Laqueisha Henderson
Tampa,FL
Summary
Highly organized Professional; knowledgeable about healthcare processes and administrative requirements. Qualified to handle insurance documentation and claims; as well as update charts and manage business correspondence. Pursued opportunity to learn new skills to enhance support with exceptional customer relationships. Onsite and Remotely!
Overview
7
7
years of professional experience
1
1
Certification
Work History
Claims Processor
Humana
Tampa, FL
06.2021 - Current
- Reviewed and process medical claims according to Plan guidelines within established turnaround time frames
- Determining validity and extent of the claim
- Interpret medical plan to assure system is coded correctly
- Reviewed claims for legitimacy and accuracy
- Analyze documentation and evidence related to claims, such as medical reports, accident reports, and witness statements
- Work Customer Service inquiries related to claim questions
- Reviewed correspondence submitted by members and providers and adjust all related claims if the additional documentation submitted warrants adjustment
- Interpret and apply insurance policy terms and conditions to claims
- Make decisions on claim settlements, including approvals, denials, or adjustments
- Calculate and authorize payment of claims within a specified monetary limit
Claims Processor
Aetna
Tampa, FL
09.2019 - 06.2021
- Reviewed and process medical claims according to Plan guidelines
- Provided clear and concise written and verbal communication regarding claim decisions and processes
- Ensure compliance with federal, state, and local regulations
- Stay updated with changes in policies, legislation and industry practices that may affect claims processing
- Respond to client customer inquiries in a courteous and professional manner
- Research assistance requests and consistently provides accurate information to resolve internal and external member and provider inquiries via verbal and written communications through all channels including phone, email, web portal, and chat interactions
- Respond to and resolves internal and external complex customer inquiries via verbal and writing
- Resolved claim payment inquiries by researching and analyzing patient activity and determines appropriate action to be taken
- Takes ownership of the resolution and sets expectations for follow up
- Ensures resubmissions, stop payments, refunds and voids are handled appropriately
- Managed an inventory of claims to evaluate compensability/liability
- Established action plan based on case facts, best practices, protocols, regulatory issues and available resources
- Planed and conducted investigations of claims to confirm coverage and to determine liability, compensability and damages
- Assessed policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate
- Assessed actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims
- Independently investigated, evaluated and negotiated 3rd party liability settlements with Attorney involvement
- Performed other duties as assigned
Authorization Specialist
EXL Service.com, LLC
Tampa, FL
01.2018 - 09.2019
- Serve a clerical and managerial role and are responsible for verifying patient-eligibility, coordinating authorization and turnaround, record coverage, as well as addressing providers concerns regarding authorization and turnaround
- Assist with crisis calls for members
Education
Technical school - Patient Care Tech
Ultimate Medical Academy
Tampa, FL01.2013
High School - undefined
Hillsborough High School
Tampa, FL01.2011
Skills
- Cold Calling
- Medical coding
- Physiology Knowledge
- ICD-10
- Clerical experience
- Epic
- Microsoft Office
- ICD-9
- Customer service
- IOS
- Customer Service
- Insurance Verification
- Medical Coding
- Medical Billing
- Customer Care
- Medical imaging
- Microsoft Excel
- Medical Records
- Call Center
- ICD coding
- Documentation review
- Sales
- HIPAA
- CSR
- Anatomy knowledge
- Medical Terminology
- CPT Coding
Certification
CNA
PCT
Phlebotomy
Timeline
Claims Processor
Humana
06.2021 - Current
Claims Processor
Aetna
09.2019 - 06.2021
Authorization Specialist
EXL Service.com, LLC
01.2018 - 09.2019
Technical school - Patient Care Tech
Ultimate Medical Academy
High School - undefined
Hillsborough High School