Latoya Hawes
Washington DC,DC
Overview
14
14
years of professional experience
Work History
Provider Network Representative, Lead
Troy Medicare
07.2024 - Current
- Network Development including provider services, provider data, credentialing and escalations
- Develop the end-to-end credentialing and re-credentialing process for all healthcare providers.
- Ensure that all provider applications are accurately completed, submitted, and processed in a timely manner.
- Collaborate with Claims, Clinical, HR, and Compliance teams to address any credentialing issues or discrepancies
- assist with audits, provide feedback to reduce errors and improve processes and performance
Case Management Assistant
Kaiser Permanente, Washington Hospital Center
05.2013 - 08.2024
- · Develops and maintains relationships with and among external agencies and providers and various internal departments as they relate to the functioning of the referral management process as they relate to accessing services and coordination of care across transition. Support the nursing staff with the SNF and home care placement process.
- Support the Case Management office with an emphasis on smooth transitions from care setting, e.g. in-basket messages, schedules follow-up appointments for our members and physicians Referral entry. Support Nursing staff with follow-up calls. Support nursing staff with trouble shooting services issues discovered during follow-up calls.
- Revises the hospital census reports from the previous and current day, and follows departmental procedures to expedite data entry/integrity and the discharge of our members across various care setting. Entry of inpatient hospital authorizations. (Including NICU). Arrange ambulance services for transport.
- Prepares and generate standardized or individual letters, memorandums, forms and materials associated with authorization and processing of hospital and referral services as needed under the direction of the Nurse.
- Participates in the orientation of new providers and staff regarding the referral management process.
- Maintains current knowledge about, understands and follows state regulation requirements regarding benefits administration, case management and the use of specific guidelines and protocols.
- Attended regularly scheduled case management and staff meetings.
Member Service Representative
KAISER PERMANENTE
06.2011 - 05.2013
- Answered inbound calls from patients and healthcare providers, providing information about insurance coverage, medical procedures, and treatment options.
- Learned and maintained an in-depth understanding of product and service information to offer knowledgeable and educated responses to diverse customer questions.
- Trained and directed new employees in call script use, conflict resolution, and data entry practices to boost customer satisfaction ratings.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
Education
Associate of Applied Science - General Studies
Prince George's Community College
Upper Marlboro, MD06.2011
Skills
- Office Operations
- Proficient in using electronic health records (EHR) software
- Claims
- Knowledge of medical terminology, healthcare regulations, and insurance policies
- UBT Leadership
- ICD-9/10 & CPT coding
- Accounts Payable and Accounts Receivable
- Microsoft Office
- Case Planning and Management
- Data Entry
- First Aid/Cpr
- Google Workspace
- Resource Coordination
- Medallion
Timeline
Provider Network Representative, Lead
Troy Medicare
07.2024 - Current
Case Management Assistant
Kaiser Permanente, Washington Hospital Center
05.2013 - 08.2024
Member Service Representative
KAISER PERMANENTE
06.2011 - 05.2013
Associate of Applied Science - General Studies
Prince George's Community College