Graise -  - Bronx, New York, NY, USA

Latonya Graise

Bronx, New York, NY, USA

Work History

Home Health Residential Aide

June 2013 - May 2014

Successfully provided daily care for resident in a home health setting
• Assisted resident in daily activities to provide maximum care
• Assisted resident in scheduling appointments, obtaining referrals, and escorting resident to and from daily activities

Insurance Specialist/Coder II

MedStar Health

October 2008 - May 2013

• Successfully assisted providers and/or patients in verifying eligibility of benefits for submission of claims
• Successfully educated providers on authorization processes to receive maximum claim reimbursement
• Verified Insurance coverage via telephone, online, and through the Electronic Verification System(EVS)
• Analyzed and processed appeals for Medicare Part D Prescription Drug Plan
• Supported doctors, hospitals, and Health Plan in obtaining prior-authorization for pre-services and post services for Medical and Pharmacy services

Appeals and Grievance Analyst

Bravo Health

July 2004 - October 2008

• Processed appeals for Quality Improvement Organization, Centers for Medicare and Medicaid services
• Performed necessary claim adjustments as required per the appeal resolution. This includes advanced levels of claims transactions/claim types and coordination of benefits.
• Analyzed system authorization to ensure accurate data entry with an understanding of Medical Management department's administrative processes and guidelines.

Appeals Coordinator

Schaller Anderson of Maryland

February 2002 - July 2004

• Process Incoming grievances and appeals for (Member, Provider, Hospitals)
• Process Claim Payment requests and generate request for Explanation of Payment/Benefits due to coding discrepancies and/or improper usage of codes.
• Provide customer support via inbound and outbound telephone calling to answer question from (Members, Provider, or Vendors)
• Prepare weekly reports for the Medical Management team

Switchboard Operator, Administrative Assistant, and Appeals Coordinator

NRI Staffing

April 2001 - January 2002

Unit Clerk Health Assistant, Cashier, Switchboard Operator

Humana Group Health Plan

March 1989 - April 2001

Qualifications & Certifications

Academy of Professional Coders

Information Systems

Strayer University

CGNA Petersburg School of Practical Nursing

Skillpages has been acquired by! is pioneering the way people find local services. Skillpages is the world’s premier directory of service providers.

Find out more

Supported Countries
Choose your country