LaTanya Hughes
Elkridge,MD
Summary
Resourceful Claims Operations Specialist recognized for high productivity and efficient task completion. Skilled in claims processing, data analysis, and regulatory compliance, ensuring smooth operations within demanding environments. Excel in communication, problem-solving, and teamwork, utilizing these soft skills to navigate complex situations and deliver results. Strive for continuous improvement and innovation in handling claims operations with precision and professionalism.
Overview
23
23
years of professional experience
Work History
Claims Operations Specialist
MD State Treasure
Annapolis, MD
10.2023 - 12.2024
- Reviewed and processed incoming claims for accuracy, completeness, and compliance with established procedures.
- Maintained records of all activities related to the handling of a claim from initial filing through final resolution.
- Communicated verbally or via email with customers regarding their inquiries about pending claims status or required documentation needed for submission.
- Processed a high volume of incoming claims in accordance with established policies and procedures.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Utilized software applications such as Microsoft Office Suite to create spreadsheets or generate reports.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
Reimbursement Specialist
Maxim Health Services
Columbia, MD
12.2019 - 09.2021
- Reviewed and processed reimbursement requests in accordance with company policies and procedures.
- Analyzed patient data to ensure accuracy of reimbursement information.
- Performed monthly audits for accuracy of claims submitted for payment.
- Maintained a database of all reimbursements, payments, and other transactions.
- Responded to customer inquiries regarding the status of their reimbursement requests.
- Ensured compliance with applicable laws and regulations when processing reimbursement requests.
- Verified that all necessary documents were included in each request before submitting it for payment.
- Verified technical reimbursement questions for providers, billing and coding staff.
Wellness Processor
Maxim Health Services
Columbia, MD
09.2019 - 12.2019
- Inputted data into the system to ensure accuracy of information.
- Tracked all material movements through manual or automated tracking systems.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
Title Service Representative
MD Speedy Tag & Title
Glen Burnie, MD
04.2019 - 09.2019
- Greeted customers and answered inquiries in a professional manner.
- Processed payments via cash, check, or credit card transactions.
- Provided excellent customer service by addressing customer needs in a timely fashion.
- Assisted customers with purchases, returns, and exchanges of merchandise.
- Reviewed title documents and provided guidance on title related matters.
Billing Specialist
Ameritox
Columbia, MD
07.2009 - 05.2018
- Reviewed medical records to ensure accuracy of billing information and patient data.
- Calculated billing charges, prepared and submitted claims to insurance companies.
- Prepared itemized statements, bills, or invoices and recorded amounts due for items purchased or services rendered.
- Verified insurance coverage and identified third-party payers for billing purposes.
- Monitored accounts receivable activity to ensure timely payment of invoices.
- Answered customer inquiries regarding billings, payments, account status.
- Resolved discrepancies between customers' remittances and invoices received.
- Maintained accurate records of collections, adjustments and denials in the system.
- Investigated incorrect billings and processed refunds as necessary.
Billing Specialist
Advanced Radiology
Woodlawn, MD
10.2001 - 06.2009
- Reviewed medical records to ensure accuracy of billing information and patient data.
- Prepared itemized statements, bills, or invoices and recorded amounts due for items purchased or services rendered.
- Calculated billing charges, prepared and submitted claims to insurance companies.
- Verified insurance coverage and identified third-party payers for billing purposes.
- Monitored accounts receivable activity to ensure timely payment of invoices.
- Resolved discrepancies between customers' remittances and invoices received.
Education
High School Diploma -
Carver Vocational- Technical High School
Baltimore, MD06-1994
Skills
- Policy Interpretation
- Insurance knowledge
- Claims Management
- Microsoft Office
- Claims Processing
- Claims analysis
- Data Entry
- Customer Service
- Teamwork and Collaboration
Timeline
Claims Operations Specialist
MD State Treasure
10.2023 - 12.2024
Reimbursement Specialist
Maxim Health Services
12.2019 - 09.2021
Wellness Processor
Maxim Health Services
09.2019 - 12.2019
Title Service Representative
MD Speedy Tag & Title
04.2019 - 09.2019
Billing Specialist
Ameritox
07.2009 - 05.2018
Billing Specialist
Advanced Radiology
10.2001 - 06.2009
High School Diploma -
Carver Vocational- Technical High School
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