Latonya Reese
Columbia,South Carolina
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
14
14
years of professional experience
Work History
Program Coordinator II
Centene, Corp.
09.2018 - 01.2024
- Maintain integrity of PHI
- Update requests for correct claims processing
- Train nurses on systems
- Initiate authorization request by using the ICD- 10 codes from faxes from hospitals, physician’s office
- Aid with administrative work for nurses
- Completed all denial correspondence.
- Collaborated with other departments within the organization to coordinate efforts that support overall organizational objectives.
- Identified areas where improvements can be made in order to increase efficiency or effectiveness.
Claims Representative
Centene, Corp.
01.2014 - 08.2018
- Data enters medical authorizations request via phone and fax
- Communicated regularly with referring physicians, nurses, case managers, social workers, and other healthcare professionals regarding referral processes and requirements.
- Processed incoming referral requests for medical services and submitted them to the appropriate insurance companies for authorization.
- Assisted patients in understanding their insurance coverage and answered questions about referrals, authorizations, and other related issues.
- Researched and responded to inquiries from providers regarding pending or denied referrals in a timely manner.
- Verified insurance eligibility for referred services using online databases and contacted insurers directly when needed.
- Identified potential problems with referrals before submitting them to insurers and worked with providers to resolve those issues quickly.
- Conducted research into medical terminology related to healthcare claims processing activities.
- Documented changes in claim statuses using specialized software systems.
Provider data management coordinator
Centene, Corp.
08.2012 - 12.2013
- Credential and enroll physicians and hospitals in a prompt matter
- Research, review and update providers request and state complaints in CRM and the PDM provider mailbox in a prompt matter
- Find claim trend issues and recommend solutions
- Audit credentialing contracts for accuracy for the Credentials committee for NCQA requirements.
- Analyzed data to identify trends in customer behavior and preferences.
- Resolved customer complaints in a timely manner while upholding company standards.
- Issued work schedules, duty assignments and deadlines for office or administrative staff.
- Planned and managed operations to achieve objectives within budgets.
- Maintained records of customer needs and preferences.
Customer Service representative
Centene, Corp.
08.2009 - 07.2012
- Research, review and analyze members and providers calls request via phone, chat and Web Portal
- Educate members on managed care benefits and aid them with finding PCP and other specialty doctors
- Informed providers of claim status and sent claims back to the claims department if necessary
- Assist with HEDIS special projects by collecting data via phone and home visits to ensure mammograms, Colonoscopies and well visits were made
- Reported measures via excel to Quality Department.
Education
Bachelor of Science sociology -
Claflin university
05.2003
High school diploma -
Orangeburg wilkinson high school
06.1996
Skills
- Knowledge of health care, managed care
- Knowledge of ICD-10
- Knowledge of Microsoft Word, EXCEL and Outlook
- Resolve provider and members issues via phone chat
- Claim Management
- Patient Care Understanding
- Multi-Tasking Skills
- Quality Assurance Evaluation
- Remote Customer Service Experience
- Administration Knowledge
Timeline
Program Coordinator II
Centene, Corp.
09.2018 - 01.2024
Claims Representative
Centene, Corp.
01.2014 - 08.2018
Provider data management coordinator
Centene, Corp.
08.2012 - 12.2013
Customer Service representative
Centene, Corp.
08.2009 - 07.2012
Bachelor of Science sociology -
Claflin university
High school diploma -
Orangeburg wilkinson high school