Latricea Thomas
Tampa,Florida
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
24
24
years of professional experience
Work History
Performance Quality Auditor II
Elevance Health
06.2011 - 01.2024
- Responsible for evaluating services provided by Facilities and all Hospitals
- Auditing different Markets to ensure claim payment accuracy in a timely manner
- (Maryland,Kentucky,Vamm,New York & New Jersey) Audit the performance of Claim Analyst to determine their processing accuracy of claims and correspondence
- Identify and track trends to improve quality and provide feedback to management regarding developmental needs
- Locate and research documentation on internal websites, Identify policy deficiencies and make recommendation based on audit findings
- Determine sources for assigned error and accurately enter the audit information into Quality performance database
- Adhere to the QPI department and company policies and guidelines.
Subject Matter Expert
Amerigroup
07.2009 - 06.2011
- Responsible for processing all levels of claims for payment
- Working on special projects to resolve provider complaints related to reimbursement issues filed with the state
- Strong organizational skills and the ability to manage multiple tasks and perform research necessary to resolve discrepancies in an accurate and timely manner
- Provide input to the supervisor on developmental needs of the team members
- Prepare and submit daily and productivity reports
- Process and review High Dollars claims for correct payment utilizing provider contracts
- Work effectively and assist provider relations staff in resolving provider reimbursement issues
- Assist other analysts with any questions for all claim issues pertaining to their market.
Claims Analyst III
Amerigroup
10.2008 - 07.2009
- Responsible for processing all levels of claims for payment for Texas, New Mexico and Nevada market for both Facility and Professional claims
- Ensure claims and information with COB indicators are processed correctly according to Coordination of Benefits guidelines
- Audit/Price inpatient, outpatient, skill nursing & home health claims utilizing COBA files to ensure correct payment per Medicare guidelines
- Work effectively and proficiently to ensure provider satisfaction by resolving inquiries and adjusting claims for proper payment
- Process and review High dollar claims for correct payment utilizing provider contracts.
Provider Liaison Support Representative
BlueCross BlueShield
06.2003 - 02.2008
- Responsible for educating providers on benefit coverage guidelines for all lines of business HMO, PPO, GBO, Traditional
- Research and resolve provider issues both written appeal and oral to determine if claims processed correctly per providers contract
- Pricing for inpatient, outpatient, and physician claims utilizing providers contract files, and re-key claims for correct pricing to ensure claim processed correct billing code
- Effectively work with other departments and face to face with members to ensure timely processing and resolution of provider and member issues
- Ensuring provider satisfaction by resolving inquiries and processing claims adjudication in a timely manner for all lines of business
- Review correspondence and medical records to determine if the reconsideration request meets the criteria for a clinical review
- Navigates and correctly uses appropriate technology tools to efficiently process and resolve claims
- Process and review High Dollar Hospital claims
- Advance knowledge of HCFA 1500 and UB92 claim processing
- Served as a collection specialist for Senate Bill 45 team.
Contract Analyst I
BlueCross BlueShield of Florida
01.2000 - 01.2003
- Review applications, apply policy and criteria, and perform primary source verification, process files and forward for main database loading
- Loads institutional/professional contracts into the Diamond System through appropriate research and provider data load activities and load provider information into PIP system
- Communicates with Network Managers when contracts cannot be administered properly
- Assists other departments with special projects
- Address impacts to contract and payment arrangement conduct system assessment and determine proper set up of the necessary changes within appropriate systems
- Strong organizational and analytical skills and the ability to manage multiple tasks and perform research necessary to resolve discrepancies in an accurate and timely manner
- Review contracts, apply policy and criteria, and perform primary source verification, process contracts for main database loading.
Skills
- Windows
- Excel
- Word
- PowerPoint
- ICD-9 and CPT-4 Codes
- Medical Coding
- Knowledge with PPO and Traditional Screens
- Claims Processing
- Excellent Oral and written communication skills
- Problem solving and analytical skills
Timeline
Performance Quality Auditor II
Elevance Health
06.2011 - 01.2024
Subject Matter Expert
Amerigroup
07.2009 - 06.2011
Claims Analyst III
Amerigroup
10.2008 - 07.2009
Provider Liaison Support Representative
BlueCross BlueShield
06.2003 - 02.2008
Contract Analyst I
BlueCross BlueShield of Florida
01.2000 - 01.2003