LaDonna Moore
Graham
Summary
Dynamic Intake Specialist with BCBS North Carolina, skilled in data entry and compassionate communication. Proven track record in enhancing client satisfaction and compliance through effective case management and conflict mediation. Adept at analyzing data to identify training needs, fostering team development, and ensuring high-quality service delivery. A results-oriented achiever with proven ability to exceed targets and drive success in fast-paced environments. Combines strategic thinking with hands-on experience to deliver impactful solutions and enhance organizational performance.
Overview
14
14
years of professional experience
Work History
Intake Specialist
BCBS North Carolina / Spectraforce Technologies
12.2023 - Current
- Answered phone calls and provided new clients with the required paperwork to initiate service.
- Maintained high levels of accuracy and compliance in data entry, ensuring all information was correctly entered into the required systems.
- Gather and analyze data to provide feedback to Team Leads on employee development needs and/or specific providers requiring education on prior approval or pre-certification process while screening inquiries to determine if authorization is required
QPPMH
Family & Youth Foundation Counseling Services
05.2023 - 08.2023
- Implement the Mental Health skill-building principles to implement interventions such as daily living skills, medication management assistance, independent living skills, community service coordination, support for healthy relationships, help with setting daily routines, budgeting assistance, social skills training, and coping mechanism training.
- Assist clients in maintaining social equilibrium and independence in the most acceptable, most accommodating environment.
QPPMH
L & G Support and Resources
05.2022 - 05.2023
- Offer support in helping clients maintain community stability and independence in the most suitable, least restrictive environment.
- Utilize Mental Health Skills Building guidelines to introduce interventions about daily living skills, medication management assistance, independent living skills, community service coordination, support for healthy relationships, assistance with setting daily routines, budgeting assistance, social skills training, and training in coping mechanisms.
Patient Billing Specialist
LabCorp
12.2019 - 08.2022
- Maintained a high level of customer satisfaction, addressing patient concerns and resolving billing disputes professionally.
- Add provider details, and ICD 10 diagnosis codes to existing scripts to submit corrected claims to insurance.
- Collaborate with doctor offices, other medical facilities, and various insurance companies to resolve patient billing issues.
- Improved cash flow management with consistent follow-up on overdue invoices and establishing clear lines of communication with patients regarding their financial responsibilities.
Patient Financial Services Representative
UNC / REX Healthcare
06.2017 - 04.2019
- Maintained compliance with industry regulations, ensuring proper handling of sensitive patient data during the billing process.
- Improved patient satisfaction by providing timely and accurate financial information.
- Negotiated payment arrangements with self-pay patients, offering flexible solutions that aligned with their financial capabilities.
- Reduced errors in billing, conducting thorough audits of patient accounts and identifying discrepancies.
Agent Contact Center Representatve
BCBS North Carolina / Manpower Inc
10.2016 - 02.2017
- Assisted BCBS Producers with policy questions and concerns regarding enrollment and cancellation.
- Researched member portfolios to determine if member prescriptions, medical procedures, and physician visits would be covered under their existing policy.
- Answered questions regarding adding and removing dependents based on QLE guidelines and special enrollment periods.
- Educated agents who called in on how to utilize the producer portal to view members’ information, provide rate quotes, and view a listing of facilities in and out of the network that the member will be able to go to for certain medical procedures.
- De-escalated challenging concerns of the agent by determining the best solution whether it includes extensive research, specific call routing, and following up with results.
Call Center Supervisor
Faneuil
11.2010 - 10.2016
- Monitored call quality and provided individual constructive feedback to enhance performance and address areas in need of improvement.
- Trained team members on performance metrics and consumer behavior identification.
- Developed process controls and metrics for daily management of the call center.
- Assisted BCBS Producers with policy questions and concerns regarding enrollment and cancellation.
- Researched member portfolios to determine if member prescriptions, medical procedures, and physician visits would be covered under their existing policy.
- Educated agents who called in on how to utilize the producer portal to view members’ information, provide rate quotes, and view a listing of facilities in and out of the network that the member will be able to go to for certain medical procedures.
- De-escalated challenging concerns of the agent by determining the best solution whether it includes extensive research, specific call routing, and following up with results.
Education
Bachelor of Science - Counseling Psychology
Saint Leo University
Saint Leo, FLSkills
- Data entry
- Intake assessment
- Compassionate communication
- Critical thinking skills
- Assertiveness
- Conflict mediation
- Insurance verification
- Case management
- Active listening
- De escalation tactics
- Problem-solving
- Behavioral intervention
- Workflow management
Timeline
Intake Specialist
BCBS North Carolina / Spectraforce Technologies
12.2023 - Current
QPPMH
Family & Youth Foundation Counseling Services
05.2023 - 08.2023
QPPMH
L & G Support and Resources
05.2022 - 05.2023
Patient Billing Specialist
LabCorp
12.2019 - 08.2022
Patient Financial Services Representative
UNC / REX Healthcare
06.2017 - 04.2019
Agent Contact Center Representatve
BCBS North Carolina / Manpower Inc
10.2016 - 02.2017
Call Center Supervisor
Faneuil
11.2010 - 10.2016
Bachelor of Science - Counseling Psychology
Saint Leo University
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