Latia Williams Email & Phone Number

United States

Remote

Jacksonville, Florida, United States

Support the clinical medical review team.Serve as a “Universal” Service Advocate responding to inquires related to all segments including Medicare, Group, and Consumer across multiple functions.Assist providers with the entry and update of prior authorization / pre service requests.Research, coordinate and resolve inquiries and claim exceptions.Process prior authorization requests received via phone, fax or correspondence following internal policies and procedures accurately timely and with attention to detail.Processing prior authorization requests from providers to assure quality clinical outcomes for health plan members. Act as a liaison between hospitals, physicians, health plans, vendors and referral sources.Coordinate with other provider service areas to identify formal education opportunities.Assist internal and external customers requiring resolution via telephone, electronically and through written correspondence.Enters referrals and documents communications, actions and other data in departmental systems.Resolve complex problems and inquiries related to enrollment, membership, claims, billing, benefits, member web sites, CMS, Federal Market Place, Guidewell Campaigns, Vendor Arrangements, Ancillary products and escalations.Determines contract and benefit eligibility.Initiates and manages clinical referrals for members.Verifies insurance coverage and obtains authorizations if needed.

Jacksonville, Florida Area

Demonstrate passion for providing superior customer service to our customers and continually seeks to understand the needs of those we serve.Follow internal processes and procedures to ensure all activities are performed in accordance with departmental and company policies and procedures.Provide members education and assist members with PCP selection and assignments.Create accurate and timely member documentation concerning all inquiries taken in accordance to established protocols to ensure resolution is provided and presented in a clear and accurate manner.Answer inbound and make outbound calls to members and/or providers regarding benefits, eligibility or customer issues.Assists with access to care and wellness programs.Resolve inquiries on first contact while ensuring that the inquiries have been addressed to the customer’s satisfaction by using all resources in an efficient and timely manner.Conduct Health Risk Assessment Surveys as needed.Create and support an environment which fosters teamwork, cooperation, respect and diversity.Maintain an awareness of all product knowledge information of Managed Care Organizations (MCO) and Healthcare Maintenance Organizations. (HMO).

Remote

• Design, build, configure, test and validate documentation needed for contract installation across various application software.• Overall employer contract loading using various databases and/or source documents.• Audit contract loads for adherence to quality measures and reporting standards.• Translate clinical/operational needs and workflow into systems specifications and configuration requirements.• Research configuration and setup installation issues and develop customer specific resolutions.• Create policy and procedure documents for new and existing accounts.• Provide detailed EOC (Evidence of Coverage) for review to ensure plan details (i.e. coverage, costs and how the plan/policy works) meets the needs of covered members.• Perform internal peer audits to ensure quality standards are continuously surpassed.• Review ANOC (Annual Notice of Change) for any changes in coverage and coverage and/or cost that will take effect the following year to determine if the current plans will continue to meet the policy holders’ needs.• Participate in process improvement projects such as designing team SharePoint and organizing team documents.

Remote

● Responsible for initial triage of members and administrative intake of members.● Manage the admission and discharge information post-notification.● Work with hospitals and the clinical team to validate and complete pre-service notification in a timely manner.● Manage the referral process and prior authorization for members and clinical staff in regards to patient intake and service notifications.● Manage medical Insurance precertification / clinical review.● Work with hospitals and clinical teams for initial triage of members.● Manage requests for health services from physicians, ancillary providers and members.● Review service inquiries for correct ICD-9, ICD-10, CPT4 & HCPCS coding.● Analyze benefit information in comparison to the patient’s diagnosis and CPT4 coding.● Provide benefit education and management on covered services and network availability.● Process and review applications for Transition of Care (TOC) and Continuation of Care (COC).

Jacksonville, Florida Area

Scheduled appointment for inpatient and outpatient services.Entered and completed patient demographics in SMS system.Completed pre-registration and register patients for upcoming visits and procedures.Verified insurance information such as co-payments, funds for collection for Emergency Room patients, inpatient and outpatient services and procedures.Answered questions regarding patient arrivals, directions to facilities and services.Reviewed insurance products, medical terminology, ICD-9 and CPT coding.

Jacksonville, Florida Area

Interacted with customers from diverse cultures and backgrounds in regards to their healthcare needs.Supported continuous improvement efforts through the early identification, investigation and resolution of problems by communicating and coordinating with the appropriate contacts for completion.Provided information and guidance to customers regarding the selection of the Company’s products, benefits and services.Provided customer service to plan members and/or providers, agents, brokers, consultants, or employer groups.Researched and resolved issues, inquiries and exceptions.

High School, Diploma

Professional Certification, Medical Insurance Coding Specialist/Coder, 4.0

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