LaTisha Griffin
Chesapeake,Virginia
Overview
13
13
years of professional experience
Work History
cCOB Specialist II Payment Integrity Department
Elevance Health
01.2023 - Current
- As a cCOB Specialist II I am responsible for researching other coverages for all commercial company groups that we service and our member on multiple platforms
- I'm required to be fully proficient in all key areas needed
- I performed multi complex functions and interprets complex rules, laws and contracts
- I'm also required to follow the end-to-end functionality on every Coordination of Benefit request that I performed
- The functions included reconciliation of claims, memberships and accounting
- I utilized internal queries and internal resource tools to ensure I'm performing the proper duties
- I reach out to other commercial carriers, members, groups, providers and attorneys as needed to collect Coordination of Benefit (COB) information to make primacy on each case
- I use a variety of commercial portals to verify primacy and to Coordinate Benefits for claims to be paid correctly
- I make outbound calls as needed to verify information for Medicare, Medicaid or Commercial coverages
Pricing Support I
Elevance Health
01.2018 - 01.2023
- As a Pricing Support Analyst I, my daily responsibilities include reviewing claims and making reimbursement determinations to the pended claims within BCOS queue I have multiple markets assigned to me daily where I maintain reimbursement data for accurate processing of Medicaid/ Medicare claims
- I review the providers contracts to ensure the reimbursement agreement is assigned correctly
- I perform my work using FACETS and MACESS and WGS to process the claims
- I also, work service forms queues such as the Demographic Change, Roster Change and Awaiting Agreement Que
- I'm responsible for assigning the correct agreements and sending it back to my internal partners
- I create projects using JIRA and work NEXTGEN request
- I also process Medicare claims using WGS
- I run queries and reports to identify pricing scenarios
- I also attend weekly meetings to stay abreast of provider reimbursement activities for applicable markets
Network Data Specialist II (Provider Data Management)
Anthem
01.2014 - 01.2018
- As a Network Data Specialist II, it is my duty to synchronize data among multiple claims systems and application of business rules as they apply to each database
- It is also my duty to validate the data in the provider databases and ensure that it adheres to the business and system requirements of customers as it pertains to contracting, network management and credentialing
- I am also responsible for making sure information is accurate and received in a timely manner
- I provide maintenance for critical issues that may arrive with provider's accounts
- I research information on claims using the provider database so claims can be processed correctly
- I work from a variety of queues with daily assignments requesting to update the provider data
- Prioritizing my day is a key component in ensuring that I meet the deliverables in the queues
- Daily, I send emails and place phone calls to conduct research and to follow up with providers and internal customers
- I also take inbound calls from providers that I previously contacted as well as calls from internal customers following up on their requests
- I am comfortable navigating between several different systems such as Facets, MACESS, WGS and Microsoft Office Applications to assist me in doing my job more effectively
Claims Analyst II
Anthem
01.2012 - 01.2014
- I research and process all intermediate level claims transactions such as inpatient, outpatient, transplant, dialysis, and hospice claims on UB-04/ HCFA1500
- I process correspondence and customer service inquires as it relates to each claim transaction
- I review provider contracts and apply the correct fee schedules as it relates to the claim that is being processed
- I review explanation of benefits statements from other carriers to facilitate coordination of proper coverage
- I review process instructions as it relates to my specific market to ensure that claims are being process accurately
Education
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Old Dominion University
01.2002
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Virginia State University
01.2000
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Churchland High School
01.1999
Skills
- Microsoft Applications
- Microsoft Excel
- Microsoft Word
- Microsoft Access (Query)
- Microsoft PowerPoint
- Microsoft Teams
- JIRA
- PEGA
- WGS
- FACETS
- MACESS
Timeline
cCOB Specialist II Payment Integrity Department
Elevance Health
01.2023 - Current
Pricing Support I
Elevance Health
01.2018 - 01.2023
Network Data Specialist II (Provider Data Management)
Anthem
01.2014 - 01.2018
Claims Analyst II
Anthem
01.2012 - 01.2014
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Old Dominion University
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Virginia State University
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Churchland High School
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