LaWanda Warren
St. Louis,MO
Overview
17
17
years of professional experience
Work History
Appeals & Grievance Coordinator
Centene
Clayton, MO
01.2020 - Current
- Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members
- Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
- Prepare response letters for member and provider complaints, grievances and appeals
- Maintain files on individual appeals and grievances
- May coordinate the Grievance and Appeals Committee
- Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
- Assist with HEDIS production functions including data entry, calls to provider's offices, and claims research
- Manage large volumes of documents including copying, faxing and scanning incoming mail
Pharmacy Technician
Schnucks
Maryland Heights, MO
12.2019 - Current
- Preparation of medications for patients
- Receiving and verifying the prescriptions
- Pricing and filling of prescriptions
- Obtaining pharmacist's approval
- Completing patient paperwork related to the filling of prescription
- Assisting Pharmacist with insurance claims processing
- Stocking and pricing of medications in inventory
- Ensuring availability of drugs by delivering them to patients or facilities
- Maintaining pharmacies safety by adhering to infection-control procedures, policies and regulations
Contract Analyst
Equifax
05.2019 - 11.2019
- Draft, review, approve, and negotiate government customer contracts, contract amendments and extensions and prepares Legal responses to bids or requests for proposals (RFPs)
- Contracting experience relating to RFP analysis and negotiation of contracts, subcontracts, task orders and modifications
- Combines business and legal expertise to create innovative custom contract solutions to meet business objectives
- Evaluates contracts for compliance and advises others on contractual rights and obligations, applying and recommending best practices
- Advises sales organization on business terms and conditions, including providing business risk analysis, and collaborates with sales and business to create contractual solutions
- Works directly with Risk Management Department / Finance / Security to coordinate and facilitate contractual requirements
- Performs contract risk analysis and escalates strategic contracts to senior Legal resources as applicable
- Participates in department projects; recommends, contributes to and may lead process improvement initiatives.
Reimbursement Specialist
UBC
St. Louis, MO
02.2019 - 04.2019
- Conduct benefit investigations by verify insurance benefits for the patient and physicians office
- Submit and obtain prior authorization as required by payer
- Accurately enter and maintain data as required in client database and patient files
- Participate in conference calls with Client Sales Representatives, client management and physicians' offices regarding status of cases, drug orders and status of alternative funding
- Provide coordination of order for product, shipment of product, and therapy initiation with pharmacy and patient
- Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, physicians, Sales Reps, pharmacies and homecare agencies
- Recognize and report adverse events, product quality complaint and potential risk events and forward information to the appropriate team member for reporting to the manufacturer
- Educate patients, prescribers, and others regarding program requirements, and facilitate referrals
- Adhering to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures.
Medical Insurance Collector USPI
St. Louis, MO
08.2018 - 01.2019
- Performed timely and accurate follow-up on claims to payers and patients following prescribed policies and procedures
- Prepared and submitted timely and accurate rebilled claims to both primary/secondary/tertiary payers following prescribed policies and procedures
- Generated claims for both electronic and/or hard-copy submission
- Accurately entered patient demographic data into the billing and collections database
- Generated Appeals and reconsiderations to insurance companies on claims that paid incorrectly or not at all.
Patient Account Representative
Saint Louis University
St. Louis, MO
03.2012 - 08.2018
- Reviewed patient accounts to identify delinquent and due balances
- Submitted claims to various insurance payers via electronic submission as well as mailed paper claims
- Followed up with insurance companies for claim processing and reimbursements
- Addressed billing issues and inquiries from patients
- Posted payments, refunds
- Adjustments and coordinated with insurance companies to resolve claims problems and reimbursement issues
- Submitted provider appeals for denied claims
- Extensive communication with members, providers and internal/external clients regarding appeals and grievances
- Submitted claims to secondary or tertiary insurances plans
- Contacted patients in order to collect on patient balance accounts
- Generated weekly statistical reports of outstanding claims for team-mates to work accordingly
- Answered all patient or insurance telephone inquiries pertaining to assigned accounts
Medical Billing Specialist
NextGen Healthcare
Maryland Heights, MO
06.2007 - 10.2012
- Benefits verification for treatments, hospitalizations, and procedures for patients and provider offices
- Reviewed patient bills for accuracy and completeness, and obtaining any missing information prior to billing
- Prepared, reviewed, and transmitted claims using billing software, for both electronic and paper claim processing
- Following up on unpaid claims within standard billing cycle timeframe
- Submitted Appeals and Reconsiderations for denied claims
- Verified insurance payer payment for accuracy and compliance according to various contracts
- Contacted insurance companies regarding any discrepancy in payments when necessary
- Posted insurance and patient payment
- Obtained referrals and pre-authorizations as necessary
- Processed Reimbursements to insurance payers and patients when necessary
- Identified and billed secondary or tertiary insurances
- Researched and appealed denied claims with supporting documentation from providers.
Education
Associate - Medical Billing
Saint Louis College of Health Careers
June 1995
Skills
- Contract Negotiation
- Triage
- Medical Billing
- Insurance Verification
- HEDIS
- Pharmacy Technician Experience
- EMR Systems
- Medical Office Experience
- Medical Terminology
- Hospital Experience
- Epic
- Emomed
- Amisys
- CRM Software
- Nextgen
- Trucare
- Prime
- ICD-9
- ICD-10
- SharePoint
- EzBoard
- Contracts
- Medical Claims
- HCFA-1500 & UB92 Claim Forms
- Medical Records
- CPT Coding
- Quality Assurance
- Documentation Review
- Documentation
Timeline
Appeals & Grievance Coordinator
Centene
01.2020 - Current
Pharmacy Technician
Schnucks
12.2019 - Current
Contract Analyst
Equifax
05.2019 - 11.2019
Reimbursement Specialist
UBC
02.2019 - 04.2019
Medical Insurance Collector USPI
08.2018 - 01.2019
Patient Account Representative
Saint Louis University
03.2012 - 08.2018
Medical Billing Specialist
NextGen Healthcare
06.2007 - 10.2012
Associate - Medical Billing
Saint Louis College of Health Careers