Keith Langston Email & Phone Number

Westwood, Ma

-Manage a team of 11 full time employees divided between two areas of specialty; Self-Pay accounts & Registration Denials. -Self-pay accounts consist of balances outstanding with patients and financially responsible guarantors. -Registration denials consist of errors involving patient registration to determine appropriate insurance responsibility or self-balance.-Serve as liaison for external customer service management team.-Development of quality assurance and productivity management initiative for department.-Development of “coaching” program for management staff.-Assist management team with interviewing and hiring of potential candidates for employment.

Waltham, Ma

Preparing, analyzing, and posting all daily cash receipts.Performing coding for all rebills as required by insurersServing as the resource person to the department staff regarding billing and claims issuesWorking as a member of the team to coordinate effective billing and collectingProviding positive and effective customer service that supports departmental and hospital Operations. Contributing to the teamwork within and between departments and organizations.Mailing claims to selected third‑party insurers and conducts routine follow‑up.Handling inquiries from third‑party reimbursement agencies, other health care providers and patients/parents, supplying any documentation as required. Reviewing insurance payment notifications and denials for appropriateness; evaluates reimbursement rates and follows up on incorrect denials and underpaid claims. Reviews and prepares refund information for reimbursement to patients and/or third‑party agencies for overpayment on accounts.Assisting in the preparation of complex coding for billing for services utilizing resource books (CPT, ICD‑9 etc.) as required. Translating codes as required by third‑party insurers.Processing and balancing daily lockbox remittances, entering, verifying and updating all cash receipts on computer system. Prepares daily bank deposits for any direct payments received in department.Retrieving daily OR schedules and ensures timely billing. Quality charge capture reconciliation.Updating computer system with any new patient, insurance as they are received and verifies insurance eligibility through various web portals

Watertown, Ma

• Analyzed data through intake forms to generate alternative solutions to posting complications to eliminate the need for “one-time” CRM case resolution• Generate client specific reporting through athenaNet, conversion to Excel to scope trends• Creation and delivery of complete training presentation for account management team and clients on findings and best practice solutions• Individual management of upwards to 15 client experience projects and balancing of escalations and amiable client status

Watertown, Ma

• Reviewed unpostable records to determine whether errors have occurred and corrected to allow payments to be posted• Identified and communicated existing and potential problems and trends in the quality of remittance processing• Created training modules for specific unpostable event types for future employees• Worked with Posting Associates to clear the backlog of Unmatched EFT payments for clients• Managed case volume for CRM program to investigate and adjust client’s payments from multiple payers• Created training modules for use in the CSC to assist with specific posting workflows• Created quality assurance workflow for offshore partners to correct current inaccuracies including massive claim amounts and also to eliminate future errors from occurring• Assisted with the creation of the Operations Live Assistance Team for Posting to expedite CSC posting issues

Watertown, Ma

• Responsible for complete implementation of Small Group practices within athenaNet• Worked cross-functionally to troubleshoot complex issues related to billing and enrollment responsibilities• Serve as a point person for day to day enrollment questions as well as an escalation point within the small group team• Reviewed and corrected initial claim denials within athenaNet to ensure quick turnaround time for clients

Watertown, Ma

• Review and provide an in-depth analysis of commercial claims to provider rapid resolution for clients• Identify denial trends and create opportunities for rules to be implemented in athenaNet• Provide advance research by contacting commercial insurance payers and ensure resolution of claims• Assisted with creation of Claims Resolution Social Committee and provided assistance during committee events

Watertown, Ma

• Oversee and manage day to day operations for up to 13 fulltime employees• Resolve escalated issues from members, medical professional and partner departments• Interview candidates for positions within Member Services and assist with the new hire orientation program• Served as the liaison for the Tufts Health Plan Member Risk Management Team• Actively coached staff to strengthen their customer service skills

Watertown, Ma

• Work with members/providers to facilitate Prior Authorizations on medications through Clinical Review - Pharmacy Specialist• Utilize separate pharmacy database to verify prescription status and member activation - Pharmacy Specialist• Interpret pharmacy coverage and explain utilization for THP members - Pharmacy Specialist• Utilize strong writing skills to respond to member email inquiries - Email Response Specialist• Work as part of team to ensure that all inquiries are responded to in accordance with department expectations and within specified time lines - Email Response Specialist• Facilitate benefit and claims inquiries from employers, brokers, and consultants - Employer Queue Specialist • Responsible for abiding by separate HIPAA privacy laws - Employer Queue Specialist • Serve as liaison between the Sales and Service Department and the Member Services Department - Employer Queue Specialist• Responded to average of 8 calls per hour from Tufts Health Plan subscribers for a wide variety of health insurance issues.• Adjusted medical claims with assistance from providers and subscribers to ensure accurate payment and adjudication

English Literature, Creative Writing

Creative Writing, Us History

Activities and Societies: Jazz Band, Program Council, Residence Hall Association