Latrice Pope
Sacramento,CA
Summary
Highly organized and detail-oriented professional with strong verbal and written communication skills. Skilled in utilizing technical knowledge to achieve exceptional customer service. Demonstrated commitment to excellence in decision-making and work ethic, while maintaining a professional demeanor and showing great initiative. Proven ability to build strategic relationships and partnerships, actively listen, creatively solve problems, and negotiate win-win outcomes. Consistently met or exceeded performance standards in fast-paced environments.
Overview
21
21
years of professional experience
Work History
Hills Physician Medical Group
02.2022 - Current
- Verify eligibility and builds referral into authorization, attaches clinical records and route authorization to appropriate clinical queue within TAT requirements
- Verify benefit details with the health plans
- Assisting nursing staff in obtaining clinical information from facilities and summarizes information, redirect patient to In Network par provider due to provider Out of Network with Hills or member health plan, and Exclusion Checks
- Follow up and addresses any needs identified during outreach call
- Update and make corrections due to errors made on authorization forms
- Maintain client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards
- Performs other duties as assigned
Centene Corporation
10.2017 - 05.2021
- Premium billing only
- Analyzing and interpreting various managed care contracts and government payer regulations
- Collaborate with internal team and external client to research and resolve any disputes or discrepancies
- Respond to premium billing requests via customer service and follow up with cases and de-escalate calls
- Documented all collections efforts and transaction records
- Maintain low volume in assigned error queues within the billing system
Apria/HealthCare
07.2015 - 10.2017
- Complete inbound/outbound calls to patient and referral sources for durable medical equipment
- Collaborated with back-office qualification teams to facilitate timely processing of orders
- Assist front office, patient registration, coordinating scheduling patient appointments with Respiratory specialist
- Collect payment and billing information as needed
InSync
10.2014 - 07.2015
- Assist with all aspects of the application process within the Covered California systems from signup to termination
- Authenticated consumers fully to confirm identification related to their accounts and report necessary changes
- Certified Enrollment counselors, federal and state agency contacts
- Explained health plan options with different carriers and tier levels, Bronze, Gold, and Platinum, thoroughly broke down deductibles and copayments
Super Shuttle
03.2013 - 10.2014
- Responsible for dispatching and assigning drivers within Sacramento, San Diego, and LA county
- Call customers to confirm reservations and welcomes them while taking the opportunity to share local contact information and confirm delivery date
- Notify customers of delays and share revised ETAs, and handle cancellations
- Assists in addressing and resolving accounting issues related to customers’ accounts
- Maintain current knowledge of routes and locations to assure timely services and accuracy
- Relay work orders, messages and information, to/from drivers, supervisors, and managers
Kelly Services
11.2011 - 03.2013
- Medicare Part D Health Net Medicare Pharmacy benefits and formularies, including CMS regulations
- Provided clinical and operational support for planning, creating, maintaining, and Prior Authorization (PA)
- Ensures timely and accurate submission of all HPMS formulary files, PA files, ST files and other UM restrictions in accordance with CMS requirements
- Submitted and maintained formulary change requests to Health Net’s pharmacy claims processor
- Assist pharmacies processing information and understanding of rejection codes
- Assist doctor’s offices with medication approval
Sprint
01.2004 - 01.2009
- Customer retention handling inbound/outbound high call volume working with high-risk customers by performing all aspects of customer service
- Resolved billing questions and provided technical support for all Sprint supported cell phones and wireless devices
- Helped the company attain the highest customer service ratings (as determined by external auditors) -- earned 100%
- Escalation representative to deescalate issues, concerns and problems with customer bill or phone issues to avoid from terminating their services
- Entered account information into billing system with a high degree of accuracy to execute transaction
Education
Certificate of Completion -
Basic Life Support (BLS)
08.2023
Certificate of Completion - In CPR, AED, First-Aid
National CPR Foundation
07.2023
Certificate - Administrative Health Care Management
San Joaquin Valley College
08.2010
Skills
- Accounting Expertise
- Complaint Resolution
- Advanced Medical Terminology Knowledge
- HMO Regulatory Compliance
- PPO Management Skills
- Medicare Knowledge
- Medi-Cal Policy Administration
- Phone Etiquette
- Patient Registration
- Data Entry Expertise
- Administrative Management in Health Care
- CPT Code Proficiency
- ICD-9 Data Management Skills
- ICD-10 Proficiency
- Healthcare Billing
- Cisco Systems Proficiency
- Epic Management
- Experience with ACIS
- Citrix Administration
- CRM Software Proficiency
- Experience with Caremark Systems
- Omni Knowledge
- Electronic Medical Record Manager
- ICM Call Handling
- Advanced Skills in Microsoft Office
- Microsoft Outlook Proficiency
- Data Analysis Using Excel
- Teamwork and Collaboration
- Training & Development
Area Of Expertise
- Lead mentor/trainer for new representatives
- Team collaboration to achieve call center goals
- Initiative, enthusiasm, tenacity, and dependability
- Voluntary customer service training
Timeline
Hills Physician Medical Group
02.2022 - Current
Centene Corporation
10.2017 - 05.2021
Apria/HealthCare
07.2015 - 10.2017
InSync
10.2014 - 07.2015
Super Shuttle
03.2013 - 10.2014
Kelly Services
11.2011 - 03.2013
Sprint
01.2004 - 01.2009
Certificate of Completion -
Basic Life Support (BLS)
Certificate of Completion - In CPR, AED, First-Aid
National CPR Foundation
Certificate - Administrative Health Care Management
San Joaquin Valley College
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