LaQuasha Hicks
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
11
11
years of professional experience
Work History
Medical Claims Examiner/Configurations Analyst
Versant Health
06.2022 - Current
- Analyze business rules associated with claim payment, adjudication, and benefit administration/provider reimbursement
- Create, test and maintain Benefit Plan additions, terms and changes
- Responsible for maintenance of Benefit Plan mapping parameters throughout the system
- Involved in company configuration of all new client and provider implementations
- Follow detailed setup procedures in complex claims/benefit plan systems
- Perform assigned daily work to meet all internal and external service level expectations
- Complete independent projects meeting all deadlines
- Represent department with internal and external clients in standing and ad-hoc meetings
- Effectively work in a team atmosphere that includes all levels of organization within a Health Plan
- Independently work on the implementation of vision benefit programs in that support client program requirements gathered through the sales process
- Display integrity and discretion to maintain confidentiality of all data.
- Verified insurance coverage and eligibility of patients for services rendered.
Intake Coordinator - Team Lead
Versant Health
01/10/21 - 05.2022
- Trained new staff in relevant processes and procedures.
- Resolved escalated customer complaints or queries promptly and efficiently.
- Supported the manager in developing plans for future projects, initiatives and objectives.
- Identified opportunities for process improvements, implementing changes when required.
- Assisted the manager in setting achievable goals for the team while monitoring progress towards them.
- Provided support to junior staff during peak periods of workloads.
- Delegated tasks appropriately according to individual skill sets.
- Delegated daily tasks to team members to optimize group productivity.
- Collaborated with management team to implement new work procedures or policies.
- Organized and prioritized incoming work orders and optimized team workflows and resources to handle dynamic demands.
- Followed staffing strategies to achieve production goals.
- Maintained positive working relationship with fellow staff and management.
Prior Authorization Specialist/Appeals and Grievance Coordinator
Versant Health
06.2018 - 01/09/21
- Assisted with cross-training to ensure that consistent methodologies and best-practice strategies are utilized
- Served as a prior authorization specialist in reviewing and processing surgical authorization requests and routine medical requests according to the set plan guidelines
- Attend health plan meetings, healthcare audits and providing updates
- Verification of eligibility, confirmation of benefits, facilitation of the referral/authorization process for members and providers
- Direct communication with the Medical Director with regards to surgical authorizations and non-standard services
- Prepared and developed denial letters for organization determinations
- Coordinated medical review and medical record verification for grievances and appeals for Senior Management
- Created and maintained master spreadsheet to record all surgical procedures, denials, and approvals
- Conducts and prepares for auditing of medical management
- Researched and resolved member complaints for all lines of business ensuring compliance with grievance and Appeals policies and procedures
- Reviewed daily reports to maintain standings with compliance deadlines.
- Trained new staff in relevant processes and procedures.
- Resolved escalated customer complaints or queries promptly and efficiently.
- Ensured compliance with company policies and procedures throughout the team.
- Promoted to team lead position in recognition of strong work ethic and knowledge of current work.
Customer Service Professional- Federal Blue Cross Division
BlueCross BlueShield NC
01.2013 - 05.2017
- Met and exceeded productivity targets by handling every interaction with top-notch customer service
- Reviewed customer account information to determine current issues and potential solutions
- Maximized customer satisfaction by handling customer email and telephone interactions
- De-escalated problematic customer concerns, maintaining calm, friendly demeanor and knowledgeable service for routine questions and service complaints
- Educated customers on special pricing opportunities and company offerings
- Performed scheduled inventory counts and supply audits
- Entered information into system to update status reports
- Monitored project progress and presented status to leaders to solve productivity issues
- Aid providers with benefit questions via phone as well as offer information concerning claims
- Primary contact in handling routine and complex policy holder inquiries, regarding signature authorization, benefits, claims, and general assistance for members
- Review EOBs with members/providers.
Education
Diploma Medical Billing and Coding -
Ashworth Community College
Diploma -
South Granville High School
Skills
- Medical Management
- Prior Authorization
- Utilization Management
- Managed Care/Medicare/Medicaid
- Determinations/Appeals and Grievances Coordination
- Nuance PDF
- Operational Audit Coordination for CMS Audit Reporting
- Medical Billing and Coding
- Outlook/Excel/HSP/ESAN Work Resources
- Attention to Detail
- Time Management Abilities
- Organizational Skills
- Analytical Skills
- Technical Analysis
- Task Prioritization
- Proficient in Microsoft
Timeline
Medical Claims Examiner/Configurations Analyst
Versant Health
06.2022 - Current
Prior Authorization Specialist/Appeals and Grievance Coordinator
Versant Health
06.2018 - 01/09/21
Customer Service Professional- Federal Blue Cross Division
BlueCross BlueShield NC
01.2013 - 05.2017
Intake Coordinator - Team Lead
Versant Health
01/10/21 - 05.2022
Diploma Medical Billing and Coding -
Ashworth Community College
Diploma -
South Granville High School