentialing process.
  • Received and evaluated applications to look for missing and inaccurate information.
  • Facilitated communication between departments, resulting in improved collaboration during the credentialing process.
  • Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.

Quality Assurance Specialist

UT Health
05.2023 - 05.2024
    • Mentored and coached team members on QA topics and strategies.
    • Participated in regular meetings with cross-functional teams to discuss progress updates, communicate concerns or challenges, and ensure alignment of project goals.
    • Meet daily quality review targets and update documentation accordingly.
    • Provide feedback to supervisors following established quality standards.
    • Participate in calibration meetings to ensure consistent evaluations.
    • Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
    • Ensured product compliance with industry regulations by staying up-to-date on relevant standards and guidelines, implementing necessary changes to maintain conformance.
    • Utilized root cause analysis techniques to identify underlying issues contributing to product defects or customer complaints.

Senior Account Representative

Texas Childrens Hospital
01.2010 - 05.2023
  • Insurance including, managed care PPO's HMO's, Medicare and Medicare Advantage A/R follow-up
  • Analyzed and resolve problems, as well as the ability to identify payor billing discrepancies
  • Appeals of corrected claims for higher reimbursement
  • May provide coordination of billing activities among peers, including recognition of problems and researching options for the supervisor/manager
  • Performs billing and insurance verification as assigned
  • Review and respond to complaints, grievances and appeals within the stated time frame for each request
  • Performed appropriate follow up with payers for payment
  • Ensured covered services are paid according to the patients benefit plan
  • Knowledge of ICD 10 and CPT coding
  • Supervise ten person A/R team
  • Managed and trained collectors, created collections strategies and developed reports to track productivity
  • Processed adjustments and manages write off work ques
  • Assists in decreasing A/R from 120 days to 30 days
  • EPIC Knowledge
  • Knowledge of Microsoft Excel, Word etc
  • Perform QA reviews for team members for documentation feedback

Insurance Verification Clerk

Texas Childrens Hospital
01.2004 - 01.2010
  • Determine if a secondary insurance should be added to the patient account ensuring the appropriate payer is selected for Primary insurance
  • Utilize the centers selected vendor for claims and eligibility and/or individual payer websites to obtain eligibility, benefits and/or pre-certs and authorization information
  • Enter the patient insurance information into patient accounting system ensuring the selection is the appropriate payer and associated financial class
  • Follow the Policies and Procedures when accepting Out of Network payers
  • Obtain authorizations from insurance companies/physician offices
  • Ensure complete and accurate information is entered into the patient accounting system and the procedure scheduled, date of service and facility name are on the authorization
  • Ensure the authorization has not expired
  • Enter authorization into patient accounting system
  • Include the name/CPT codes effective date of the authorized procedures
  • Ensure high-cost implant/supply or equipment rental is included on authorization
  • Check insurance company approved procedure lists/medical policies
  • If procedure is not payable, notify patient
  • If patient wants to proceed, obtain signature on Medicare ABN or other non-covered notification form
  • Calculate co-pay and estimated co-insurance due from patients per the individual payer contract per the individual payer contract and plan as applicable
  • Acceptance of in-network benefits for out-of-network payers must be pre-approved by SCA Compliance Dept
  • Be familiar with individual payer guidelines and the process of collecting over the counter payments/deductibles/copay/co-insurance
  • Knowledge of payer contracts including Medicare, Medicaid and other government contracts and guidelines and workmen's compensation fee schedule
  • Contact the patient and communicate the center financial policy
  • Facilitated timely claim submissions by maintaining up-to-date knowledge of insurance guidelines and requirements.
  • Assisted in reducing account receivables aging by effectively tracking pending authorizations and following up on unresolved claims in a timely manner.
  • Increased patient satisfaction by providing clear explanations of insurance benefits and assisting with questions or concerns.
  • Elevated team performance by sharing best practices and offering constructive feedback, fostering a culture of continuous improvement.
  • Expedited pre-authorization requests by efficiently gathering necessary documentation from patients and medical professionals.
  • Optimized revenue cycle management through close collaboration with billing specialists, enabling better coordination across departments.
  • Demonstrated strong organizational skills, adeptly handling large volumes of data while maintaining high levels of accuracy and attention to detail.
  • Reduced claim denials by diligently reviewing patient information and ensuring accuracy in data entry.

Education

High School -

James Madison High School
Houston, TX
01.2003

Skills

  • Effective oral and written communicator
  • Organized
  • High attention to detail
  • Excellent time management skills
  • Ability to handle stress
  • Ability to meet tight deadlines
  • Positive attitude
  • Motivated team player
  • Ability to work with minimal supervision
  • Productivity standards
  • Microsoft Office Suite
  • HIPAA Compliance
  • Provider enrollment
  • Document Review

References

Available Upon Request

Timeline

Credentialing Specialist

UT Health
06.2024 - Current

Quality Assurance Specialist

UT Health
05.2023 - 05.2024

Senior Account Representative

Texas Childrens Hospital
01.2010 - 05.2023

Insurance Verification Clerk

Texas Childrens Hospital
01.2004 - 01.2010

High School -

James Madison High School

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LaQuana Williams