Latisha Gray
Houston,TX
Summary
Detail-oriented and driven Healthcare Quality Analyst with 5 years of progressive experience ensuring the accuracy and compliance of medical exam documentation. Known for a strong commitment to quality, exceptional attention to detail, and effective collaboration with healthcare professionals to resolve documentation discrepancies. Consistently exceeds performance targets and now seeking to leverage expertise and leadership potential in a more advanced quality or compliance role.
Overview
14
14
years of professional experience
Work History
Quality Control Analyst
Maximus
Houston, Texas
01.2021 - Current
- Review MDE (Medical Disability Examination) requests for consistency with the DBQ.
- Review MDE reports and DBQs (Disability Benefits Questionnaires) for completeness and typographical and grammatical correctness.
- Communicate with medical providers and facilitate any necessary corrections to MDE reports and DBQs prior to submission to the VA.
- Verify that any special requests or necessary second reviews have been completed, consistent with the VA’s preferences.
- Ensure that all diagnostics requested by the medical provider have been completed, reviewed by the medical provider, and are submitted with the final report.
- Perform daily queue maintenance to ensure that every case assigned has updated notes and any needed action has been taken.
- Communicate with the Medical Advisory Board on cases that need additional review, may be outside the scope of the assigned medical provider’s training or expertise, or has presented a problem/issue with the assigned medical provider.
- Consistently achieve weekly/monthly qualitative and quantitative goals set by management and VA.
Patient Service Representative (Patient Billing)
Acclara Solutions, LLC
Houston, Texas
05.2016 - 09.2018
- Answers questions and resolves issues based on phone calls, emails, internet inquiries from patients, clients and others while maintaining consistent quality.
- Third party hospital and physician billing for TriHealth facilities.
- Provide problem resolution by effectively communicating with other departments and the patient or facility.
- Receive, distribute and/or own tasks including resolution and appropriate customer support.
- Effectively document and track contacts with patients, clients and vendors.
- Ensure all interactions with patients (both internal and external) are professional and courteous.
- Escalate appropriate referrals, complaints, grievance and appeals according to client requirements.
- Educate participants, clients and others on self-service options.
- Assist in preparation of daily, weekly or monthly reports.
- Update insurance information to reflect current status and rebill.
- Completes tasks, generates letters and files associated paperwork.
- Effectively interact with all team members for purpose of resolving participants' or clients' needs.
Pharmacy Technician / Prior Authorization Representative
Xerox Healthcare
Houston, Texas
10.2015 - 05.2016
- Obtain and enter demographic, clinical, financial information into our computer database
- Work at least 50- 70 accounts claims from Callback Queue or faxes
- Carry out insurance verification, consent and notification
- Answer Multiple Line Phones (Very High Volume)
- Posting Payments to the Correct Patient Accounts
- Creating Appeal Templates to appeal claims to Insurance Agencies
- Coding Claims using rejected pharmacy codes
- Interacting with members and MDO’s to ensure claim approval
- Retrieving Medical Records through database (MedHok & RxClaim)
Administrative Assistant / Patient Care Assistant
Royal Healthcare
Houston, Texas
08.2011 - 07.2015
- Highly skilled in greeting customers and answering high volume phone calls.
- Comprehensive Knowledge of patient care charts and patient histories
- Well versed in typing and filing of documents
- Substantial knowledge of medical insurance plans
- Proven ability to maintain self-control when dealing with harsh patients or situations
- Open and distribute incoming regular and electronic mail and other material and co-ordinate the flow of information internally and with other departments and organizations
Medical Administrative Assistant / Insurance Billing and Coding / Data Entry
Healthcare Business Connection
Houston, Texas
11.2013 - 05.2014
- Code records by following prescribed coding standards such as ICD-9 and CPT
- Review physician notes and obtain necessary clarifications where necessary
- Ensure signatures on all medical records
- Assign appropriate medical codes to all diagnosis and services
- Prepare appropriate claim documents
- Posting payments to the correct members account
- Follow up with insurance companies and ensure that all claims come to fruition
Education
Bachelor Of Health Science - Health and Medical Sciences
University of Phoenix
Tempe, AZHealthcare Administration -
Pima Medical Institute
04.2014
High School Diploma -
The Leaders Academy
06.2011
Skills
- MDEO (medical disability examination office) vendor experience
- Experience conducting reviews of medical exam documentation in accordance with established medical and legal requirements
- Understanding of Medical Terminology
- Medical Benefit experience
- Computer Billing Systems
- Insurance Verification
- Claims Process/Medisoft
- Interpersonal Skills
- Medical Terminology & Human Anatomy
- Microsoft Office Proficient
- Excellent knowledge of EMR/EHR
Timeline
Quality Control Analyst
Maximus
01.2021 - Current
Patient Service Representative (Patient Billing)
Acclara Solutions, LLC
05.2016 - 09.2018
Pharmacy Technician / Prior Authorization Representative
Xerox Healthcare
10.2015 - 05.2016
Medical Administrative Assistant / Insurance Billing and Coding / Data Entry
Healthcare Business Connection
11.2013 - 05.2014
Administrative Assistant / Patient Care Assistant
Royal Healthcare
08.2011 - 07.2015
Healthcare Administration -
Pima Medical Institute
High School Diploma -
The Leaders Academy
Bachelor Of Health Science - Health and Medical Sciences
University of Phoenix