Lashea Green
Florence,SC
Summary
Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease. Gifted in working with stressed, confused and upset individuals in need of benefits information and supportive guidance to navigate different systems. Effective at operating within health regulations and any department guidelines to manage telephone calls, emails, letters and in-person requests for assistance. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Appeals Specialist
BlueCross BlueShield
05.2023 - Current
- Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy
- Prepares unit reports, analyzes and interprets workload, and processes issues utilizing various software tools
- Updates letters and documents within the department when necessary
- May gather and prepare documentation for legal inquiries and administrative requests.
- Collaborated with cross-functional teams to gather necessary documentation and evidence to support the appeals process.
- Managed high-stress situations with professionalism, ensuring that appeals were handled promptly and accurately even under tight deadlines or heavy caseloads.
- Expedited resolution times for appeals cases by efficiently managing workload and prioritizing urgent matters.
- Improved the appeals success rate by researching legal precedents and staying up-to-date with current industry regulations and guidelines.
Customer Service Representative
Synchrony
09.2022 - 05.2023
- Handled inbound calls from cardholders
- Provided exceptional customer service
- Maintained up-to-date customer information
- Resolved inquires and authorized sales.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Responded to customer requests for products, services, and company information.
- Processed customer service orders promptly to increase customer satisfaction.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
Billing Account Representative
Mcleod Health
05.2022 - 09.2022
- Maintains a professional image and exhibits excellent customer relations to patients, visitors, physicians, and co-workers
- Responsible for efficient and effective follow-up on third party payers to determine why payment has not been received within a specified amount of time
- Reviews and interprets payer remittances for the purpose of verifying accuracy of payments, adjustments and to determine appropriate action to be taken on denied claims, per guidelines
- Initiates appeals for denied claims per payer guidelines
- Reviews patient account files as necessary for accuracy of information, necessary signatures, pre-certification, insurance benefits, and deposits made
- Submit electronic and hard copy claims in an accurate and timely manner and makes all necessary corrections to the claims that do not pass the billing edits and payer requirements
- Contact payers for status of unpaid claims and research to ensure that questions and requests for information are addressed in a timely and professional manner to facilitate resolution and reimbursement
- Assure timely, effective, and thorough management of claims to ensure full, expected reimbursement for services provided
- Reviews and resolves credit balances in an accurate and timely manner according to policy
- Obtain patient payments and/or set up payment plans according to policy and document any payment arrangements on patient account
- Prepares accounts with outstanding balances for the collection agency
- Understands and complies with processes for corrected claims, per payer guidelines
- Maintains knowledge of payor guidelines for assigned specialties
- Prioritize claims based on aging and outstanding dollar amounts or as directed by management
- Answer telephone calls from patients and other callers promptly and with courtesy, demonstrating service excellence as a top priority
- Communicates payer trends or problems identified as impacting reimbursement to the management team
- Manage their time to meet collection goals and productivity standards as defined by the management team
- Participates in quarterly AR meetings with the assigned Medical Practices and educational sessions
- Ability to look up ICD-10 and CPT Treatment codes from online service or using traditional coding reference
- Regularly meets with the Billing Manager to discuss and resolve reimbursement issues or billing obstacles
- Demonstrates the ability to work independently and prioritize a heavy workload in a fast-paced environment
- Strong emotional maturity
- Strong time management, organizational and written/verbal communication skills
- Must have strong problem solving, attention to detail and accuracy skills
- Proficiency in Microsoft Word, Outlook, and Excel
- Proficiency in Math and Medical Terminology
- Ability to maintain highly sensitive and confidential information.
- Increased rate of successful collections through proactive follow-up on overdue accounts and negotiation of payment arrangements.
- Enhanced client relationships through timely and accurate invoice generation and payment tracking.
- Maintained comprehensive records of transactions, facilitating easy access to information during audits or review periods.
Community Manager
Intermark Management Corporation
06.2021 - 02.2022
- Managed all aspects of assigned properties- 2 LIHTC properties (98 units total)
- Designed business plans for assigned properties that suits resident’s needs
- Inspected and arranged maintenance to meet standards
- Maintained a positive and productive relationship with tenants
- Negotiated lease/contracts with contractors in a timely and reliable manner
- Advertised and marketed vacant units to attract prospective tenants
- Collected receivable accounts and handled operating expenses
- Developed and managed annual budgets by forecasting requirements and analyzing variances, data, and trends
- Accomplished financial goals and reported periodically on financial performance
- Built relationships with prospective clients to expand business opportunities.
