Summary
Overview
Work History
Education
Skills
Timeline
Generic

Arlandria Tinsley

Mobile

Summary

Experienced Medical Only Claims Specialist with a strong background in healthcare customer service and administration. Demonstrated expertise in accurately maintaining medical records, assessing claims compensability, and effectively managing reserves. Adept at utilizing computer systems and conducting insurance verifications to ensure compliance with HIPAA regulations. Seeking a role to leverage skills and knowledge in contributing to the success of a healthcare organization.

Overview

10
10
years of professional experience

Work History

Case Manager

Cencora
08.2024 - Current
  • Partnered with physicians, social workers, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
  • Assisted with outreach and engagement services to engage clients and maintain working relationships.
  • Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
  • Monitored clients' progress and tracked client services to provide crisis interventions.
  • Monitored program performance and outcomes for successful delivery of services.

Patient Access Claims Specialist -Remote

GetixHealth
09.2019 - 08.2024
  • Maintain strict adherence to HIPAA privacy and security standards during the processing of patient information.
  • Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
  • Verify patient demographics and insurance details to ensure accurate registration in healthcare databases.
  • Update and uphold the integrity of patient records by recording accurate personal and financial information.
  • Respond to patient inquiries with professionalism and confirm insurance eligibility using digital verification systems.

Customer Service Specialist

The Results
04.2017 - 09.2019
  • Documented customer interactions in a CRM with strict adherence to HIPAA guidelines, ensuring the integrity and confidentiality of patient information.
  • Addressed customer issues effectively via telephone, email, and social media, providing professional and empathetic support that enhanced client satisfaction.
  • Improved issue escalation protocols and supported quality control initiatives, resulting in enhanced service delivery and elevated customer satisfaction metrics.

Sales Representative

Sears
05.2015 - 04.2017
  • Addressed customer inquiries and resolved issues across in-person, phone, and email interactions, leading to improved customer satisfaction.
  • Provided customized product recommendations based on extensive product knowledge, aiding in meeting sales goals and retaining customers.
  • Kept detailed client records to facilitate personalized follow-up, enhancing customer relationships and contributing to growth in sales and repeat patronage.

Education

High School Diploma -

C.F. Vigor High School
Mobile, AL
05.2014

Skills

  • Customer Service
  • Pre-Admission Requests
  • Quality Assurance
  • Post-Discharge Care
  • Coordination
  • Insurance Company Knowledgeable
  • Quality Standards and Protocols
  • Gathering Information From Patients
  • Patient Confidentiality and Data Security
  • Explaining Policy and Procedures
  • Calm and Effective Under Pressure
  • Evaluating Quality of Care
  • Microsoft Office
  • Documenting and Recording Information
  • Verbal and Written Communication
  • Helpful and Service-Oriented
  • Communicating to Patients and Families
  • Caring and Empathetic
  • Organized and Efficient
  • Authorization Verification
  • Medical Terminology Expertise
  • Insurance Information Collection
  • Communication
  • Problem-solving
  • Computer Proficiency
  • Interpersonal Skills
  • Time Management
  • Organizational Skills
  • Claims Processing
  • Workers' Compensation Experience
  • Patient support
  • Knowledge of Microsoft Word and Excel
  • Individualized counseling

Timeline

Case Manager

Cencora
08.2024 - Current

Patient Access Claims Specialist -Remote

GetixHealth
09.2019 - 08.2024

Customer Service Specialist

The Results
04.2017 - 09.2019

Sales Representative

Sears
05.2015 - 04.2017

High School Diploma -

C.F. Vigor High School

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Arlandria Tinsley