Toshiya Luckey is seeking a position in the health industry utilizing skills in commercial insurance, workers compensation, Medicare, and Medicaid. He has over 10 years of experience in medical billing, claims processing, and auditing. His background includes roles as an operations policy compliance specialist, financial counselor, quality assurance analyst, and claims examiner/trainer. Toshiya Luckey has strong computer skills and is proficient in many systems used in healthcare such as IDX, Centricity, and Salesforce.

1. Toshiya D. Luckey
Toshiya.Luckey@gmail.com
469-644-7294
Objective: To obtain a position within the Health Industry in order to maximize my skills in the
Commercial, Workers Compensation, Medicare, and Medicaid.
Education:
Remington College Criminal Justice 2000-2001
Everest College Criminal Justice 2002-2003
Work Experience:
Teletrac Inc (Operations Policy Compliance Specialist)
October 2013-August 2014
Performed audits in Salesforce and other platforms to ensure policy and procedure guidelines are met
Reported weekly and bi weekly to Operation Executives of previous weeks KPI’s
Wrote and edited policy and procedure directives and updates to the companys CRM
Tracked representatives via Traincaster to ensure required courses attended and tests passed with
80% accuracy
Interacted with Sales and Operations in regards to customer satisfaction and procedure accuracy
Reported process trends and gaps in processes
Performed team and individual audits
Led in the creation of audits and reviewed processes to include notification and resolution
First Choice Emergency Room (Financial Counselor)
March 2013- September 2013
Corresponded with patients and insurance companies via inbound/outbound phone calls, email, and
mail.
Worked claims in collections 60, 90, 120, and 150 days delinquent via Centricity.
Verbally explained level of care, claims processing, balances, and negotiated discounts with patients.
Transferred balances and wrote off accounts. Tracked and reported payments paid to members.
Monitored claims submitted to commercial insurance companies for timely and proper payment.
Ensured claims were processed per patient benefits or sent back for adjustment.
Trained incoming employees on Collections Protocol and Processes. Audited and coached
employees as needed.
Schumacher Group ( Quality Assurance/Reporting Analyst II)
February 2011 - January 2012
Completed high level reports and audits to ensure company is running properly daily. Provided
management with daily volume of claims and statements extracted from TES to Bar, including
categorization, and daily monetary cash balances.

2. Provided and participated in performance training of employees. Recommended employee
improvements, wrote step-by-step Policy & Procedures for selected departments, provided
employee coaching, and reported errors to supervisors weekly.
Performed daily analysis ensuring all electronic claims have been submitted and accepted by all
payers. Provided weekly trending reports to upper management advising of accepted and rejects
with explanation.
Audited Collections Dept to ensure proper protocol was taken when recalling accounts. Researched
and completed all return accounts from collection agencies and report results. Audited/Trained
Edits Teams to ensure proper protocol was taken when prepping claims for payment. .
Distributed daily snapshot of all functions throughout company and all subsidiaries to Executive
Management team
Dell Perot Systems (Kaiser Permanente CSR/Claims Examiner/Trainer )
January 09 - January 11
Verified, keyed, and processed submitted Medicaid, CHIP Perinate, and Physical Therapy UB92 and
HCFA claims according current and relevant State Rules and Regulations.
Exceeded production averages and accuracy minimums for payments and denials.
Communicated with providers and members through clear and concise correspondence.
Monitored and followed up on pending claim activity requiring additional information timely and
accurately.
Took inbound member, provider, and broker calls. Enforced HIPPA laws with each phone call and
processed claim.
Audited accounts to ensure correct information was received. Made necessary corrections and
request additional information if required. Verified and updated member information and ensured
claims were processed according to each contract.
Explained Explanation of Benefits/Schedule of Coverage, advised members/providers of deductible/out
of pocket accumulations. Aided in medical/prescription authorization approvals. Trained and
provided coaching to incoming employees.
Related Skills:
10 Key By Touch, 40 wpm, ICD9, HCFA, UB92, CPT Codes, Medical Terminology, Analytical, Attentive to
Detail, Strong Interpersonal Skills, Excellent Written and Verbal Skills, Superb Customer Skills and
Etiquette, Insurance Verification, Pre Authorization, Claims Follow-Up, Knowledgeable of HIPPA Guidelines,
Medicare, Medicaid, Commercial Medical, Workers Compensation
Computer Software:
IDX, PBI, Centricity, Centricity EDI, Traincaster, Salesforce, Bill Pay, Kryptiq, Authorize. net, Excel (Pivot
Tables, Formulas, and V Lookup) Diamond, Power Trak, QNXT, Macess, Resolve It, Word, Access, Power
Point, Lotus Notes, Citrix, Brightree, MedForce, Internet Proficient