Laura Howard
Canton,IL
Summary
Quality Assurance Lead providing critical support maintaining QMS standards. Over 3 years of experience performing necessary QA audits and pulling key data to assemble detailed analytical reports. Maintained high quality threshold levels, overseeing comprehensive technical framework drafts and reviews. Issued detailed calls-to-action, noting criteria and obstacles to quality management system effectiveness.
Overview
13
13
years of professional experience
Work History
Care Management Support Assistant
Humana
05.2023 - Current
- Contribute to administration of care management
- Provide non-clinical support to assessments and evaluations of members needs and requirements to achieve and/or maintain an optimal wellness state by guiding members/families toward and facilitate interactions with resources appropriate for the care and wellbeing of members
- Preform varied activities and moderately complex administrative/operational/customer support assignments
- Assists team with SME/TOC/ICT items
- Pilot Projects - Post-HRA, IWHA
Quality Analyst
BroadPath Healthcare Solutions
07.2020 - 05.2023
- Lead 3-6 Quality Analyst
- Review daily tasks that need to be completed by QA associates
- Go over quality disputes prior to review with supervisor
- Review updated policies and procedures for Quality Audits with associates
- Training QA Associate's to be able to run their own projects
- Showing them how to run client meetings, internal meetings, update and review reports
- Work at home auditing 15-20 call recordings daily
- Complete new trainer, quality analyst, supervisor, and agent certifications for client
- Gathering, analyzing and interpreting data for internal operation meetings and client meetings
- Sending overviews of reports to executive management and other departments
- Reviewing trends from both client audits and internal audits
- Gathering information to send out Quality Tips and process changes to agents
- Completing weekly metrics, review supervisor attainment, complete Power Points for Weekly Business Review Decks, exceptions, Audit-the-Auditors on operations and quality, and running Internal and Client quality calibrations.
Flex Trainer
BroadPath Healthcare Solutions
09.2021 - 04.2022
- Streamlined training content, making sure it is updated for future classes
- Assisting with training classes when there is no trainer available with Headcount of 60+ agents
- Creating classes with Moodle and setting up Adobe Connect Meetings.
Provider Assistant
BroadPath Healthcare Solutions
07.2019 - 07.2020
- Work at home answering provider calls for providing information on commercial member's eligibility, benefits, claims, per-certifications/authorizations
- Explaining remittance advise, detailed payment information on separate line items, and denial reasons or return claims
- Going over appeal processes, corrected claim processes and timely filing for these processes
- Assist providers with contract and credentialing processes and status
- Programs used include CSS, MetaVance, Foresight 5.1 (electronic claims), Telnet, PIMS, Blue Docs, Flow Manager and Image Retriever, Blue2, Blue Web, Health Payor Manager, Onbase.
Referral Specialist
BroadPath Healthcare Solutions
07.2018 - 01.2019
- Work at home answering provider calls for setting up authorizations for Medicare Advantage outpatient procedures, DME, Surgery, Home Health, Therapy, Bio Pharmacy and Pain Management
- Used Amisys, Filenet and Envolve for daily activities
- Worked with management to create spreadsheets for reporting notes and submitted to client spreadsheets including escalations, follow-ups, date changes, and fax requests.
Call Center Agent / Escalation Supervisor
Sykes Enterprise
07.2015 - 07.2018
- Work at home for different call centers
- Answer incoming calls and follow-up calls with customers on sales and technical support
- Set up trouble tickets and service orders for customers
- Use email and chat for contacting customers and different departments
- Support employee development through coaching, counseling, and training
- Identify system and workflow improvements to enhance the customer service agent's efficiency
- Handle customer escalations as needed
- Worked with Avaya phone system, Avaya Agent Workstation and Team workstation.
Medicare & Medicare Advantage Plan Billing and Denials Specialist
Graham Hospital Association
08.2011 - 05.2015
- Batch billed and manually billed Medicare and Medicare Advantage claim to the appropriate insurance company
- Worked denials received from insurance companies
- Worked exception reports, small balance reports, and late charge reports
- Helped with Medicare audits by getting the information ready for accounting department
- Worked Medicare vouchers by posting denials for medical necessity, non-covered charges, adjustments, federal adjustments
- Corrected registration errors when wrong insurance was entered
- Answered phones
- Worked Credit and Late charge adjustments to insurance companies.
Education
Associate of Applied Science - Health Information Management
Spoon River College
Canton, IL07.2011
Associate of Applied Science - Computer Networking Specialist
Robert Morris College
Peoria, IL11.2003
Skills
- Printers
- Scanning
- Accounting
- Peachtree
- Billing (5 years)
- Microsoft Office (10 years)
- Meditech (5 years)
- Medical Records
- Scheduling
- EMR (5 years)
- Fss0 (5 years)
- FileNet
- CSS
- Citrix (6 years)
- Moodle (1 year)
- Quality assurance (4 years)
- Time management
- Five9 (1 year)
- Salesforce (3 years)
- Quickbase (5 years)
- VMWare (1 year)
- Quality audits (4 years)
- Auditing
Timeline
Care Management Support Assistant
Humana
05.2023 - Current
Flex Trainer
BroadPath Healthcare Solutions
09.2021 - 04.2022
Quality Analyst
BroadPath Healthcare Solutions
07.2020 - 05.2023
Provider Assistant
BroadPath Healthcare Solutions
07.2019 - 07.2020
Referral Specialist
BroadPath Healthcare Solutions
07.2018 - 01.2019
Call Center Agent / Escalation Supervisor
Sykes Enterprise
07.2015 - 07.2018
Medicare & Medicare Advantage Plan Billing and Denials Specialist
Graham Hospital Association
08.2011 - 05.2015
Associate of Applied Science - Health Information Management
Spoon River College
Associate of Applied Science - Computer Networking Specialist
Robert Morris College
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