Demetrius Blackman
Los Angeles
Summary
Dynamic professional with a proven track record at L.A Care Health Plan, excelling in customer service and revenue cycle management. Skilled in ICD Coding and adept at conflict resolution, consistently improving efficiency and productivity. Achieved significant improvements in claims processing and appeals, demonstrating a fast learning ability and exceptional multitasking skills.
Overview
9
9
years of professional experience
Work History
Customer Service Representative III
L.A Care Health Plan
08.2023 - 07.2024
- Assist Providers in response to telephonic and electronic inquiries on all products paid/unpaid claims.
- Ensure accurate information is being given to the provider in a timely manner.
- Escalate provider concerns to the Claims Department for resolutions.
- Assist provers with provider disputes, incorrectly paid claims, payment check status and Explanations of EOB request.
- Answer High Volume calls within call center.
- Assist members with Provider transfers/member i.d cards/ transportation/ coverage disputes/ member materials.
- Process member payments for Covered California member monthly premiums.
- Document interaction with providers and members.
Revenue Cycle Representative
MediRevv Tegria RCM
05.2021 - 01.2023
- Work with Management to standardize work flows and establish/improve processes to promote efficiency and productivity.
- Ensure all incorrect charge and claim discrepancies are corrected.
- Correct clearing house rejections and payer rejections daily.
- Notify manager regarding payer rejection trends works where necessary to accomplish continues flow of work within the department.
- Perform coding corrections & appeals.
- Collaborate with billing, coding, payment posting and/or business office manager and insurance payers on denied and/or corrected claims.
- Work special projects for upper leadership as designed.
- Assisted coworkers with additional training as needed.
Patient Account Representative Team Lead
Nthrive
10.2015 - 05.2021
- Full complete managed care medi-cal and commercial medi-cal followup on 35-40 claims per day.
- Track down inpatient authorizations from IPA's, complete retrospective reviews with complete medical records.
- Verify and obtain expected reimbursement per APR DRG calculator and contract manager.
- Complete appeals such as medical necessity, eligibility, timely filling and underpayments.
- Verify member eligibility submit claims to accurate Health Plans, IPA, or Capitated Facility.
Collections Specialist
Comprehensive Toxicology
05.2015 - 07.2015
- Make 80 - 100 calls per day to various adjustors, defense attorneys, applicant attorneys and insurance companies.
- Collect and resolve outstanding balance on various Workman's Compensations cases for toxicology services rendered to injured workers.
- Complete research on cases by getting accurate information on claims as well as determining Fee schedule sop cases can be collected effectively.
Education
Graduate Certificate - Medical Billing & Insurance Coding
UEI College
Gardena, CA05-2012
High School Diploma -
Animo South L.A Charter High School
Los Angeles, CA06-2011
Skills
- Scheduling
- Complaint resolution
- Conflict resolution
- Appeals
- ICD Coding
- CPT Coding
- Medical Records
- 60 WPM
- Explanations of Benefits
- Authorization/Retro Authorizations
- Adjust to changes quickly
- Fast Learner
- Citrix, Practice Vision, Salesforce, Epic, Emdeon, GPMS, Waystar, Noridian
- Multitasking
Timeline
Customer Service Representative III
L.A Care Health Plan
08.2023 - 07.2024
Revenue Cycle Representative
MediRevv Tegria RCM
05.2021 - 01.2023
Patient Account Representative Team Lead
Nthrive
10.2015 - 05.2021
Collections Specialist
Comprehensive Toxicology
05.2015 - 07.2015
Graduate Certificate - Medical Billing & Insurance Coding
UEI College
High School Diploma -
Animo South L.A Charter High School
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