LATONIA JETER
Columbia,SC
Summary
I'm highly motivated, with a desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively, unsupervised, and as a team. Proficient, with the capability to simultaneously complete work tasks. I can provide specialized clerical duties while delivering exceptional customer service, and decision-making skills. Also skilled in oral and written communication, team leadership, and relationship-building. Strong understanding of regulations, laws, and policies related to public assistance programs, such as Medicaid and Medicare.
Overview
8
8
years of professional experience
Work History
Eligibility Caseworker
TEK Systems Global Services
, SC
08.2022 - Current
- Managed intake of new claims and performed routine follow-ups.
- Interpreted policy changes from state and federal agencies as they relate to program eligibility criteria.
- Processed reviews and applications in a timely manner, while ensuring accuracy and production requirements.
- Granted, modified, denied, or terminated assistance based on key information and eligibility determination.
- Collaborated with other departments within the organization to ensure accurate processing of applications.
Patient Service/Administrative Assistance
Palmetto Infusion Services
Columbia, SC
04.2021 - 05.2022
- Communicate with physician offices to obtain and attach referrals and authorizations to patient appointments.
- Communicated with insurance companies to determine coverage, complete eligibility verification, and identify discrepancies preventing patient appointments.
- Organized files, developed spreadsheets, faxed reports, and scanned documents to patients' accounts.
- Processed and maintained patient authorizations for services rendered.
- Monitored the status of all pending authorizations and updated records accordingly.
Claim Appeals Analyst
Exela Technologies
Columbia, SC
11.2019 - 02.2021
- Resolved coding discrepancies and denials to maximize reimbursement.
- Analyzes hospital and provider claims to identify contractual underpayments, or billing errors.
- Validated accuracy of diagnosis codes as well as modifiers used on claims before final submission to payer and insurance companies.
- Reviewed appeals submitted by patients and providers to ensure accuracy and compliance with policies.
- Inputted data into the system, maintaining accuracy of provider coding information and reported services.
Patient Account Specialist
Receivable Solutions
Columbia, SC
06.2017 - 11.2019
- Accessed patient information through various software applications, maintaining strict confidentiality to remain compliant with HIPAA regulations.
- Processed refunds, disbursements, and payments according to the company's reimbursement policies.
- Conducted research on customer accounts to identify any outstanding balances or issues that need resolution.
- Collaborated with relevant parties to resolve billing issues, insurance claims, and patient payments.
- Assessed billing statements for correct diagnostic codes and identified problems with coding.
Education
South University
Columbia, SC01.2016
South Carolina State University
Orangeburg, SC01.2009
HS Diploma -
Lower Richland High School
Hopkins, SC01.2007
Skills
- Attention to detail and the ability to multitask
- Proven analytical skills for interpreting data
- Medical terminology
- Healthcare Common Procedure Coding System HCPCS, CPT
- Eligibility determination
- Claims Processing and Case Management
- Knowledgeable in CMS, Epic, Citrix, Cerner, Facets, and MMIS CRM, and PCS (person composite system)
- Microsoft office (Word, Excel, Powerpoint)
Timeline
Eligibility Caseworker
TEK Systems Global Services
08.2022 - Current
Patient Service/Administrative Assistance
Palmetto Infusion Services
04.2021 - 05.2022
Claim Appeals Analyst
Exela Technologies
11.2019 - 02.2021
Patient Account Specialist
Receivable Solutions
06.2017 - 11.2019
South University
South Carolina State University
HS Diploma -
Lower Richland High School
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