Latanya Grooms
Sun City Center,FL
Summary
Dynamic professional with extensive experience at Care Plus, excelling in medical claims management and customer service excellence. Proven track record in dispute resolution and appeals, enhancing operational efficiency. Adept at using Microsoft Office suite and demonstrating exceptional organizational skills. Successfully processed over 250 invoices daily, ensuring accuracy and attention to detail.
Overview
18
18
years of professional experience
1
1
Certification
Work History
A/R and A/P Billing Specialist
Florida Digestive Health Specialists
Bradenton, FL
08.2023 - 07.2024
- Review and reprocess denied claims.
- Collect payments from customers.
- Invoice processing and verifying discrepancies.
- Work alongside each office department.
- Administrator with making sure the doctors get paid.
Accounting Specialist/Sr. Claim Processing Representative
Care Plus
Tampa, FL
09.2011 - 08.2023
- Medical Claims Processing, billing, and provider customer services experience.
- Proficiency in all Microsoft Office-Basic understanding using Word, Excel, and Outlook
- Determines whether to return, deny, or pay claims following organizational policies and procedures and decisions typically focus on interpretation of area/department policy and methods for completing assignments.
- Processed 250+ invoices daily.
- Indexing to verify information within the invoices provided to send into the processing queue.
- Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing and works under minimal direction.
- Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.
Quality, Intake, Client Services, Medical Claims Specialist
Care Centrix
Tampa, FL
09.2011 - 02.2022
- Lead and coordinate companywide efforts to streamline quality practices, improve operational efficiency and provide ongoing training and education.
- Participated in various QI committees and work groups convened to improve process and/or health.
- Outcomes, and contributes meaningful detail, based on functional knowledge.
- Confer with members, providers, MD offices and hospitals by telephone to provide information about products and services, insurance verification and obtain details of complaints.
- Provide accurate information in response to customer inquiries, troubleshoot issues and resolve complaints. Guide customer service representatives in decision making, when necessary, to best accommodate customers. Successfully implemented call center support for all markets through site visits and delivery of comprehensive training.
- Successfully meeting all employee performance requirements across all business units. Work with management to ensure appropriate changes are made to improve customer satisfaction.
- Medical Claims Processing, billing, and provider customer services experience. Proficiency in all Microsoft Office-Basic understanding using Word, Excel, and Outlook
- Perform companion calls to develop and train customer service representatives.
Client Care Advisor
Vangent/Medicare
04.2009 - 06.2010
- Lead in the development of new and improved program processes including developing new help guides for Medicare beneficiaries and support documents for project officers that aid in more efficient workflow and coordination across the agency.
- Work with internal departments and management if necessary to ensure client priorities are understood, and resources are executing on commitments.
- Assists in developing business and staffing plans and is ultimately responsible for the success of all departmental projects.
- Successfully developed and analyzed performance metrics data every quarter and produces written reports to measure and monitor the progress of strategic plan project goals.
- Coordinated with the Quality department to design and implement a Coaching Workshop for all account supervisors.
Customer Service Representative
Medco
06.2006 - 05.2008
- Work with both patients and physicians to coordinate Medical plans and medications coordination.
- Own the patient experience through resolving customer issues and ensuring 100% follow-up to customers.
- Accurately obtain and enter patient information, including shipping, insurance, and payment information.
- Escalate complex claims to the Sr. Billing & Reimbursement Specialists for appropriate action.
- Directly responsible for processing mail orders, inventory, and monitoring of prescription drug delivery status
- Provide all clerical support for payments, filing, audits, emails and special requests.
Education
Associate of Science - Criminal Justice
Springfield College
Springfield, MASkills
- Medical claims management
- Dispute resolution and appeals
- Customer service excellence
- Quality assurance
- Microsoft Windows proficiency
- Purchase order processing
- Microsoft Office suite
- Medical terminology expertise
- Organizational skills
- Time management strategies
- Accounting software proficiency
- Invoice processing accuracy
- Attention to detail
Certification
Paralegal Certificate
Timeline
A/R and A/P Billing Specialist
Florida Digestive Health Specialists
08.2023 - 07.2024
Accounting Specialist/Sr. Claim Processing Representative
Care Plus
09.2011 - 08.2023
Quality, Intake, Client Services, Medical Claims Specialist
Care Centrix
09.2011 - 02.2022
Client Care Advisor
Vangent/Medicare
04.2009 - 06.2010
Customer Service Representative
Medco
06.2006 - 05.2008
Associate of Science - Criminal Justice
Springfield College
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