LaTonya Gold
Kansas City,MO
Summary
Trustworthy professional offering a keen understanding of the latest insurance requirements for prior authorizations. Determined Prior Authorization Specialist boasting extensive claim researching and effective collaboration skills with other members of the office staff. Friendly Patient Scheduler with extensive knowledge of inpatient and outpatient scheduling. Committed to accurate records and efficient scheduling. Adept at multitasking, working quickly and assisting with office administration duties.
Overview
34
34
years of professional experience
1
1
Certification
Work History
Prior Authorization Specialist
Aetna Better Health of Kansas
11.2018 - 12.2024
- Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills
Billing/ Insurance Verification
Quest Diagnostics
03.2015 - 10.2018
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling
- Updated patient and insurance data and input changes into company computer system
- Identified important patient and demographic information
Insurance Verification Representative
McKesson Specialty Health
01.2010 - 03.2015
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling
- Updated patient and insurance data and input changes into company computer system
- Identified important patient and demographic information
Patient Account Representative
Research Medical Center
01.2006 - 08.2014
- Assisted colleagues during peak periods or absences, showcasing teamwork skills while maintaining personal workload demands efficiently.
- Posted payments and processed refunds.
- Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
- Worked with outside entities to resolve issues with billing, claims, and payments.
Patient Account Representative
Baptist Lutheran Medical Center
03.2001 - 08.2006
- Posted payments and processed refunds.
- Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
- Worked with outside entities to resolve issues with billing, claims, and payments.
- Promoted a positive work environment by actively participating in team meetings and contributing ideas for process improvements.
- Streamlined billing processes for increased efficiency in managing patient accounts.
Patient Account Representative
Trinity Lutheran Medical Center
02.1991 - 07.2001
- Posted payments and processed refunds.
- Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
- Worked with outside entities to resolve issues with billing, claims, and payments.
- Promoted a positive work environment by actively participating in team meetings and contributing ideas for process improvements.
- Facilitated smooth communications between patients, providers, and insurers, fostering an atmosphere of trust and collaboration.
Education
High School Diploma -
Bishop Hogan High School
Kansas City, MO05.1990
Skills
- Issue research
- Understanding of medical terms
- Knowledgeable in Microsoft software
- Precertification requirements
- Troubleshooting
- Flexible
- Organizational skills
- Data management
- Office workflow support
- Insurance knowledge
- Educating patients
- Checking in patients
- Confidentiality
- Data entry
- Charting expertise
- Patient scheduling
- HIPAA compliance
- Insurance verification
- Insurance billing
- Medical Billing Understanding
- Follow-up skills
- Strong empathy
- Data entry proficiency
- Medical terminology knowledge
- Team collaboration
Accomplishments
- Built productive relationships with patients and insurance companies, increasing payment rates.
- Resolved outstanding claims in first 3 months on job.
- Trained and mentored new staff on proper procedures, service standards, and compliance.
- Improved department productivity 90% by implementing strategic process improvements.
- Used Microsoft Excel to develop inventory tracking spreadsheets.
Certification
- Master Collector Certificate – Receivables Management Association International(RMAI).
- Revenue Cycle Representative Certification – Healthcare Financial Management Association.
- Credit Risk Analyst Certification (CRA) - Risk Management Association.
- Certified Receivables Professional (CRP) - Receivables Management Association International (RMAI).
- Certified Asset Recovery Specialist (CARS) - Allied Finance Adjusters Conference Inc.
- Financial Counseling Certification Program (FCCP) - National Endowment for Financial Education.
- Debt Settlement Specialist Certification - International Association of Professional Debt Arbitrators (IAPDA).
- Credit Business Associate (CBA) - National Association of Credit Management (NACM).
Languages
English
Full Professional
Timeline
Prior Authorization Specialist
Aetna Better Health of Kansas
11.2018 - 12.2024
Billing/ Insurance Verification
Quest Diagnostics
03.2015 - 10.2018
Insurance Verification Representative
McKesson Specialty Health
01.2010 - 03.2015
Patient Account Representative
Research Medical Center
01.2006 - 08.2014
Patient Account Representative
Baptist Lutheran Medical Center
03.2001 - 08.2006
Patient Account Representative
Trinity Lutheran Medical Center
02.1991 - 07.2001
- Master Collector Certificate – Receivables Management Association International(RMAI).
- Revenue Cycle Representative Certification – Healthcare Financial Management Association.
- Credit Risk Analyst Certification (CRA) - Risk Management Association.
- Certified Receivables Professional (CRP) - Receivables Management Association International (RMAI).
- Certified Asset Recovery Specialist (CARS) - Allied Finance Adjusters Conference Inc.
- Financial Counseling Certification Program (FCCP) - National Endowment for Financial Education.
- Debt Settlement Specialist Certification - International Association of Professional Debt Arbitrators (IAPDA).
- Credit Business Associate (CBA) - National Association of Credit Management (NACM).
High School Diploma -
Bishop Hogan High School
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