Lashanda Lenoir
St Louis,MO
Summary
Highly organized Grievance and Appeals Coordinator with a background in managing complex Grievance processes across diverse healthcare settings. Possess strong communication skills for liaising between patients, healthcare providers, and insurance companies. Known for ability to interpret medical policies and regulations while maintaining compliance and patient satisfaction. Demonstrated history of successfully resolving disputes and reducing claim denials.
Overview
23
23
years of professional experience
Work History
Grievance and Appeals Coordinator
Centene Corporation
St Louis, Missouri
02.2024 - 08.2024
- Compiled and documented information for grievance cases.
- Facilitated communication between providers and payers regarding payment disputes.
- Responded promptly to all correspondence from third-party payers regarding patient claims.
- Reviewed denied claims for potential resubmission or reconsideration.
- Collaborated with physicians, nurses, administrators, and other staff members to resolve issues quickly and efficiently.
- Analyzed data related to denials, recoupments, adjustments to identify patterns or discrepancies.
- Verified details with policyholders and requested additional information.
- Gathered, analyzed and prepared response letters for members and provider complaints.
Coordination of Benefits Specialist
Centene Corporation
St Louis, Missouri
03.2018 - 12.2023
- Coordinated with other departments to ensure efficient workflow processes.
- Participated in ongoing training and compliance activities.
- Researched and evaluated members information for compliance with internal policies and procedures.
- Maintained detailed records of member verifications and associated documentation.
- Updated patient and insurance data and input changes into company computer system.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Communicated with insurance carrier, patient and third party or employer to verify patient insurance benefits.
- Ensured compliance with federal and state regulations regarding insurance verification.
- Resolved insurance-related issues and discrepancies to prevent claim denials.
- Maintained up-to-date knowledge of insurance policies, including Medicare and Medicaid.
- Verified patient insurance coverage, benefits, and eligibility for services across multiple insurance platforms.
- Met with supervisor weekly to submit completed assignments and discuss progress.
Customer Service and Collections Representative
Macy's Credit Operations
Bridgeton, Missouri
10.2001 - 03.2016
- Contacted customers to discuss and resolve past due accounts.
- Referred cases involving fraud, bankruptcy or insolvency to appropriate parties for resolution.
- Researched account information to ensure accuracy of records.
- Followed up on promises made by customers regarding payments or settlements.
- Participated in training sessions on best practices related to debt collection.
- Updated account status and maintained accurate records of all collection activities.
- Met demands of busy collections group by performing high volume of daily calls.
- Recorded and updated customer personal accounts with accurate contact information.
- Remained calm, stayed professional, and provided exceptional service on calls, even when interacting with difficult individuals.
- Assisted with training new hires on customer service and collections processes.
- Cross trained in multiple departments as needed.
Education
High School Diploma -
Normandy High School
St Louis, MO05-1997
Skills
- Problem-solving capabilities
- Effective Communication/active Listening
- Teamwork and Collaboration
- Written Communication
- Analytical Thinking
- Interpersonal Skills
- Self Motivation
- Time management abilities
Timeline
Grievance and Appeals Coordinator
Centene Corporation
02.2024 - 08.2024
Coordination of Benefits Specialist
Centene Corporation
03.2018 - 12.2023
Customer Service and Collections Representative
Macy's Credit Operations
10.2001 - 03.2016
High School Diploma -
Normandy High School
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