Laurian Nanton Wallace
Lehigh Acres
Summary
Healthcare professional with extensive experience in Radiation Oncology and Radiology, specializing in healthcare billing and insurance regulations. Demonstrated leadership in team management, achieving a 95% appeal turnover rate. Proficient in ICD-10 coding and recognized for fostering compassionate patient interactions, contributing to quality improvement in clinical environments.
Overview
33
33
years of professional experience
1
1
Certification
Work History
Denials Specialist
Rayus Radiology
Minneapolis
04.2024 - 12.2025
- Collaborated with billing teams to resolve outstanding claims efficiently.
- Reviewed medical records to support appeals for denied claims.
- Documented denial resolutions accurately in claims management system.
- Communicated with insurance providers to clarify discrepancies in claims.
- Monitored regulatory changes affecting claim denials and necessary adjustments.
- Analyzed policy language and medical records to identify coverage issues.
- Investigated payment errors due to incorrect claim processing and documented findings.
- Monitored trends in claim denials to identify process improvement opportunities.
Lead/Escalator/Lead/Supervisor CPAT
21st Century Oncology/Genesiscare USA/IC
Fort Myers
11.2018 - 01.2024
- Supervised Central Prior Authorization Team of 22 members, overseeing timesheet approval and HR duties.
- Assisted Manager with daily workflow management and departmental operations.
- Facilitated resolution of discrepancies in authorization processes for collections department.
- Escalated documentation requests to physicians, dosimetrists, and medical coders as necessary.
- Requested and secured authorizations and referrals to ensure compliance and efficiency.
- Reviewed Verifiers Work list for discrepancies impacting departmental processes.
- Updated CPAT Authorizations Guide to reflect current procedures and requirements.
- Managed Master Roster for key personnel, ensuring accurate staffing information.
Manager Insurance Department
Advanced Pain Management-Spine Specs
Fort Myers
10.2012 - 05.2018
- Supervised staff of 12 in billing, authorizations and verifications departments which made up the Insurance Department
- Entered all charges for procedures and Physician Fess from Park Center for Procedures and billed them in Next -Gen EPM
- Upload all claims from Next-Gen to Practice Insight clearinghouse
- Achieved 95% appeal turnover of high- ticket procedures
- Produced monthly A/R reports for high ticket procedures
- Responded to customer requests via telephone and email.
- Worked directly with all departments in practice to achieve correct billing and documentation practices
- Copied, logged and scanned supporting documentation.
- Fort Myers, FL
Medical Assistant/Clinical Coordinator
Advanced Pain Management-Spine Specs
Fort Myers
10.2012 - 05.2018
- Scribe enter dx codes, order Radiology, physical Therapy orders provided a comforting and soothing environment.
- Prepared patients for X-rays, electrocardiograms, suture removal and dressing changes.
- Obtained information about clients' medical history, drug history, complaints and allergies.
- Recorded patients' medical history, vital statistics and test results in medical records.
- Escorted patients to examination rooms.
- Monitored vital signs, such as blood pressure and pulse.
- Entered patient, procedure and equipment into computer system.
- Prepared Room and drew up medications for injections.
- Took direction from physicians, RN and LPNs.
- Upload ultrasound images from machine to patient charts 15 years clinical experience.
- Fort Myers, FL
Medical Assistant
The Colorectal Institute - under 21st Century Oncology
Fort Myers
09.2006 - 01.2012
- Prepared initial patient charts for admission.
- Escorted patients to examination rooms.
- Welcomed patients and inquired as to their wellbeing since their last treatment.
- Prepared and administered medications as directed by a physician.
- Assisted patients with proper positioning for minor surgeries.
- Changed sterile dressings.
- Assist with Physical Examination, Minor Surgeries ad Wound/Ostomy Care.
- Maintained accurate records of patient care, condition, progress and concerns.
- Provided a comforting and soothing environment.