Claims Processor 1
BlueCross BlueShield
03.2020 - 06.2021
- Processed denials of claims
- Processed adjustment claims for both pre and post pay departments
- Investigated and analyzed adjustment claim history and denial records
- Prescreened records for review and maintain accurate records of all claims
- Performed quality control of work processes
- Assisted manager with special projects.
Case Manager Assistant
Optimal
05.2018 - 06.2020
- Coordinated patient care by linking patients with doctors, and nurses, patient transfer officers, and community care provider to match the patients’ needs with professionals who can meet them
- Keyed details of patient’s medical and treatment status into digital spreadsheets and databases as well as associating relevant documents with those records by scanning them
- Communicated with payers such as health care providers to ensure what services to pay for and that all required documentation is necessary to release funds
- Interacted with patients and their families to keep them aware of their treatment status and next steps
- Ensured understanding of CPT and ICD codes for treatments and symptoms.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
Technical Information Specialist
BlueCross BlueShield
07.2019 - 03.2020
- Processed ingoing/outgoing mail and prepares work for nursing staff
- Troubleshot claims prior to nurse review and after review
- Processed denials of claims
- Processed adjustment claims for both pre-pay and post-pay departments
- Investigated and analyzed adjustment claim history and denial records
- Prescreened records for review and maintains accurate records of all claims
- Used database to research, gather, analyze and present data.
- Organized information by studying, analyzing, interpreting and classifying data.
- Communicated with provider community and assisted provider service department in responding to inquiries
- Performed quality control of work processes
- Assisted manager with special projects.
Customer Service Representative
Assurant
06.2018 - 07.2019
- Handled in-bound calls from our customers by researching and resolving loan level inquiries in hazard insurance, mortgage banking and property loss
- Listened to our customer’s concerns and showed empathy while resolving their issue
- Took the initiative to truly understand our customers current challenges, solve them, and use your expertise to proactively help them avoid future challenges
- Participated in special projects, assume new responsibilities, and adjust priorities as requested.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Responded to customer requests for products, services, and company information.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
AR Reimbursement Counselor (Benefit Verification Specialist)
Lash group/Talent Bridge Agency
10.2017 - 12.2017
- Collected and reviewed all patient insurance information needed to complete the benefit verification process
- Verified patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/ provider options according to Program Specific SOPs
- Utilized the verification process that include electronic validation of pharmacy coverage and medical eligibility
- Identified any restriction and details on how to expedite patient access
- Documented and initiated prior authorization process, and claims appeals
- Completed quality review of work as part of finalizing product
- Reported any reimbursement trends/delays to supervisor
- Performed related duties and special projects assigned.
HR Service Representative/Benefit Advisor/Lowes
Randstad
09.2017 - 10.2017
- Handled a high volume of inbound calls from our client’s employees as well as conduct outbound calls for follow up as required
- Greeted the employees, answered concerns and questions, educated them, and solved complex issues relating to their health care benefits, 401k savings, life benefits, retirement plans, leave of absence, payroll, and human resource related services
- Utilized interpersonal skills and extensive on-the-job training that provided professional, knowledgeable, helpful, courteous, and responsive customer service
- Accessed customer accounts and product information, by toggling between multiple screens and systems, that provided accurate answers and support within the parameters of Alight Solutions policies and procedures
- Created and updated employee files in database, as authorized.
Customer Service Representative
Synchrony Financial
05.2017 - 09.2017
- Handled inbound calls from cardholders
- Provided exceptional customer service
- Maintained up-to-date customer information
- Resolved inquires and authorizes sales.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Responded to customer requests for products, services, and company information.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
HR Service Representative/Benefit Advisor/Target
Randstad
01.2017 - 04.2017
- Handled a high volume of inbound calls from our client’s employees as well as conduct outbound calls for follow up as required
- Greeted the employees, answered concerns and questions, educated them, and solved complex issues relating to their health care benefits, 401k savings, life benefits, retirement plans, leave of absence, payroll, and human resource related services
- Utilized interpersonal skills and extensive on-the-job training that provided professional, knowledgeable, helpful, courteous, and responsive customer service
- Accessed customer accounts and product information, by toggling between multiple screens and systems, that provided accurate answers and support within the parameters of Alight Solutions policies and procedures
- Created and updated employee files in database, as authorized
- Stayed current on Alight's programs and services through an on-going training provided by Alight Solutions.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
Processing Specialist
Assurant Solutions
03.2015 - 01.2017
- Processed documents in an accurate and timely manner that ensured proper insurance coverage for homeowners and to meet or exceed the client satisfaction goals
- Identified policy type and determined appropriate action needed (PUD, Townhomes, Flood, Wind, etc.)
