La'Tone Jean
Buckeye,AZ
Summary
A motivated Corporate Professional with the drive to excel and grow within a strong organization. Self-motivated individual that works hard as a team player to achieve goals and beat expectations. Various experiences within the healthcare and banking and finance arenas have produced a well-rounded individual with the skills to quickly learn new processes and procedures.
Overview
10
10
years of professional experience
Work History
Product Success Associate (Remote)
Cedar
10.2021 - Current
- Working with the world's largest and most sophisticated Hospitals and Physician Staffing agencies addressing their reported concerns regarding issues within Cedar’s platform.
- Triaging the information provided to identify any patterns or potential issues that need addressing.
- Helping to trouble shoot potential bugs and escalating to various engineering teams by creating a JIRA.
- Provide our clients with timely and proactive updates on the progress towards resolution, ensuring that we deliver responsive customer service.
- Continually help to improve our processes by learning and sharing the best practices for strategy setting, idea capture, work prioritization.
- Proven ability to learn quickly and adapt to new situations,
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Managed time efficiently in order to complete all tasks within deadlines.
- Excellent communication skills, both verbal and written.
- Developed and maintained courteous and effective working relationships.
Prior Authorization Specialist (Remote)
CEDAR
01.2021 - 10.2021
- Processing prior authorization rules based on documented guidelines.
- Determining whether an prior authorization is complete with appropriate. billing/coding requirements and supporting documents.
- Transferring medical data from paper formats into computer files or database systems.
- Typing in data provided directly from customers.
- Verify data by comparing it to source documents.
- Update existing data.
- Retrieve data from the database or electronic files as requested.
- Organized and detail-oriented with a strong work ethic.
- Participated in team projects, demonstrating an ability to work. collaboratively and effectively.
Account Receivable Representative (Remote)
NThrive
11.2018 - 04.2020
- Contacts government or commercial healthcare insurance companies to follow up on outstanding accounts receivable.
- Identifies billing errors for correction and resubmits claims to insurance carriers.
- Follows up on payment errors, reimbursement, and denials.
- Reviews insurance EOBs and initiates appeals as necessary.
- Prints and mails UB04s or HCFA 1500s as necessary for account resolution.
- Remains up to date with all commercial and managed care pricing models, rules, and regulations.
- Remains up to date with all Medicare and Medicaid rules and regulations.
- Proven ability to develop and implement creative solutions to complex problems.
- Demonstrated a high level of initiative and creativity while tackling difficult tasks.
Account Receivable Representative II
Omnicare, CVS Health
10.2017 - 01.2018
- Supporting the billing/Revenue Qualification processes for facilities customers in client's database
- Support collection and reimbursement strategies and initiatives to improve operations and results
- Suggest changes to department policies and procedures as appropriate
- Drive for productivity goals, push for daily progress and achievement, and recommend measures for improvement
- Learn all billing systems and accurately respond to questions regarding client invoicing and adjustments while ensuring compliance
- Engage in training for new employees and provide ongoing training as needed Provide timely feedback to management
- Support reporting that addresses billing variances, denials, and payment discrepancies on a timely basis
Clinical Administrative Coordinator (Remote)
Optum, United Health Group
12.2016 - 09.2017
- Respond to incoming Provider calls enter notifications and Provider's status of existing notification and determine if notification is required
- Provide excellent Customer Service to Providers
- Constantly meet established productivity, schedule adherence, and quality standards. Hospital, Physician, or Medical/Clinical experience, Medicare and/or Medicaid experience, Coding (ICD-9 or CPT) experience, Healthcare/Insurance Benefits experience, High volume Call Center experience
- Professional experience in office settings using telephone and computer as primary instruments Professional experience in Clerical or Administrative role.
- Worked effectively in fast-paced environments.
- Self-motivated, with a strong sense of personal responsibility
Intake Coordinator
United Healthcare
05.2016 - 12.2016
- Performed initial Triage of Members, Administrative Intake of Members or managing Admission/Discharge information, post-notification, and working with hospitals and Clinical team.
- This function includes managing Incoming calls, managing requests for services from providers and providing information on available network services, transferring members, as appropriate, to Clinical staff.
- As an government contractor, this position required favorable adjudication following submission of The Department of Defense form SF85P.
- Resolve Customer Service inquiries which could include Entering notifications and Providers' status of an existing notification and determining if notification is required.
- ICD-9 and CPT Coding.
- Provide excellent Customer Service to both Providers and Enrollees Constantly meet established productivity, schedule adherence, and quality standards.
- Assist with faxes and emails.
Customer Care Representative
Humana
01.2013 - 01.2014
- Responding to questions, handling issues, and providing guidance to both internal and external customers over the phone in a fast-paced call center environment.
- Worked in Argus to adjudicate claims and override claims, worked to get Prior Authorizations for medications, talked to Doctors' offices and worked within internal processes to get approvals.
- Worked with PBM's and co-insurances to help members get the medication needed.
- Also worked with several drug companies to get members who had Medicare/Medicaid signed up with trials or with programs that offer discounts for new or existing medications
- Worked with refilling maintenance medications and setting up mail order accounts, talked with retail pharmacies to help them assist members and get there medication expedited and filled
- Used problem solving and keen analytical skills to resolve any issues rather financial or end of benefits for the month, year to ensure members received medication needed
- Receive, document, and resolve customer inquiries by using established best practices Educate customers, providers and employers about company products and service over the telephone.
Education
Certificate of Completion - Backend SQL, DevOps, Python
Nucamp
New York, NY05.2022
Certificate of Completion - Advanced Nursing
Joliet Junior College
Joliet, IL01.2001
High School Diploma -
Joliet West High School
Joliet, IL06.1998
Skills
- Medical Terminology
- ICD-10 Codes
- Medical records
- Medical Billing
- DME
- Financial Management
- Managed Care
- SQL
- PYTHON
- DEVOPS
- DJANGO
- EMR/ EHR Systems
- MS Office Suite
Timeline
Product Success Associate (Remote)
Cedar
10.2021 - Current
Prior Authorization Specialist (Remote)
CEDAR
01.2021 - 10.2021
Account Receivable Representative (Remote)
NThrive
11.2018 - 04.2020
Account Receivable Representative II
Omnicare, CVS Health
10.2017 - 01.2018
Clinical Administrative Coordinator (Remote)
Optum, United Health Group
12.2016 - 09.2017
Intake Coordinator
United Healthcare
05.2016 - 12.2016
Customer Care Representative
Humana
01.2013 - 01.2014
Certificate of Completion - Backend SQL, DevOps, Python
Nucamp
Certificate of Completion - Advanced Nursing
Joliet Junior College
High School Diploma -
Joliet West High School
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