LATOYA A. COACHMAN
Fort Lauderdale, FL 33311
Cell/ 754-301-1276
Email: kldowcoa@yahoo.com
____________________________________________________________________________
Professional Experience:
06/2016-Current- Skyemed Pharmacy and Infusion services, Pompano Beach, FL
Reimbursement Analyst
Managing outstanding AR balances with special attention on rejected claims, incorrectly billed claims to Insurance companies. Specialize in Commercial, Medicare, Medicaid, Workers comp and PBM electronic payers.
Daily work duties include but not limited to:
• Verify patient health plan benefits and coverage
• Appealing authorization decision with Utilization Management Department
• Reviewing orders to make sure they are up to date and accurate to services that are administered to the patient
• Running daily and monthly AR reports by aging and date billed.
• Bill PBM and commercial payers for all therapies.
• Attach all delivery tickets to corresponding claims
• Payment posting for patient pay, commercial, Medicare and Medicaid payers
• Manage all Self Pay accounts by making sure all payments are made prior to services being rendered.
• Appeal denials at Redetermination and Reconsideration levels.
• Speaking with Provider Relations as needed regarding underpayments.
• Researching Patient assistance programs to aid with paying patient responsibility
• Speaking with insurances on daily basis regarding payment status
• Reviewing unfavorable decisions from commercial insurances and Medicare
• Determining hardship status of patients for hardship waiver
• Setting up payment plan for patient responsibility
• Managing Medicare Part B Audits
03/2013-06/2016- Ambient Healthcare Specialty Pharmacy/Optum Rx, Weston, FL
Reimbursement Specialist/Patient Accounts
Work duties include:
• Obtaining Authorizations for Home Infusion services and Home Health
• Verify patient health plan benefits and coverage
• Appealing authorization decision with Utilization Management Department
• Reviewing orders to make sure they are up to date and accurate to services that are administered to the patient
• Manage all Self Pay accounts by making sure all payments are made prior to services being rendered.
• Appeal denials at Redetermination and Reconsideration levels.
• Speaking with Provider Relations as needed regarding underpayments.
• Researching Patient assistance programs to aide with paying patient responsibility
• Speaking with insurances on daily basis regarding payment status
• Reviewing unfavorable decisions from commercial insurances and Medicare
• Determining hardship status of patients for hardship waiver
• Setting up payment plan for patient responsibility
02/2009-1/2013 Mrb Acquisition Corp./dba Open-aire, Ft. Lauderdale, FL
Patient Accounts Coordinator IV
Work duties include:
• Billed for patients oxygen and Infusion therapy as well as other dme services, billed to commercial insurances, Medicare, and Medicaid.
• Follow up with denials by Appeals or requesting necessary medical records to process claims.
• Manage patient account balances, copays and insurance balances.
• Process patient Hardship waivers, and process patient statements each month. Send necessary information for insurance audits.
• Appeal unfavorable decisions with Medicare, and commercial insurances on all levels.
• Process overpayments/refund for all insurances including Medicare and Medicaid and patients.
• Review Certificate of medically necessity to make sure it is accurate and up to date.
• Call patients primary physicians for medical records and tests.
• Also have knowledge of Brightree software and AS400 data base.
09/2005 - 12/2008 Health Care Credit Union/ICAN Benefit Boca Raton, FL Billing Collections Specialist/Patient Advocate
• Request UB-04, UB-92, and HCFA from providers to process bills
• Request itemized bill for review of pre-existing conditions
• Request W-9 from providers
• Review EOB and EOP with patient and providers
Education:
Boyd Anderson high school - high school diploma-2003
ATI Technical- studied in Medical Billing and Coding as well as Medical Terminology- 07/2008
AAPC membership- 09/2017
Qualifications:
Proficient in Microsoft Word 2003, 2007 and 2010
Excel 2003, 2007 and 2010 programs, Power point, Microsoft Office and Microsoft Access.
Mastered CPR+, Caretend, Brightree, AS400, MediSOFT, Salesforce, and First Data
*References available upon request.
