LAQUASHA HICKS
Summary
Results-driven configurations analyst skilled in streamlining client onboarding and integration processes. Proven track record in analyzing and implementing business rules for claims and benefit administration, ensuring compliance and accuracy. Highly effective in managing complex projects independently while maintaining exceptional communication and interpersonal skills.
Overview
13
13
years of professional experience
Work History
Configurations Analyst
Versant Health
06.2022 - Current
- Analyze business rules associated with claim payment, adjudication, and benefit administration/provider reimbursement
- Configured new client and provider implementations, facilitating seamless onboarding and integration
- Created, tested, and maintained benefit plan additions, terms, and changes to ensure compliance and meet client needs
- Independently work on the implementation of vision benefit programs in that support client program requirements gathered through the sales process.
- Supported system accuracy by maintaining mapping parameters for benefit plans.
- Follow detailed setup procedures in complex claims/benefit plan systems
- Developed and assessed reports according to project specifications.
- Represented department in internal and external meetings, effectively communicating requirements and updates
- Executed various independent projects to fulfill client requirements meeting all deadlines
Prior Authorization Specialist/Appeals and Grievance Coordinator
Versant Health
06.2018 - 05.2022
- Reviewed and processed surgical authorization requests and routine medical requests as prior authorization specialist, ensuring adherence to plan guidelines.
- Facilitated direct discussions with Medical Director on surgical authorizations and non-standard service requests.
- Coordinated medical review and verification of medical records for grievances and appeals, providing timely updates to Senior Management.
- Resolved member complaints across all lines of business, ensuring compliance with grievance and appeals policies and procedures.
- Prepared and developed denial letters for organization determinations.
- 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.
- Cross-trained a team of 15 people to ensure consistent methodologies and best-practice strategies were utilized.
- Conducts and prepares for auditing of medical management.
- Created and maintained master spreadsheet to record all surgical procedures, denials, and approvals.
- Reviewed daily reports to maintain standings with compliance deadlines.
Customer Service Professional
BlueCross BlueShield NC
01.2013 - 05.2017
- Met and exceeded productivity targets by handling every interaction with top-notch customer service.
- Enhanced customer satisfaction through effective handling of email and telephone interactions.
- De-escalated problematic customer concerns, maintaining a calm, friendly demeanor.
- Analyzed customer account information to identify issues and recommend solutions.
- Educated customers on special pricing opportunities and company offerings.
- Assisted providers with benefit inquiries over the phone and provided information on claims.
- Served as primary contact for routine and complex policyholder inquiries regarding signature authorization, benefits, claims, and general assistance.
- Examined EOBs alongside members and providers to ensure understanding of benefits.
- Customer Service Professional - Federal Blue Cross Division
Education
High School Diploma -
South Granville High School
Creedmoor, NC01-2009
Skills
- SQL
- Regulatory Compliance
- Utilization Management
- Determinations/Appeals and Grievances Coordination
- Report creation
- Project management
- Implementation planning
- Analytical thinking
- Microsoft office
- Time Management
- Multitasking
- Customer Service
Timeline
Configurations Analyst
Versant Health
06.2022 - Current
Prior Authorization Specialist/Appeals and Grievance Coordinator
Versant Health
06.2018 - 05.2022
Customer Service Professional
BlueCross BlueShield NC
01.2013 - 05.2017
High School Diploma -
South Granville High School