Natasha LeDay
Summary
Analytical Claims Specialist with proven experience investigating and resolving property, health, and business claims.
Delivers professional and balanced customer service and meets needs of insured, claimant and internal and external customers. Insurance expert with exceptional knowledge of legal liabilities and claims practices and superior interpersonal skills.
Detail-oriented and strategic Healthcare Billing Specialist with 10+ years of experience in insurance claims management, insurance verification, customer service, and healthcare billing. Proven track record of ensuring accurate documentation review and effective settlement determinations. Skilled in assessing coverage, conducting Medicaid knowledge assessments, and performing thorough accident investigations.
Overview
12
12
years of professional experience
Work History
Appointment Scheduler
OPTUM SERVE-Remote
01.2024 - Current
- Setup Appointments/Follow Up with Physicians, Vision, Dental, Radiology, and other Various Providers & Hospitals for Veterans.
- Followed HIPPA Regulations & Compliance.
- Maintained composure and professionalism in high-pressure scenarios through active listening and empathetic communication, resulting in 30% increase in customer satisfaction scores.
Claims Specialist
SAGILITY HEALTH-Remote
03.2022 - 11.2023
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Implement rigorous double-check procedures for documentation of denied/accepted insurance claims by meticulously verifying each claim policy guidelines & medical records, resulting in 20% reduction in processing errors.
Insurance Verification Specialist
THE SMITH CENTER (Clayton Services)
12.2019 - 01.2022
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Communicated with insurance carrier, patient, and third party or employer to verify patient insurance benefits.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Updated patient and insurance data and input changes into company computer system.
Customer Service Representative
COMCAST, XFINITY
07.2019 - 11.2019
- Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
Claims Specialist
CARDON OUTREACH
07.2016 - 02.2019
- Oversaw regulatory and strategic initiatives to ensure accuracy of medical claims.
- Modified and updated existing policies and claims to reflect change in beneficiary, amount of coverage or type of insurance.
- Coordinated and planned investigations of claims to confirm compensability and coverage.
Liability Claims Adjuster
GEICO
03.2015 - 03.2016
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Negotiated and settled claims according to information presented through reports, research and data verification.
- Investigated claims, conducted field audits, determined losses and reported findings.
- Identified and obtained evidence to ascertain claim value.
Healthcare Billing Specialist
LABCORP
07.2012 - 03.2015
- Applied HIPAA privacy and security regulations while handling patient information.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
- Reviewed claims for coding accuracy.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
Education
No Degree - BACHELOR OF SCIENCE IN HEALTH MANAGEMENT
University of Phoenix
Katy, TXSkills
- Documentation review
- Settlement determinations
- Coverage assessments
- Medicaid & Medicare knowledge
- Accident investigations
- Medical terminology
- HIPAA Regulations & Compliance
- Communication
- Commercial Insurance knowledge
- Problem-Solving Skills
- Attention to Detail
- Meeting deadlines
Timeline
Appointment Scheduler
OPTUM SERVE-Remote
01.2024 - Current
Claims Specialist
SAGILITY HEALTH-Remote
03.2022 - 11.2023
Insurance Verification Specialist
THE SMITH CENTER (Clayton Services)
12.2019 - 01.2022
Customer Service Representative
COMCAST, XFINITY
07.2019 - 11.2019
Claims Specialist
CARDON OUTREACH
07.2016 - 02.2019
Liability Claims Adjuster
GEICO
03.2015 - 03.2016
Healthcare Billing Specialist
LABCORP
07.2012 - 03.2015
No Degree - BACHELOR OF SCIENCE IN HEALTH MANAGEMENT
University of Phoenix
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