Fort Lauderdale, FL 33311
Cell/ 754-301-1276
Email: kldowcoa@yahoo.com
____________________________________________________________________________
Professional Experience:
06/2016-Current- Skyemed Pharmacy and Infusion services, Pompano Beach, FL
Reimbursement Analyst
Managing outstanding AR balances with special attention on rejected claims, incorrectly billed claims to Insurance companies. Specialize in Commercial, Medicare, Medicaid, Workers comp and PBM electronic payers.
Daily work duties include but not limited to:
• Verify patient health plan benefits and coverage
• Appealing authorization decision with Utilization Management Department
• Reviewing orders to make sure they are up to date and accurate to services that are administered to the patient
• Running daily and monthly AR reports by aging and date billed.
• Bill PBM and commercial payers for all therapies.
• Attach all delivery tickets to corresponding claims
• Payment posting for patient pay, commercial, Medicare and Medicaid payers
• Manage all Self Pay accounts by making sure all payments are made prior to services being rendered.
• Appeal denials at Redetermination and Reconsideration levels.
• Speaking with Provider Relations as needed regarding underpayments.
• Researching Patient assistance programs to aid with paying patient responsibility
• Speaking with insurances on daily basis regarding payment status
• Reviewing unfavorable decisions from commercial insurances and Medicare
• Determining hardship status of patients for hardship waiver
• Setting up payment plan for patient responsibility
• Managing Medicare Part B Audits
03/2013-06/2016- Ambient Healthcare Specialty Pharmacy/Optum Rx, Weston, FL
Reimbursement Specialist/Patient Accounts
Work duties include:
• Obtaining Authorizations for Home Infusion services and Home Health
• Verify patient health plan benefits and coverage
• Appealing authorization decision with Utilization Management Department
• Reviewing orders to make sure they are up to date and accurate to services that are administered to the patient
• Manage all Self Pay accounts by making sure all payments are made prior to services being rendered.
• Appeal denials at Redetermination and Reconsideration levels.
• Speaking with Provider Relations as needed regarding underpayments.
• Researching Patient assistance programs to aide with paying patient responsibility
• Speaking with insurances on daily basis regarding payment status
• Reviewing unfavorable decisions from commercial insurances and Medicare
• Determining hardship status of patients for hardship waiver
• Setting up payment plan for patient responsibility
02/2009-1/2013 Mrb Acquisition Corp./dba Open-aire, Ft. Lauderdale, FL
Patient Accounts Coordinator IV
Work duties include:
• Billed for patients oxygen and Infusion therapy as well as other dme services, billed to commercial insurances, Medicare, and Medicaid.
• Follow up with denials by Appeals or requesting necessary medical records to process claims.
• Manage patient account balances, copays and insurance balances.
• Process patient Hardship waivers, and process patient statements each month. Send necessary information for insurance audits.
• Appeal unfavorable decisions with Medicare, and commercial insurances on all levels.
• Process overpayments/refund for all insurances including Medicare and Medicaid and patients.
• Review Certificate of medically necessity to make sure it is accurate and up to date.
• Call patients primary physicians for medical records and tests.
• Also have knowledge of Brightree software and AS400 data base.
09/2005 - 12/2008 Health Care Credit Union/ICAN Benefit Boca Raton, FL Billing Collections Specialist/Patient Advocate
• Request UB-04, UB-92, and HCFA from providers to process bills
• Request itemized bill for review of pre-existing conditions
• Request W-9 from providers
• Review EOB and EOP with patient and providers
Education:
Boyd Anderson high school - high school diploma-2003
ATI Technical- studied in Medical Billing and Coding as well as Medical Terminology- 07/2008
AAPC membership- 09/2017
Qualifications:
Proficient in Microsoft Word 2003, 2007 and 2010
Excel 2003, 2007 and 2010 programs, Power point, Microsoft Office and Microsoft Access.
Mastered CPR+, Caretend, Brightree, AS400, MediSOFT, Salesforce, and First Data
*References available upon request.