- Made appropriate updates to client database to meet regulatory obligations
- Made timely premium payments from established escrow accounts to ensure continuous coverage
- Exhibited strong time management to handle multiple demands and competing priorities
- Met deadlines and quality standards with a sense of urgency
- Communicated and coordinated with insurance agents and/or insurance carriers to verify information, update status and meet deadlines/requirements
- Addressed any questions, concerns, or suggestions in a timely and professional manner
- Built and maintained effective internal working relationships and supported team members in meeting company goals
- Developed an expert level understanding of how the Processing Specialist role fit into the larger organizational context
- Communicated status updates and appropriately escalated issues and opportunities to meet the needs of clients and homeowners.
Claims Processor I
Blue Cross Blue Shield
03.2013 - 03.2015
- Examined and processed complex or specialty claims according to business/contract regulations, internal standards and examining guidelines
- Entered claims into the claim system after verification of correct coding of procedures and diagnosis codes
- Verified that claim have been keyed correctly
- Ensured that claims are processing according to established quality and production standards
- Corrected processing errors by reprocessing, adjusting, and/or recouping claims
- Researched and resolved claims edits and deferrals
- Performed research on claim problem by utilizing policies, procedures, reference materials, forms, and coordinates with various internal support areas
- Processed claims in a timely and accurate manner while delivering a high level of customer service
- Exhibited strong verbal communication skills in a telephonic environment
- Worked well independently and managed multiple tasks with minimal supervision
- Ensured understanding and executed claims workflow
- Adjudicated and escalated issues as appropriate
- Secured ADP II/Security Clearance through the Department of Health.
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
Education
No Degree - Healthcare Administration
Limestone College
Gaffney, SCSkills
- HIPAA Compliance Knowledge
- Professionalism and Ethics
- Continuous learning mindset
- Organizational abilities
- Medical Terminology Familiarity
- Strong analytical skills
- Data entry proficiency
- Negotiation Techniques
- Medical coding knowledge
- Documentation expertise
- Appeals Process Proficiency
- Healthcare Regulations Expertise
- Insurance Policies Understanding
- Teamwork and Collaboration
- Problem-Solving
- Time Management
- Attention to Detail
- Problem-solving abilities
- Multitasking
- Reliability
- Critical Thinking
- Excellent Communication
- Active Listening
- Team Collaboration
- Effective Communication
- Decision-Making
- Claims Processing
- Adaptability and Flexibility
- Microsoft Office
- Relationship Building
- Team building
- Documentation skills
- Data Entry
- Medical Terminology
- Interpersonal Skills
- Analytical Thinking
- Goal Setting
- Professionalism
- Insurance Coverage Verification
Certification
- Medical billing and coding Training - April 2018-October 2018
- Property Management Training - July 2021
Timeline
Appeals Specialist
BlueCross BlueShield
05.2023 - Current
Customer Service Representative
Synchrony
09.2022 - 05.2023
Billing Account Representative
Mcleod Health
05.2022 - 09.2022
Community Manager
Intermark Management Corporation
06.2021 - 02.2022
Claims Processor 1
BlueCross BlueShield
03.2020 - 06.2021
Technical Information Specialist
BlueCross BlueShield
07.2019 - 03.2020
Customer Service Representative
Assurant
06.2018 - 07.2019
Case Manager Assistant
Optimal
05.2018 - 06.2020
AR Reimbursement Counselor (Benefit Verification Specialist)
Lash group/Talent Bridge Agency
10.2017 - 12.2017
HR Service Representative/Benefit Advisor/Lowes
Randstad
09.2017 - 10.2017
Customer Service Representative
Synchrony Financial
05.2017 - 09.2017
HR Service Representative/Benefit Advisor/Target
Randstad
01.2017 - 04.2017
Processing Specialist
Assurant Solutions
03.2015 - 01.2017
Claims Processor I
Blue Cross Blue Shield
03.2013 - 03.2015
No Degree - Healthcare Administration
Limestone College