LaToya Clay
Powder Springs,MI
Summary
Detail-oriented professional with excellent communication, interpersonal, and creative thinking skills. Aiming to leverage my abilities to successfully fill the vacancy at your company. Frequently praised as hard-working by my peers, I can be relied upon to help your company achieve its goals.
Overview
26
26
years of professional experience
Work History
Customer Service Representative
First Call Claims Solutions
Tennessee Ridge, TN
03.2025 - Current
- Resolved customer inquiries efficiently, enhancing satisfaction and loyalty.
- Processed claims accurately, ensuring compliance with company policies and procedures.
- Managed escalated issues, providing effective solutions to complex customer concerns.
- Trained new staff on customer service protocols and systems to improve overall team performance.
- Developed streamlined communication processes, reducing response times for customer queries.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
Transitional Care Manager
Pruitt Health
Austell, GA
03.2024 - 04.2025
- Coordinated patient assessments and developed individualized plans of care for transitioning patients according to current standards of practice.
- Provided education and support to families regarding post-discharge processes, medications, follow-up appointments, resources.
- Developed and implemented policies and procedures to ensure smooth transitions for patients from acute care settings to home health or community services.
- Maintained up-to-date knowledge base on new technology and best practices related to Transitional Care Management.
- Provided training sessions on topics related to TCM process improvement initiatives.
- Collaborated with payers and insurance companies to secure necessary authorizations for services required during transition periods.
- Deliver medication to patients homes, review instructions, and perform medication reconciliation ensuring accuracy between current medication
- Coordinate and facilitate telehealth visits between patients and pharmacists, specialist, therapists and primary care providers
- Instruct patients on the use of Remote Patient Monitoring (RPM) equipment providing ongoing support, when necessary
- Conducted clinical evaluations utilizing evidence-based practices and quality improvement initiatives to improve outcomes and reduce readmissions.
Business Office Manager
Pruitt Health
Austell, GA
10.2022 - 08.2024
- Ordered office supplies within budgetary guidelines to maintain inventory control.
- Reconciled bank accounts on a monthly basis ensuring accuracy in all transactions.
- Submitted and reviewed invoices to accounts payable for administration.
- Streamlined administrative processes, enhancing operational efficiency and supporting executive management, while ensuring precise documentation and compliance.
- Managed complex ICD-10-CM and CPT-4/HCPCS coding, ensuring compliant charge capture for ancillary services within strict billing deadlines.
- Managed office layout and supplies, boosting efficiency and reducing costs.
- Supported executives with scheduling and travel, ensuring policy compliance.
- Facilitated auditor interactions by organizing financial documents.
- Resolved management issues, enhancing employee satisfaction and productivity.
- Facilitated seamless onboarding processes for new hires, while providing crucial clerical support during audits and financial reviews.
- Optimized office operations, enhancing productivity and reducing expenses through strategic supply management and layout improvements.
- Streamlined onboarding processes, integrating HR and IT functions to improve equipment management and new hire integration efficiency.
- Reviewed claims, ensuring policy compliance and accurate processing.
- Collaborated with anti-fraud units to resolve suspicious claims swiftly.
- Trained new staff, boosting team efficiency and protocol adherence.
- Managed event logistics, ensuring smooth executive operations.
- Enhanced claims process efficiency, maintaining precise financial records.
- Coordinated seamless referrals through insurance and medical specialists, improving patient care and streamlining pre-certification processes.
Assistant Practice Manager
OrthoAtlanta LLC
Austell, GA
03.2019 - 02.2022
- Ensured meticulous compliance with federal and state employment laws, mitigating legal risks and maintaining impeccable personnel records.
- Streamlined office operations, enhancing payment processes and data management efficiency, while driving HR initiatives for improved employee engagement.
- Pioneered advanced office management procedures, substantially boosting workflow efficiency and establishing new benchmarks in the industry.
- Led staff management efforts to cultivate professionalism and optimize patient care flow, fostering a cohesive team environment.
- Resolved claim issues, enhancing payment accuracy and efficiency.
- Managed claims, aligning with industry standards and payer requirements.
- Partnered with auditors and cross-functional teams to resolve open items, improving documentation and financial reporting processes.
- Implemented solutions for EDI rejections and patient statement errors, significantly reducing processing delays and improving cash flow.
Insurance Coordinator
Options Unlimited
Huntington, NY
03.2000 - 06.2014
- Facilitated patient care by coordinating referrals between insurance providers and medical specialists, enhancing healthcare accessibility.
- Streamlined event logistics for executive operations, minimizing disruptions and optimizing organizational workflow efficiency.
- Mentored new staff members, fostering team growth and promoting strict adherence to established protocols and best practices.
- Managed office layout and supplies, boosting efficiency and reducing costs.
- Supported executives with scheduling and travel, ensuring policy compliance.
- Facilitated auditor interactions by organizing financial documents.
- Resolved management issues, enhancing employee satisfaction and productivity.
- Facilitated seamless onboarding processes for new hires, while providing crucial clerical support during audits and financial reviews.
- Optimized office operations, enhancing productivity and reducing expenses through strategic supply management and layout improvements.
- Streamlined onboarding processes, integrating HR and IT functions to improve equipment management and new hire integration efficiency.
- Reviewed claims, ensuring policy compliance and accurate processing.
- Collaborated with anti-fraud units to resolve suspicious claims swiftly.
- Trained new staff, boosting team efficiency and protocol adherence.
- Managed event logistics, ensuring smooth executive operations.
- Enhanced claims process efficiency, maintaining precise financial records.
- Coordinated seamless referrals through insurance and medical specialists, improving patient care and streamlining pre-certification processes.
Education
Bachelors of Applied Science - Business/Healthcare Administration
New York Medical Career Training Center
NY08-2000
Certificate - Medical Assistance
New York Medical Career Training Center
NY03-1996
Skills
- Records Management
- Claims Processing
- Process Improvement
- Employee Engagement
- Payroll Processing
- ICD-10-CM Coding
Timeline
Customer Service Representative
First Call Claims Solutions
03.2025 - Current
Transitional Care Manager
Pruitt Health
03.2024 - 04.2025
Business Office Manager
Pruitt Health
10.2022 - 08.2024
Assistant Practice Manager
OrthoAtlanta LLC
03.2019 - 02.2022
Insurance Coordinator
Options Unlimited
03.2000 - 06.2014
Certificate - Medical Assistance
New York Medical Career Training Center
Bachelors of Applied Science - Business/Healthcare Administration
New York Medical Career Training Center