Alfreda Jones
Dothan,AL
Summary
Dynamic Benefits Specialist with extensive experience at TriWest Healthcare Alliance, adept at resolving complex issues and enhancing employee satisfaction. Proficient in HRIS systems and relationship building, I have successfully improved retention rates through effective communication and innovative problem-solving. Committed to delivering exceptional service in fast-paced healthcare environments.
Overview
9
9
years of professional experience
Work History
Expert Benefits Specialist
TriWest Healthcare Alliance
02.2025 - Current
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email, and in-person interactions.
- Assisted in resolving complex benefits issues, leading to increased employee satisfaction and retention rates.
- Updated HRIS systems as needed to reflect benefit-related changes accurately, maintaining up-to-date records for all team members.
Lead Certification Specialist / Contractor
Pfizer Oncology
09.2024 - 02.2025
- Compiled data from various sources to prepare certifications.
- Enhanced overall brand reputation by maintaining high-quality standards within each offered certification program while also continuously seeking ways to innovate and improve offerings based on industry demands.
- Interpreted requirements and reviewed projects to assess compliance.
Referral Management Clerk/ Medical Records Special
Southeast Health Medical Center
03.2024 - 09.2024
- Scheduled appointments with specialists on behalf of clients.
- Verified insurance benefits and eligibility for pain management procedures before referring clients.
- Coordinated with medical staff and patients to find cost-effective options for services.
- Built professional relationships with service providers.
- Obtained prior authorization for surgical procedures. Within Epic
Certification Specialist
Pfizer Oncology
08.2023 - 03.2024
- Facilitated interdepartmental collaboration to identify synergies between certification programs and other organizational initiatives, maximizing the value of resources.
- Coordinated with subject matter experts to develop relevant exam content for various certifications, ensuring validity and reliability.
Pharmacy Benefits Manager
Maxor Pharmacy
06.2021 - 08.2023
- Ensured compliance with regulatory requirements, maintaining accurate records and documentation of pharmacy benefit management activities.
- Developed comprehensive drug formularies, ensuring access to safe, effective, and affordable medications for members.
- Managed relationships with key stakeholders, including employers, health plans, and pharmacy networks, fostering a collaborative approach to pharmacy benefits management.
Patient Account Representative II
Vanderbilt University Medical Center
12.2019 - 07.2021
- Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
- Worked with outside entities to resolve issues with billing, claims, and payments.
- Provided exceptional customer service, handling sensitive patient situations with professionalism and empathy.
Patient Access Representative II
Health Services Inc
08.2018 - 12.2019
- Ensured compliance with HIPAA regulations to maintain confidentiality of sensitive patient information during all interactions.
- Enhanced overall patient experience with empathetic communication and thorough explanations of insurance benefits and coverage.
- Facilitated smooth billing processes by verifying insurance eligibility, obtaining authorizations, and accurately entering claim details into the system.
Patient Access Representative
Jackson Hospital and Clinic
06.2016 - 08.2018
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Adapted quickly to changing demands within the healthcare environment, demonstrating flexibility and a strong commitment to quality patient care.
- Provided excellent customer service through active listening skills, understanding patient needs, and offering tailored solutions where applicable.
- Contributed to a positive work environment by fostering strong relationships among colleagues, promoting teamwork, and sharing best practices.
Education
Medical Management
UMA
OnlineAssociate Of Applied Arts -
Faulkner University
Montgomery, AL05.2018
HS Diploma -
Dale County High
Midland City, AL05.2000
Skills
- Verbal and written communication
- Healthcare benefits
- Benefits explanation
- Written and oral communication
- Relationship building
- Policy interpretation
- HRIS systems
- Documentation and reporting
- Proficient in Salesforce, Paragon, Athena, Epic, Care Radius, Opsconnect and DOMA
Timeline
Expert Benefits Specialist
TriWest Healthcare Alliance
02.2025 - Current
Lead Certification Specialist / Contractor
Pfizer Oncology
09.2024 - 02.2025
Referral Management Clerk/ Medical Records Special
Southeast Health Medical Center
03.2024 - 09.2024
Certification Specialist
Pfizer Oncology
08.2023 - 03.2024
Pharmacy Benefits Manager
Maxor Pharmacy
06.2021 - 08.2023
Patient Account Representative II
Vanderbilt University Medical Center
12.2019 - 07.2021
Patient Access Representative II
Health Services Inc
08.2018 - 12.2019
Patient Access Representative
Jackson Hospital and Clinic
06.2016 - 08.2018
Medical Management
UMA
Associate Of Applied Arts -
Faulkner University
HS Diploma -
Dale County High