Larriqua Evans
Lancaster,TX
Summary
Ambitious healthcare professional with 7+ years of experience in patient, provider, and payer financial services. Skilled in government collections and proficient in healthcare platforms including HSP Meditrac, HSP Uniflow, Meditech, Connance, and Veracity. Extensive expertise in upstream and downstream healthcare operations and business processes. Successfully led small teams, communicated effectively with internal and external clients, and collaborated with direct leadership. Possess extensive knowledge of health exchange, credentialing, Medicaid, and Medicare billing practices, as well as patient and provider relations. Proficient in Microsoft Excel, Word, and Outlook for streamlining processes and improving efficiency. Adapts seamlessly to diverse environments, developing strong service skills and effective problem-solving abilities. Progressive, self-driven, and goal-oriented leader consistently achieving positive outcomes by leveraging all available resources.
Overview
9
9
years of professional experience
Work History
Medicaid Collector IV
Christus Healthcare
03.2020 - Current
- Collect balances due from payors ensuring proper reimbursement for all services
- Identify and forward proper account denial information to designated departmental liaison
- Maintain active knowledge of all governmental agency requirements and updates
- Performed daily management of collector queue using appropriate collection system and reports.
- Demonstrate knowledge of standard bill forms and filing requirements
- Manage underpayment resolution efficiently by promptly addressing discrepancies and following Payor guidelines for timely resolution.
- Identify and communicate trends impacting account resolution
- Enhanced accuracy of RTP status claims by strictly following Medicare guidelines in designated claim system
- Proficient in utilizing CMS 838 credit balance report
- Responsible for initiating Medicare Redetermination, Reopening, and reconsideration to meet requirements of timely filing guidelines.
- Conduct thorough research on complex claim issues, effectively resolving discrepancies and ensuring accurate reimbursement.
- Develop strong relationships with insurance providers, facilitating efficient communication for faster resolution of outstanding claims.
- Maximize revenue recovery by efficiently processing and managing Medicaid claims.
- Analyze trends in denials and rejections to identify recurring issues requiring policy or procedural adjustments.
- Ensure timely follow-up on denied or rejected claims, significantly increasing likelihood of successful collections.
- Process online and paper appeal submissions and refund requests.
- Enter client details and notes into system for interdepartmental access and review.
- Improved turnaround times for processing credentials by diligently reviewing and verifying provider eligibility.
- Coordinated with various departments to obtain necessary documentation for credentialing processes, promoting seamless collaboration.
- Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
- Managed multiple priorities effectively, resulting in on-time completion of credentialing tasks for numerous providers simultaneously.
Commercial Collector III
CHRISTUS Health
03.2018 - 03.2020
- Consistently achieved daily productivity standards
- Documented IPO occurrences for reporting purposes during team briefings.
- Effectively relayed precise details on account denials to relevant department contacts
- Dedicated efforts to ensure proper denial resolution and timely turnaround
- Monitored and communicates errors generated by other departments, communicating trends
- Provided continuous updates and information to Business Office Management regarding reimbursement and payment methodology, payer related issues, registration issues, and other controllable QA activities
- Prioritized and resolved correspondence, rejected claims, and returned mail within 48 hours of receipt
- Achieved timely resolution and documentation of all received business service requests, meeting required deadlines.
- Enhanced internal communication among departments involved in collections, fostering collaborative environments focused on achieving common goals.
Customer Service Representative
CHRISTUS Health Plan
04.2017 - 02.2018
- Offered comprehensive support to members regarding their healthcare coverage
- Communicated clear and accurate details on eligibility and benefits to both providers and members.
- Managed approximately 90 calls for inbound and outbound call activities per day
- Worked cross-departmentally to resolve issues with member account on one touch resolution methodology
- Provided assistance to members in identifying in network healthcare providers
- Examined claim status for providers.
- Investigated and resolved patient and provider inquiries and complaints quickly.
- Enhanced patient, provider and payer satisfaction by efficiently addressing and resolving healthcare-related inquiries.
Customer Service Representative
Health Management Systems (HMS)
03.2015 - 04.2017
- Performed daily verification of eligibility and benefits for over 200 policies using phone communication, ensuring accurate member information when online updates were not available.
- Enhanced member satisfaction by addressing concerns promptly and providing professional assistance.
- Resolved escalated member issues professionally, demonstrating empathy and understanding while maintaining company guidelines.
Education
Associate of Applied Science - Health Care Administration
Tarrant County Community College
05.2025
Skills
- HIPAA Compliance
- Claims Processing
- Insurance Verification
- Medicaid Regulations
- Teamwork and Collaboration
- Problem-solving abilities
- Excellent Communication
- Organizational Skills
- Microsoft Office
- Facility support
Timeline
Medicaid Collector IV
Christus Healthcare
03.2020 - Current
Commercial Collector III
CHRISTUS Health
03.2018 - 03.2020
Customer Service Representative
CHRISTUS Health Plan
04.2017 - 02.2018
Customer Service Representative
Health Management Systems (HMS)
03.2015 - 04.2017
Associate of Applied Science - Health Care Administration
Tarrant County Community College
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