Takesha Scott
Conway
Summary
Experienced human services and healthcare professional with over 10 years in eligibility determination, benefits administration, and claims processing. Skilled in reviewing applications, verifying documentation, and ensuring regulatory compliance. Expertise includes Medicaid, SNAP, and Medicare claims, with a focus on effective communication and collaboration with clients and multidisciplinary teams.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Eligibility Specialist I
South Carolina Department of Health and Human Services (SCDHHS)
Conway
06.2023 - Current
- Review and determine eligibility for MAGI Medicaid applications and renewals.
- Contact clients to obtain and verify required information and documentation.
- Approve or deny applications in accordance with state and federal guidelines.
- Maintain accurate case records and ensure timely case processing.
- Collaborate with coworkers to address complex cases and meet departmental goals.
Claims Processor II
Blue Cross Blue Shield/CGS
Tennessee
02.2022 - 06.2023
- Review and process Medicare claims accurately and efficiently.
- Maintain daily production goals and ensure compliance with company standards.
- Analyze documentation and resolve claim discrepancies.
Human Services Specialist I
South Carolina Department of Social Services
Conway
04.2020 - 02.2022
- Determined client eligibility for SNAP benefits according to state regulations.
- Verified application information and supporting documentation.
- Processed applications and maintained accurate case records.
- Assisted clients in obtaining required documentation and understanding program requirements.
Billing Specialist
Grand Strand Pediatrics
Myrtle Beach
03.2018 - 04.2020
- Processed insurance billing and reconciled patient and insurance payments.
- Resolved billing inquiries and account discrepancies.
- Retrieved and processed Electronic Remittance Advices (ERAs).
- Trained peers on billing procedures and system processes.
- Utilized Allscripts and Phreesia systems to manage patient accounts.
Claims Processor I
Blue Cross Blue Shield
Surfside Beach
06.2016 - 03.2018
- Processed insurance claims in compliance with company guidelines and regulations.
- Reviewed claim submissions for accuracy and completeness prior to processing.
- Assisted in training new staff on claims processing procedures and best practices.
Claims Processor I
Kelly Services
06.2015 - 06.2016
- HIPAA and compliance training
- Entered claim information into database systems, ensuring accuracy and compliance.
- Managed workload to consistently achieve productivity and quality benchmarks.
Education
Medical Billing and Coding Diploma -
Miller-Motte Technical College
Conway, SCAssociate Degree - Medical Assistant
Miller-Motte College
Conway, SCSkills
- Eligibility Determinations
- Medicaid and SNAP Programs
- Application Processing
- Case Management
- Documentation Verification
- Customer Service
- Claims processing
- Data management
- Microsoft Office Suite
- HIPAA Compliance
- Problem Solving
- Team Collaboration
- Achieved performance targets
- Consistently exceeded goals
- Leadership support
- Client intake assistance
- Peer coaching sessions
Certification
- Certified Clinical Medical Assistant (CCMA)
- Certified Medical Assistant (CMA), 02/01/27
- Mental Health First Responder Aid
Timeline
Eligibility Specialist I
South Carolina Department of Health and Human Services (SCDHHS)
06.2023 - Current
Claims Processor II
Blue Cross Blue Shield/CGS
02.2022 - 06.2023
Human Services Specialist I
South Carolina Department of Social Services
04.2020 - 02.2022
Billing Specialist
Grand Strand Pediatrics
03.2018 - 04.2020
Claims Processor I
Blue Cross Blue Shield
06.2016 - 03.2018
Claims Processor I
Kelly Services
06.2015 - 06.2016
Medical Billing and Coding Diploma -
Miller-Motte Technical College
Associate Degree - Medical Assistant
Miller-Motte College