Latoya Edmon

Verified insurance eligibility and benefits, submitted clinical information with ICD/CPT codes to obtain prior authorizations, and collaborated with providers to escalate denials to appeals.

Reviewed, researched, and negotiated physician and dental claims, ensured ICD/CPT coding accuracy, and repriced bills per contractual agreements while maintaining HIPAA compliance.

Processed and assessed medical expense claims, reported procedural irregularities, and recommended process optimizations to improve workflow efficiency and claim accuracy.

Analyzed and processed provider transactions in accordance with plan provisions, resolved complex cases using technical expertise, and identified opportunities for operational improvements.

Managed billing and claims for urgent care and ABA therapy, executed coding and submissions using practice management and EMR systems (eMDs, Waystar) to collect payments efficiently.

Conducted provider research to secure savings, negotiated resolution proposals aligning with client policies, and managed post-claim service inquiries while ensuring HIPAA compliance.

Investigated and resolved automobile, homeowner, and medical claims, applied CPT/ICD/HCPCS coding and DRG/CSM assignments, and maintained accurate claim payments and communication with stakeholders.

Earned an Associate Degree in General Studies, completed in May 1996.

Completed High School Diploma with a general education focus, graduating in May 1993.