Latisha Wilder
Midland City
Summary
Dedicated professional with 8 years of experience in claim service and health plan operations, seeking a Claims Benefit Specialist role. Proficient in ensuring timely resolution and high customer satisfaction; adept at claim payment processes and Medicaid/Medicare coordination. Excelled in claim data accuracy and effective communication across multiple customer service positions.
Overview
7
7
years of professional experience
Work History
Claims Rep I
Elevance Health
03.2023 - Current
- Review and process incoming claim referrals, ensuring document completeness and legibility, and collaborate with relevant parties to obtain additional information when necessary
- Accurately examine, interpret, and enter claims data, resolving first and second-level processing issues and system edits
- Apply expertise in Medicaid/Medicare reimbursement, coordination of benefits, and explanation of benefits interpretation to facilitate medical claims adjudication and customer service
Service Center Representative
Sedgwick
08.2021 - 01.2023
- Provided comprehensive guidance to customers on claim documentation, processing timelines, and payment details, ensuring clarity and understanding of procedures
- Acted as a key contact for inbound communication, addressing inquiries and resolving issues in accordance with client protocols and service standards
- Documented interactions with claimants effectively, educating them on specific client requirements and benefit plans to facilitate informed decisions
- Efficiently routed new claims to suitable handlers and escalated complex issues to specialists or management, maintaining high levels of customer service
Business Office Representative
Memorial Health Systems
09.2020 - 05.2021
- Managed patient admissions processes, including insurance verification, co-payment collection, and demographic information entry, ensuring accuracy for clean claim billing
- Conducted quality assurance checks on patient data to support efficient billing operations and minimize errors
- Handled patient inquiries via telephone, resolving account issues and providing clear communication regarding billing and coding practices
Admitting Clerk
Merit Health Biloxi
03.2020 - 10.2020
- Coordinated the admission, processing, and discharge of patients, ensuring efficient handling of paperwork and bed-tracking for ED operations
- Managed switchboard operations and patient inquiries, providing information and transferring calls to appropriate departments, while maintaining patient confidentiality
- Facilitated patient registration, verified insurance coverage, and handled financial transactions, including collection of co-pays for various hospital services
Medical Receptionist
Merit Health
11.2019 - 03.2020
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Checked patient insurance, demographic, and health history to keep information current.
- Helped patients complete necessary medical forms and documentation.
- Maintained strict confidentiality of patients information, adhering to HIPAA regulations and medical office policies.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Managed high call volumes, directing calls to appropriate departments while maintaining a polite and professional demeanor.
- Managed multi-line phone system and pleasantly greeted patients.
- Provided compassionate customer service, creating a welcoming atmosphere for patients and their families.
- Maintained current and accurate medical records for patients.
- Assisted healthcare providers with administrative tasks, enabling them to focus on quality patient care.
- Developed strong relationships with patients, fostering loyalty and trust in the practice''s services.
- Enhanced patient satisfaction by efficiently managing the front desk operations and addressing inquiries in a timely manner.
- Contributed to a positive work environment by collaborating effectively with colleagues and supporting team initiatives.
- Ensured accurate record-keeping by diligently updating patient information and verifying insurance coverage.
- Transcribed phone messages and relayed to appropriate personnel.
- Kept waiting room neat and organized by stacking magazines, removing trash, and cleaning glass.
- Streamlined appointment scheduling for improved patient flow and reduced wait times.
- Coordinated specialist referrals for patients requiring additional care, facilitating efficient transfer of medical records as needed.
- Supported office staff and operational requirements with administrative tasks.
- Handled billing procedures accurately, ensuring prompt payment from both patients and insurance providers.
- Organized essential medical documents, streamlining access to vital information for healthcare providers during appointments.
- Reduced no-shows by implementing appointment reminder system through phone calls or text messages.
- Facilitated effective communication between patients, medical staff, and insurance companies to ensure seamless coordination of care.
Patient Service Representative
Flowers Hospital
03.2019 - 10.2019
- Managed patient information with strict adherence to HIPAA regulations, ensuring confidentiality and integrity of sensitive data during registration and records maintenance
- Addressed and resolved patient inquiries with professionalism, providing clear communication and enhancing customer service satisfaction
- Verified insurance coverage and policy constraints using online eligibility systems, optimizing the accuracy of patient scheduling and registration processes
Patient Access Specialist
Tallahassee Memorial Hospital
12.2017 - 03.2019
- Ensured accuracy in patient data collection, verifying demographics and insurance details, and efficiently managed pre-admission, admission, transfer, and discharge procedures
- Conducted patient registration for Emergency Room visits, assessed insurance eligibility for services, and facilitated the collection of co-payments and outstanding balances
Education
High School Diploma - undefined
Pine Forest High
Pensacola, FL06.2011
Skills
- CPT Coding
- Insurance Verification
- Scheduling
- Collection Management
- Medical Terminology
- Billing/Collection Management
- Customer Relations
- Proficiency With EHR, Cerner, Athena, Star, Macess, Facets Programs
- Proficiency in Computer Skills: Word, Excel,10-Key by Touch, Basic English and Mathematical Skills
- Typing35 WPM
- Call Center Operations
- Customer Service Experience
- Medical Records
- Good Stress Tolerance/High-Energy Attitude
- Adjudication
- Coverage Determination
- System Navigation
- Cost Management
- Decision Making
Timeline
Claims Rep I
Elevance Health
03.2023 - Current
Service Center Representative
Sedgwick
08.2021 - 01.2023
Business Office Representative
Memorial Health Systems
09.2020 - 05.2021
Admitting Clerk
Merit Health Biloxi
03.2020 - 10.2020
Medical Receptionist
Merit Health
11.2019 - 03.2020
Patient Service Representative
Flowers Hospital
03.2019 - 10.2019
Patient Access Specialist
Tallahassee Memorial Hospital
12.2017 - 03.2019
High School Diploma - undefined
Pine Forest High
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