Larail Moyea
Suwanee,GA
Summary
Diligent Claims Representative with solid background in claims management, prepared to make significant impact. Skilled in assessing and processing claims accurately, resolving complex issues, and ensuring customer satisfaction. Effective team collaborator with focus on achieving results and adapting to changing needs. Known for analytical thinking, communication skills, and attention to detail.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Patient Access Representative
Northside Hospital
08.2021 - Current
- Develops proficiency in various healthcare software programs for accurate documentation of patient encounters and streamlined workflows within the department.
- Facilitate smooth billing processes by verifying insurance eligibility, obtaining authorizations, and accurately entering claim details into the system.
- Negotiate payment plans with patients experiencing financial difficulties, resulting in increased collection rates without sacrificing customer satisfaction
- Train new hires on department procedures, policies, and software systems, ensuring consistent quality service delivery from all team members.
Tutor
Potential Tutoring
03.2011 - Current
- Provide one-on-one tutoring sessions, tailoring instruction to meet the specific needs of each student while promoting independent learning skills.
- Tutor diverse groups of students to strengthen subject comprehension, boost confidence, and build important learning skills.
- Implement creative instructional techniques to address the unique challenges faced by students with learning differences.
- Maintain detailed records of student progress, using data to inform future instruction and target areas for improvement.
Claim Specialist Representative
Texas Children's Health Plan
07.2016 - 11.2020
- Evaluated and analyzed claims to ensure accuracy, completeness, and prioritizing to meet compliance with company policies.
- Confirmed prior authorizations, pre-certification or notification to payers required for hospital admissions, treatments or procedures.
- Handled and interpreted medical documentation such as CMS1500 claim forms and EOB's on a daily basis.
- Verified CPT, ICD-10 and HCPCS codes for claims/billing to ensure accurate payments.
- Expedited claim resolution times with diligent follow-ups on pending claims, collaborating closely with healthcare providers and insurance carriers.
Disability Adjudicator Assistant
Peak Performers
02.2015 - 07.2016
- Delivered exceptional customer service to patients by communicating important information and patiently listening to issues.
- Scheduled adjudicated disability appointments for various types of disabilities, including physical and mental impairments.
- Collaborated with medical professionals to gather crucial information for accurate claim assessments.
- Responded to telephone and written inquiries from clients, insurance carriers, claimants, attorneys, repair shops, appraisers, physical damage experts and physicians within statutory requirements.
Education
Associate of Applied Science - Medical Office Administration
Central Piedmont Community College
Charlotte, NC11.2012
Skills
- Customer relations and support
- Written/Verbal communication
- Healthcare systems navigation
- Claims processing software- (athena)
- Claims processed in a timely manner
- Healthcare common procedures coding system (HCPCS)
- Strong knowledge of medical terminology, ICD-10 and CPT coding
- Electronic health records management (EHR) Allscripts
- Prior authorization processing
- CMS 1500 and UB-04 forms
- HIPAA Patient confidentiality
Certification
Certified Medical Office Administration
Languages
Spanish
Professional Working
Timeline
Patient Access Representative
Northside Hospital
08.2021 - Current
Claim Specialist Representative
Texas Children's Health Plan
07.2016 - 11.2020
Disability Adjudicator Assistant
Peak Performers
02.2015 - 07.2016
Tutor
Potential Tutoring
03.2011 - Current
Associate of Applied Science - Medical Office Administration
Central Piedmont Community College
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