Lataynga Kennedy

Appeals

Denials

Claim Corrections

Insurance Payer Web Portal Search

Adding Room/Bed Charges

Answering incoming calls from Insurance Companies

Monitor incoming emails/Fax for Auth and/or Denials

Availity.com Web Portal for Appeals

Upload Clinicals to all Payor Web Portals

Complete Task sent by Revenue Cycle Personnel

Place outbound phone calls to insurance companies in regards to Auth, denials, EOB, and Appeals.

Mail and or Fax Second level Appeals and Reconsiderations

Work closely with Utilization Management

A

• Managed Rejected claims for Medicare Advantage Plans. Placed Appeals on Availity and UHC web portals. Filed Corrected Claims using 1500 forms. Understanding EOB's helped me to complete assigned tasks sent via work ques.
• Bucket List with rejected and denied claims
• Workers Compensation Claims Specialist
• Medicare/Medicaid Write Offs
• Sending corrected claims re EOB reasonings
• Advised Physicians when more details clinicals are needed for an appeal or a reconsideration
• Upgraded or downgraded charges depending on the P2P outcome

• Timely follow-ups for all Workers Compensation and No Fault billing and collection, claim denials, and claim appeals. Thorough reviewing of charts and correspondence to determine the merits of the case. Draft written responses to address any collections issues Assertive negotiate settlements on the phone and intelligent negotiation skills Work Comp Appeals Board Experience Retrieve authorizations/referrals from insurance companies Handle ALL aspects of billing: charge entry, payments, A/R management. Support to all staffing locations and providers as needed working as an intermediary between our patients and their workers compensation carriers. Prioritize daily tasks while working independently in a fast paced environment. Perform additional duties as requested by Supervisory or Management team.

• Workers Compensation Specialist
• Informed injured workers of all treatment options.
• Coordinated claims case management with physicians and other health care professionals.
• Identified cases in need of medical management.
• Identified cases requiring workplace surveillance.
• Evaluated injured employees’ compliance with prescribed physical therapy regimens.
• Responsible for hospital and physician billing. The duties include working with payers to resolve issues and facilitate prompt payment of claims. Thorough knowledge and understanding of patient billing and claims submission
• Provided Injured Workers with referrals, completed mileage forms, arranged appointments with the Employer and the Nurse Case Manager
• Set up surveillance if and when injury was in question.
• Analyzed and evaluated existing compensation and benefits programs and recommended improvements.
• Researched and analyzed wage, salary and other industry trends.
• Created detailed job description library for organization and maintained relevance with regular updates..
• Resolved problems, improved operations and provided exceptional service.

• Responsible for providing Work Compensation & Customer Support. Answer switchboard, Retail &, schedule appointments (Medisys)
• Prepare, file and maintain charts. Place cold calls and outbound call regarding collections. Call center intake.
• Verify all insurance. Collect co-pays, surgery payments, and deductibles. Placed ICD-10 codes on Medical Records in order to bill the 1500 forms to the correct insurance company for payment.
• Pre-certification of CT scans and surgeries. Medical Billing and Coding were also part of my job duties.
• Request insurance referrals and all paperwork related.
• Request x-rays, labs and medical records.
• Responsible for referral letters and dictation notes.
• Responsible for call reminders and mail distribution.
• Software uses: Restate, Optum, & Script Care.

• Duties included translation of doctors, therapist, nurses and case management services into service codes. Key service codes into computer for each patient who has been seen for the day.
• This position requires that I pay close attention to details and work at a swift pace. Sales, Retail & Customer Support
• Medical Records Clerk
• Duties included checking out records to doctors, therapists, nurses, case managers and other facilities
• Pulling records for appointments for the next day, putting appointments into computer, answer phone
• Locate records if it's not on the shelf, put all records in numerical order on shelf, and repair broken chart
• File all paper work in records, make new records, and organize record room. Make sure all records was returned to record room by the end of the day.

• Recorded names, addresses, purchases, and reactions of prospects contacted. Collection and payment arrangements were my top priority.
• Contacted businesses or private individuals by telephone to solicit sales for goods or services.
• Explained products or services and prices, and answer questions from customers.
• Obtained customer information such as name, address, and payment method, and enter orders into computers.

• Responsible for ensuring the delivery of outstanding customer service in scheduling patient clinical services and necessary pre-registration requirements which include obtaining complete and accurate patient demographics, benefits eligibility, pre-certification approvals from insurance companies and physicians offices, identifying insurance and/or patient responsibility. Responsible for capturing and documenting all pertinent patient, subscriber, and insurance information. Responsible for securing authorizations. Working knowledge of PHI and HIPPA.