LaShawna Hayes
Columbus,OH
Summary
Dedicated team player adept at managing customer service and claims processing for policyholders. Looking for a long-term position with a growth-oriented company.
Overview
16
16
years of professional experience
Work History
Patient Care Coordinator
Quantum Health
Dublin, OH
07.2021 - 07.2023
- Provided administrative support for patient care staff.
- Coordinated insurance authorizations, collected co-payments and resolved discrepancies.
- Completed insurance verifications and claim forms for patient intake and processing.
- Collaborated with nursing staff to advocate for individual patient needs and insurance coverage.
- Determined liability, compensability and benefits due on each claim.
- Supported efficient handling of complex claims and followed up on open, denied or suspended claims to complete required line items.
- Assisted claimants, providers and clients with problems or questions regarding claims.
Customer Claims Representative
VSP Vision Care
Columbus, OH
07.2017 - 05.2020
- Verified details with policyholders and requested additional information.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Applied HIPAA privacy and security regulations while handling patient information.
- Explained policies, procedures and services to patients.
Customer Solutions Specialist
IGS Energy
Dublin, OH
05.2012 - 07.2016
- Inbound calls from eye care patients an doctors
- Assist with finding a doctor, enrollments
- Assisted doctors with back end orders and locating patients
- Updated patient records and assisted with claims and explanation of insurance benefits.
- Engaged in conversation with customers to understand needs, resolve issues and answer product questions.
Collections Representative
Discover Financial Services
New Albany, OH
03.2012 - 07.2016
- Reasoned with customers and attempted to negotiate full balance payments.
- Handled irate customers smoothly to achieve performance targets.
- Used effective questioning techniques to clarify why debtors were delinquent.
- Handled contracts and payments on accounts.
- Received payment and posted to appropriate customer accounts.
Claims Representative
Tailored Management/BWC
Columbus, Ohio
03.2007 - 01.2009
- Investigated questionable claims to determine payment authorization.
- Reviewed data to verify validity of claims and determine case management actions.
- Obtained necessary information to complete proper evaluation of injury claims.
- Gathered information from various third parties to determine claim acceptability.
- Interviewed claimants, medical specialists and employers to determine pertinent claim information.
Education
Human Resources Management/Personnel Administration, General
Columbus State Community College
01.2005
Independence High School
01.1995
East High School
01.1993
Skills
- Patient Care Coordination
- HIPAA Compliance
- Claims Processing
- Microsoft Office
- Calm and Effective Under Pressure
- Caring and Empathetic
- Verbal and Written Communication
- Documenting and Recording Information
- Decision Making
- Database Management
- Insurance Claims Review
- Attention to Detail
- Claims Investigation
- Policy Knowledge
Timeline
Patient Care Coordinator
Quantum Health
07.2021 - 07.2023
Customer Claims Representative
VSP Vision Care
07.2017 - 05.2020
Customer Solutions Specialist
IGS Energy
05.2012 - 07.2016
Collections Representative
Discover Financial Services
03.2012 - 07.2016
Claims Representative
Tailored Management/BWC
03.2007 - 01.2009
Human Resources Management/Personnel Administration, General
Columbus State Community College
Independence High School
East High School