Tongia Lawson
New Orleans,LA
Summary
Attentive healthcare passionate about offering expert support for emotional, physical and mental needs. Caring, and vigilant. Bringing top-notch multitasking, organizational, and conflict management skills. Versatile and hardworking professional with 15 years of experience caring for diverse conditions. Committed to leveraging knowledge of industry equipment and technology to support diagnosis and treatment.
Overview
16
16
years of professional experience
Work History
Analyst, Case Management
Aetna, CVS Health
Kansas City, KS
11.2015 - Current
- Review accuracy and completeness of information requested and ensure that all supporting documents are present.
- Collaborated with cross-functional teams to identify opportunities for process improvement and increased efficiency.
- Improved internal knowledge sharing by developing comprehensive documentation outlining standard operating procedures for various tasks.
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
- Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
- Supports the administration of the hospital, case management, and quality management processes in compliance with various laws and regulations, NCQA standards, CMSA standards where applicable.
- Identifies high-risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
- Coordinates and implements assigned care plan activities and monitors care plan progress.
- Maintained accurate records of all data collected during analysis processes.
Patient Access Representative
LCMC Health
New Orleans, LA
05.2012 - 11.2015
- Verifies insurance coverage, collecting, and documenting insurance benefits and authorization requirements and procuring necessary authorizations.
- Documenting insurance information, personal information, payment methods, and other important patient information.
- Perform insurance verification by running automated eligibility response at point-of-service to ensure active coverage and completing notification of admission with insurance company within established timeframe.
- Adapted quickly to changing demands within the healthcare environment, demonstrating flexibility and a strong commitment to quality patient care.
- Provided excellent customer service through active listening skills, understanding patient needs, and offering tailored solutions where applicable.
- Improved patient satisfaction scores by actively addressing concerns and providing prompt assistance during the check-in process.
- Assisted with administrative tasks such as filing, data entry, and report generation to support streamlined office operations.
- Supported medical staff by coordinating diagnostic testing appointments, lab results retrieval, and necessary referrals in a timely manner.
- Contacting insurance companies regarding coverage, pre-approvals, billing, and other issues.
- Processing payments from patients and handling billing issues between patients and insurance companies.
- Researches and resolves any issues impeding the efficient and effective registration of accounts; working with team on quality assurance scores to improve accuracy and by monitoring the workques for those accounts.
- Created new patient accounts in EMR system as needed.
Revenue Cycle Specialist
Ocshner Medical Center
Metairie, LA
01.2009 - 05.2012
- Increased revenue by identifying and resolving billing errors in a timely manner.
- Trained new team members on revenue cycle best practices, contributing to a more knowledgeable workforce.
- Served as a liaison between clinical departments, finance, and administration, ensuring smooth communication for proper revenue cycle management.
- Ensured accurate billing with thorough audits of patient accounts and insurance claims.
- Reached out to insurance companies to verify coverage.
- Enhanced customer satisfaction by promptly addressing and resolving billing disputes.
- Maintained clear documentation of all activities related to unpaid claims or denied services.
- Improved patient satisfaction by providing clear, concise explanations of billing procedures and insurance coverage.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
Education
Sarah T. Reed High School
New Orleans, LouisianaBachelor of Science - Healthcare Management Information
Capella University
Skills
- Customer service
- Communication skills
- Computer literacy
- Leadership
- Microsoft excel
- Microsoft word
- Project Management
- Insurance Verification
- Audit Support
- Analysis Skills
- Database Management
- Microsoft SQL
Timeline
Analyst, Case Management
Aetna, CVS Health
11.2015 - Current
Patient Access Representative
LCMC Health
05.2012 - 11.2015
Revenue Cycle Specialist
Ocshner Medical Center
01.2009 - 05.2012
Sarah T. Reed High School
Bachelor of Science - Healthcare Management Information
Capella University