LaToya Smith
McDonough,GA
Summary
In-depth Quality Assurance Specialist with success in prioritization and multitasking. Exceptional communication and organizational skills. Committed to paying impeccable attention to reviews and auditing procedures.
Overview
13
13
years of professional experience
Work History
Quality Assurance Specialist
Wipro United Healthcare
Atlanta, GA
11.2016 - Current
- Communicated with production team members about quality issues.
- Reported repeated issues to supervisors and production agents, collaborating to identify issue roots and rectify problems.
- Monitored performance and generated reports detailing quality and focusing on trending areas of improvement.
- Creating training materials for production team on new lines of business.
- Document quality assurance activities and create audit report daily
- Manage over 50 agents quality score, trending errors to avoid clients errors
Data Loading Analyst
Wipro United Healthcare
Atlanta, GA
11.2015 - 11.2016
- Maintain internal provider grid to ensure all information is accurate.
- Update each provider's CAQH database file timely according to schedule
- Complete re-credentialing application to add providers to commerical payers, Medicare and Medicaid.
- Credential new providers and re-credential current providers with hospital at which they hold staff affiliations.
- Maintain accurate provider profiles on CAQH, NPPES and NDB database.
- Work closely with billing staff to identify and resole any denials or authorization issues related to provider credentialing.
- Proceed 30 cases daily
Data Loading Analyst
HP Enterprise Services
Tucker, GA
01.2013 - 11.2015
- Respond to question regarding member and provider eligibility, claim submission procedures and claim processing
- Accurate and timely documentation of response to complex providers inquiries.
- Reviewed 50 plus claims submission daily.
- Complies with contract requirements, business unit rules, related industry and legal regulations.
- Escalate more complex questions and issues appropriately.
Front Desk Receptionist
Hands On Physical Therapy
Stockbridge, GA
04.2010 - 01.2013
- Greeted guests at front desk and engaged in pleasant conversations while managing check-in process.
- Received 20 calls daily
- Answered multi-line phone system to respond to inquiries and transfer calls to correct departments and personnel.
- Resolved customer issues quickly and notified supervisor immediately when problems escalated.
- Maintained files and records by implementing effective filing systems that boosted efficiency and organization.
Education
Associate of Arts - Medical Administrative Assistant
Everest Institute - Atlanta Downtown
Atlanta, GA02.2009
High School Diploma -
Morrow High School
Morrow, GA05.2005
Skills
- Excellent data collection and analysis skills
- Great communication skills, both verbal and written
- Strong attention to detail with great turnaround time with task
- Working knowledge of relevant regulatory standards
- Ability to work as part of team
- Having strong quality assurance skills
- Performance testing
- Organization and Time Management
- Correction action planning
Additional Information
Helped established new office in Tampa, Fl for new staff training to process provider's credentialing,
Timeline
Quality Assurance Specialist
Wipro United Healthcare
11.2016 - Current
Data Loading Analyst
Wipro United Healthcare
11.2015 - 11.2016
Data Loading Analyst
HP Enterprise Services
01.2013 - 11.2015
Front Desk Receptionist
Hands On Physical Therapy
04.2010 - 01.2013
Associate of Arts - Medical Administrative Assistant
Everest Institute - Atlanta Downtown
High School Diploma -
Morrow High School
Similar Profiles
Shyneria MonfortShyneria Monfort
Supervisor at Wipro (United Healthcare)Supervisor at Wipro (United Healthcare)
NIBEDITA BHATTACHARJEENIBEDITA BHATTACHARJEE
Product Manager (Pan India) at Wipro GE Healthcare Pvt LtdProduct Manager (Pan India) at Wipro GE Healthcare Pvt Ltd
Sneha Latha CSneha Latha C
Executive Assistant/Opeartions Analyst(Consultant) at Wipro GE Healthcare Private LimitedExecutive Assistant/Opeartions Analyst(Consultant) at Wipro GE Healthcare Private Limited