- Entered patient, procedure and equipment into computer system.
- Answer Telephones/Schedule Appointments for Follow up, New Patients, Radiology, and Surgery.
- Call in Medications to Pharmacy.
- Oriented and trained new staff on proper procedures and policies.
- Maintained a safe and clean environment up to infection control standards, responsible for OSHA and Bio-hazard training.
- Participated in Continuous Quality Improvement (CQI) activities.
- Order Medical supplies and equipment for (4) offices.
- Maintenance of all equipment such as Autoclave, Flexible Sigmoid Scope and all surgical Instruments.
- Fort Myers, FL
Senior Management Consultant
NYC Health + Hospitals
New York
05.2000 - 12.2003
- Review and process all Corporate -wide invoices for Information services Department.
- Saved the Corporation over a 1/2 million dollars by getting rid of unnecessary payphone's and telephone lines in all hospitals.
- Interact with Verizon, AT&T and other vendors on bids, circuits and equipment for corporate office and Hospitals.
- Prepare, review and update data and voice circuit reports.
- Prepare weekly report for the Assistant Vice President of Information Services on all communication issues.
- Prepare fiscal budget for Corporate Telecommunications Department.
- New York, NY
Telephone Operator/Senior Healthcare Program Planner Analyst
NYC Health + Hospitals/Elmhurst
Queens
06.1993 - 12.2003
- Answer internal/External calls via switchboard.
- Responsible in contacting personnel for all Emergency codes such as Trauma Teams, Team 700's, Fire and various other emergencies.
- Supervise staff of 14 after combination of 2 Telecommunications Department into 1 call center.
- Created automated tree for Network of 2 hospitals.
- Prepare doctors on-call for all Departments within hospital schedule for telephone operators.
- Interacted with all departments regarding communications needs.
- Reviewed and processed telecommunications invoices and interacted with Verizon, AT&T and other vendors.
- Queens County, NY
Education
Registered Medical Assistant Certificate - Medical Assistant/ Billing and Coding/Phlebotomy
The New York School for Medical and Dental Assistants
Long Island City, NY01.2002
Associate of Applied Science - Business Administration
Plaza College
Forest Hills, NY01.1996
High School Diploma -
Newtown High School
Elmhurst, NY01.1991
Skills
- Healthcare billing expertise
- Patient care and bedside manner
- Team leadership skills
- Deadline management and prioritization
- Supervisory training experience
- Autonomous work capability
- Knowledge of insurance regulations
- Minor surgery assistance awareness
- Physical exam support
- ICD-10 coding proficiency
- Wound care management
- HIPAA compliance knowledge
- Therapeutic procedure competency
- Quality improvement strategies
- Compassionate patient interaction
- Insurance form completion expertise
- Clinical procedure experience
- Electronic health record management
Certification
- Certified Billing and Coding Specialist - CBCS
- Registered Medical Assistant - RMA
References
References available upon request.
Timeline
Denials Specialist
Rayus Radiology
04.2024 - 12.2025
Lead/Escalator/Lead/Supervisor CPAT
21st Century Oncology/Genesiscare USA/IC
11.2018 - 01.2024
Manager Insurance Department
Advanced Pain Management-Spine Specs
10.2012 - 05.2018
Medical Assistant/Clinical Coordinator
Advanced Pain Management-Spine Specs
10.2012 - 05.2018
Medical Assistant
The Colorectal Institute - under 21st Century Oncology
09.2006 - 01.2012
Senior Management Consultant
NYC Health + Hospitals
05.2000 - 12.2003
Telephone Operator/Senior Healthcare Program Planner Analyst
NYC Health + Hospitals/Elmhurst
06.1993 - 12.2003
Registered Medical Assistant Certificate - Medical Assistant/ Billing and Coding/Phlebotomy
The New York School for Medical and Dental Assistants
Associate of Applied Science - Business Administration
Plaza College
High School Diploma -
Newtown High School