Letitia Taylor
Summary
Experienced Provider Technical Specialist with 10 years of providing technological insight for training and managing organizational IT infrastructures. Hands-on leader assisting with technology research, consulting services, and planning and support, including in-field testing and staff training. Conducted periodic audits and troubleshooting to maintain a seamless, high level of optimized technology access. Critical expertise in leading full healthcare IT deployment, including design aid, management, and evaluation.
Overview
15
15
years of professional experience
Work History
Provider Technical Specialist I
Samaritan Health
12.2023 - Current
- Skillfully review workload to set and maintains priorities
- Analyze and manage routine information on providers in multiple states
- Update complex arrangements, accreditation information, directory date, reporting data, and provider linkage affiliations
- Reviewed and updated provider data sheets and reports returned from providers
- Contacted providers via telephone or in writing to verify data submitted and enter data into various systems
- Provide support to providers and Network Coordinators
- Performed payment and other provider-type analyses on an ad hoc basis
- Investigated issues surrounding claims
- Payments to physicians, quality incentive programs, credentialing/re-credentialing, and pricing
- Works closely with accounting on the year-end process tax process for providers.
- Trained junior technicians on industry best practices and company-specific procedures, fostering a culture of continuous learning and professional growth.
- Provided exceptional customer support, resolving complex technical issues with effective communication skills.
Patient Account Coordinator
Aston Carter - Atrium Health
10.2023 - 12.2023
- Completes claims and documents billing activity according to governmental regulations, agency policies, and department guidelines
- Reviews trends specific to denials, root cause, and A/R impact
- Reviews insurance credit balances to determine root cause, and takes necessary action to resolve account
- Complete logs, reports, forms, and records to properly document medical claims daily
- Process and research electronic remittances and bank deposits
- Works with Specialty Payers and other facilities to ensure compliance and payment
- Transfers charges between Patient and Facility accounts as required
- Examine medical treatment records, police reports, damage to physical property, and medical bills to gauge the overall extent of liability
- Escalates problem accounts as needed and leads the appeal process.
- Improved patient satisfaction by efficiently handling account inquiries and resolving billing issues.
- Developed comprehensive knowledge of multiple insurance plans, allowing for efficient navigation of varying requirements and processes.
Healthcare Account Manager and Claims Specialist
Preferred Health Plan of the Carolinas
07.2020 - 10.2023
- Examine claims records and forms to determine whether the patient has medical insurance
- Review the provision of the certificate of policy to determine the patient's included medical coverage
- Complete logs, reports, forms, and records to properly document medical claims daily
- Adhere to all company policies, procedures, and guidelines in addition to compliance with insurance regulations on federal and state levels
- Examine medical treatment records, police reports, damage to physical property, and medical bills to gauge the overall extent of liability
- Ensure all claims information remains confidential and engage in continuing education and training opportunities.
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
- Designed and introduced leadership development, coaching and team management model, resulting in promotion of employees into increased levels of responsibility.
Data Analyst Specialist
Genpact, LLC - Blue Cross Blue Shield
11.2019 - 02.2020
- Ensured compliance with established internal control procedures by examining records, reports, operational practices, and documentation
- Research, analyze, and administer healthcare plans and wellness programs, from medical and dental benefits to disability and family leave
- Coordinate non-salary employee compensation like retirement plans, pensions, tuition reimbursement, and stock options
- Assist with the administration of all benefits and retirement programs
- Appeal decisions made by insurance companies, resolve disputes and solve problems with benefits and compensation programs
- Perform quality checks of benefits-related data
- Completed audit work papers by documenting findings as per defined processes
- Performed adequacy appraisals of internal control systems and communicated audit findings by preparing a report and discussing with individuals audited
- I was a Healthcare Contract Author and engaged in continuous knowledge development regarding the sector's rules, regulations, best practices, and performance standards
- Provided services and support to staff, administration, government, and state
- Daily, I would troubleshoot and analyze to determine the root cause of any issues while administering direct resolution
- Systems utilized: FACETS, POWER MHS, Business Objects, EPIC, and MEET.
- Utilized data visualization tools to effectively communicate business insights.
- Produced monthly reports using advanced Excel spreadsheet functions.
Billing and Claims Specialist
Hospice and Palliative Care Charlotte Region
06.2019 - 10.2019
- Managed the status of accounts, balances, and inconsistencies and processed claims after review for resolution
- Made requests for Medicaid authorizations by entering patient information based on insurance benefits and self-pay information
- Utilized NC Tracks/NC Medicaid to verify the accuracy of Medicaid approvals including specific periods of start and end dates.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
Provider Data Specialists
UnitedHealth Group
12.2009 - 03.2018
- Demonstrated superior levels of knowledge and skills daily regarding solving routine problems, prioritizing agreed-upon deadlines, and loading the NDB Database with group accuracies
- Prepare and maintain biweekly employee reports, and new-hire and absentee reports
- Maintain and update company organizational charts, phone directory, and other requested reports as needed
- Assist the HR manager in obtaining statistics and information in the renewal process of any health, life, and retirement plans that benefit the company
- Prepare and set up meetings designed to help employees obtain information and understand company benefits and other related incentive programs
- Ensure distribution of required employee notices
- Audit, examine, and validate financial records and risk performance recommending to clients and managers their findings that reflect a true and fair picture of business operations
- Provided support for internal and external staff
- SME and trainer
- Daily, I interpreted and verified contract language, information, and intent to load the information
- Loaded contract information, and implemented updates and amendments (e.g., fee schedule updates, new fee schedule, demographic changes, termination, and rate corrections)
- I also accurately utilized appropriate systems (NDB, COSMOS, FACETS, PPO-One, NICE, EPIC, and PULSE)
- Reviewed and maintained reports (e.g., metrics, dashboards, spreadsheets associated with procedures and facts to solve routine problems or conduct routine analyses.
- Streamlined data entry processes for increased efficiency and reduced errors.
- Enhanced provider data accuracy by conducting thorough audits and reviews of the database.
Education
Master of Science - Healthcare Administration
Winston-Salem State University
Winston-Salem, NC05.2023
Bachelor of Science - Business Administration
Johnson C. Smith University
Charlotte, NC05.2019
Skills
- Security understanding
- Internet of Things
- Curriculum Development
- Zoom Proficiency
- Canvas Familiarity
- Research Methods
- Student Engagement
- Assessment Techniques
- Scholarly Writing
- Lecture Capture
Timeline
Provider Technical Specialist I
Samaritan Health
12.2023 - Current
Patient Account Coordinator
Aston Carter - Atrium Health
10.2023 - 12.2023
Healthcare Account Manager and Claims Specialist
Preferred Health Plan of the Carolinas
07.2020 - 10.2023
Data Analyst Specialist
Genpact, LLC - Blue Cross Blue Shield
11.2019 - 02.2020
Billing and Claims Specialist
Hospice and Palliative Care Charlotte Region
06.2019 - 10.2019
Provider Data Specialists
UnitedHealth Group
12.2009 - 03.2018
Master of Science - Healthcare Administration
Winston-Salem State University
Bachelor of Science - Business Administration
Johnson C. Smith University
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