Latonya Taylor
Katy,TX
Summary
Highly efficient professional with vast experience in achieving set targets through process/service improvement. Extensive background in converting complex data into actionable insights to drive decision-making processes. Skilled in analyzing trends, crafting detailed reports, and enhancing business operations through technology solutions. Demonstrated ability to work collaboratively across teams to implement improvements, leading to increased efficiency and productivity. Eager to contribute to a dynamic team and support organizational goals.
Overview
20
20
years of professional experience
Work History
SENIOR ANALYST BUSINESS ANALYTICS
CVS HEALTH
Irving, TX
04.2022 - Current
- Review and resolve client and/or CMS enrollment audit inconsistencies and support internal departmental and external client calls independently along with capturing and delivering meeting agendas, minutes, action items, etc.
- Ensured that all eligible beneficiaries are successfully enrolled in their respective Medicare Part-D plans and perform in accordance with Center for Medicare & Medicaid Services (CMS) guidelines.
- Identify potential process gaps and/or risks associated with client enrollment procedures, and contribute to finding innovative solutions
- Utilized analytical skills and knowledge of business to manage multiple clients, resolving enrollment discrepancies, performing complex day-to-day enrollment tasks, understanding and applying Medicare Part D Guidelines, and managing small improvement projects.
- Communicate professionally with internal partners and co-workers to drive success for the client and promote a collaborative work environment
- Managed strong relationships with our Employer Group Waiver Plan (EGWP) clients and internal partners.
- Designed automated reporting processes utilizing SQL queries and Excel macros for streamlined data analysis.
- Managed timely flow of business intelligence information to users.
- Provided training and support to team members on data analysis tools and techniques.
- Monitored enrollment processes and analyze reports across multiple enrollment systems
- Research, process, and formulate solutions for routine and complex enrollment issues.
- Consistently communicate project statuses to clients, lead weekly calls, and influence clients on implementing optimal enrollment practices
- Created and maintained client documentation, policies and procedures
BENEFITS SETUP REPRESENTATIVE II
CVS HEALTH
RVING, TX
01.2019 - 12.2020
- Evaluate client requests while performing the necessary benefits testing and quality assurance validation using AS400/Salesforce systems for 20+ clients.
- Organize with benefits coders and testers, and the organization requirements team to deliver the best quality systems and task force for the vast number of clients, increasing the sales rate by an additional 15%.
- Assessed, substantiated, and captured client intent for new plan executions and provided process changes to existing plans.
- Responsible for building tests on client intent and then running claim validation for correct copay and drug list, which is 60% of my day.
QUALITY ANALYST
AETNA HEALTHCARE
ARLINGTON, TX
01.2017 - 01.2019
- Steered standard quality reviews/audits to measure compliance with published policies, procedures, customer, and regulatory guidelines
- Assessed, identified, and escalated system errors to partners for improvements, maintaining client loyalty and resulting in a 55%+ client turnaround
- Acted as a subject matter expertise regarding policies, procedures, and function-related applications/systems tools
- Executed routine quality audits for 70+ claims daily, in harmony with set guidelines for high dollar, random, and health plan claims service operations to verify 100% compliance
CARE MANAGEMENT ASSOCIATE
AETENA HEALTHCARE
ARLINGTON, TX
01.2016 - 01.2017
- Provided onsite training for 2 sessions daily by utilizing company-based materials/own materials, consulting on healthcare data needs, and guarantee proper skillset, enhancing performance by 33%+
- Coordinated with the sales management supervisor by monitoring multiple databases to keep track of all inventories, identify discrepancies, and promptly resolve them, attaining a 90%+ resolution.
- Maximized client experience by de-escalating 50+ high-intensity inquiries and requests daily.
- Oversaw multiple special projects to guarantee the smooth running of the projects from commencement to accomplishment
Program Coordinator
Superior Healthcare
Dallas, TX
03.2015 - 12.2015
- Initiate authorization requests for skilled, inpatient nursing facility requests in keeping with the prior authorization list for STAR+PLUS members.
- Resolved conflicts and negotiated agreements between parties to reach win-win solutions to disagreements and clarify misunderstandings
- Proactively identified and solved complex problems impacting operations management and business direction
- Collaborated with internal teams across departments to ensure effective operations of the program.
CLINICAL ADMIN COORDINATOR
UNITED HEALTHCARE
PLANO, TX
01.2006 - 03.2015
- Resolved 50+ inquiries and requests by handling emails and faxes from providers and clients
- Acted as a subject matter on knowledge of ICD-9/10, CPT coding, and HCPC for Medical and Behavioral Health billing and coding systems
- Reviewed and determined gap exceptions for the policies, generating letters, and transferred each case to the next business unit, meeting and exceeding quality production goals by 25%+
- Maintained time-sensitive documentation, including case management, coordination, interventions, and outcomes, guaranteeing 99%+ compliance with program goals and regulatory agencies.
Education
COMPUTER APPLICATION CERTIFICATE - MS WORD, EXCEL, INTERNET EXPLORER, OUTLOOK, AND WINDOWS OS
RICHARD COLLEGE
DALLAS, TEXAS01.2016
FINANCIAL PLANNING CERTIFICATE -
RICHARD COLLEGE
DALLAS, TEXAS01.2016
High School Diploma -
South Oak Cliff High School
Dallas, TXSkills
- Microsoft Office products (Excel, Word, Outlook)
- Quality control, management, and assurance
- VLOOKUP
- Analytics program experience
- Client management
- Performance monitoring
- Business intelligence
- Tech-Savvy
- AS400 and RX Claim systems
- HSR, EDI, TRUCARE Systems
- Salesforce system
- Problem solving
- Customer service
- Business Development
- Forward thinker, solution-driven
- Medical terminology
- Excellent communication skills
- QNXT, ACAS Systems
- ICD-9/10, CPT/HCPCS codes
- Teamwork and collaboration
- Experienced in a fast-paced environment
- Data analysis
- Critical thinking
- Time management
- Root Cause and workflow Analysis
- Documentation and reporting
- SQL and databases
- Data research and validation
Timeline
SENIOR ANALYST BUSINESS ANALYTICS
CVS HEALTH
04.2022 - Current
BENEFITS SETUP REPRESENTATIVE II
CVS HEALTH
01.2019 - 12.2020
QUALITY ANALYST
AETNA HEALTHCARE
01.2017 - 01.2019
CARE MANAGEMENT ASSOCIATE
AETENA HEALTHCARE
01.2016 - 01.2017
Program Coordinator
Superior Healthcare
03.2015 - 12.2015
CLINICAL ADMIN COORDINATOR
UNITED HEALTHCARE
01.2006 - 03.2015
COMPUTER APPLICATION CERTIFICATE - MS WORD, EXCEL, INTERNET EXPLORER, OUTLOOK, AND WINDOWS OS
RICHARD COLLEGE
FINANCIAL PLANNING CERTIFICATE -
RICHARD COLLEGE
High School Diploma -
South Oak Cliff High School
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