Summary
Overview
Work History
Education
Skills
Timeline
Generic

Galina Tamplin

Lewisville,Texas

Summary

Dynamic Claims Analyst with extensive experience at Platinum Dermatology, adept at claims analysis and negotiation. Proven track record in enhancing customer satisfaction and resolving complex issues efficiently. Skilled in Salesforce and critical thinking, consistently achieving high-quality outcomes while maintaining compliance with industry regulations.

Overview

24
24
years of professional experience

Work History

Claims Analyst Project Clean up Addison GRP

PLATINUM DERMATOLOGY
04.2025 - 05.2025
  • Maintained strict confidentiality with all personal data as per company guidelines.
  • Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
  • Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
  • Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
  • Work through reports to detail denied claims
  • Dispute original claim and find out where it was mishandled
  • Call and dispute with insurance companies
  • Help set patient for surgery with knowledge of out of pocket cost .

Denial Resolution Specialist

GUIDEHOUSE
01.2024 - 04.2025
  • Analyzed root causes of recurring issues to implement preventive measures, reducing the number of future complaints.
  • Maintained detailed records of all interactions and resolutions for future reference and analysis purposes, improving overall efficiency in handling similar cases down the road.
  • Assisted colleagues in navigating challenging situations by sharing expertise and offering guidance when requested or needed.
  • Managed high volumes of customer inquiries for efficient resolution, enhancing overall client experience
  • Research and respond to patient inquires
  • Review accounts daily and take necessary actions to resolve balances
  • Performs research and make determination of correction
  • Resolve accounts balances with insurance companies and patients
  • Research contract terms and compiles for appeals
  • Submit adjustments and negative balance request
  • Make out going calls to patient for updated or correct payer information before moving to patient share

Latch/Work Comp Collector

Post Acute Medical
03.2021 - 11.2023
  • Collaborated with team members to achieve monthly targets, promoting a positive work environment and boosting overall productivity.
  • Contacted customers to discuss payment schedules and set up or immediately process payments.
  • Reduced outstanding debts by implementing strategic collections tactics and maintaining open lines of communication with customers.
  • Streamlined debt collection processes for increased efficiency in the workplace.
  • Maintained high volume of calls and met demands of busy and productive group.
  • Improved customer satisfaction by effectively resolving delinquent accounts through negotiation and payment plans.
  • Maintained accurate records of all collection activities, ensuring compliance with industry standards and regulations.
  • Trained new team members on scripts, company services, and collection strategies
  • Communicates All Denials to the Billing Supervisor
  • Responds to payers by phone or correspondence concerning claims issues
  • Aggressively works aged accounts to expedite cash and reduce bad debt and A/R days
  • Assists with all calls, correspondence, and concerns regarding Medicare claims with the FIs
  • Takes action on bill review requests from the Collections Team in a timely manner
  • Completes the worklists daily and ensures all accounts are set for follow-up
  • Reviews unbilled accounts and ATB to ensure timely billing and collection
  • Communicates all denials to the billing supervisor
  • Meets corporate goals monthly on billing and collections
  • Works with others as a team player, as well as the hospital/clinic staff
  • Investigates COB issues and communicates with appropriate staff members for resolution
  • Responsible for obtaining medical records required for certain commercial claims
  • Ensures all prebilling tasks are completed and correct information is sent out on claims

Collector Workcomp

CONCENTRA
08.2019 - 04.2020
  • Trained new team members on scripts, company services, and collection strategies.
  • Developed strong relationships with clients, fostering trust and facilitating successful account resolutions.
  • Persistently reached out to customers with extremely past due accounts to recover lost revenue.
  • Negotiated with account holders to devise repayment plans and minimize collections receivables.
  • Provided excellent customer service during difficult conversations, defusing tensions while effectively collecting payments.
  • Performed collections on outstanding/overdue claims
  • Prepared payer appeals
  • Responsible for workers comp and injury claims
  • Sent out reconsiderations
  • Rebilled for corrected claims

Denial Resolution Specialist

CARENOW CORP
04.2017 - 08.2019
  • Managed high volumes of customer inquiries for efficient resolution, enhancing overall client experience.
  • Coordinated with internal departments as needed to gather information on each individual case, facilitating a more accurate and timely response.
  • Responsible for all activities related to resolving and monitoring claims
  • Years of experience in customer and appealing claim denials received from work comp payers
  • Reviewed, identified, and serviced and utilized skills to analyze problems and resolve payer denials, prepare payer appeals for denied claims written off, and adjust them the first time
  • Reprocessed and rebilled claims
  • Tracked and followed up on requests for refunds or the opportunity for growth and recoupment in accordance with payer requirements and practices adhered to the code professional development of conduct philosophy, mission, and value statement, and performed other duties as assigned
  • Problem resolution, technology, knowledge, skills, and abilities
  • Clear understanding and working knowledge of payer account management and denials and appeals process and clear understanding of healthcare claims processing
  • Worked independently as well as in a cross-functional team environment by collaborating with others and sharing tools skills and knowledge
  • Solid problem-solving and analysis skills that demonstrated resource fullness and attention to detail

Utilization Specialist

GENEX SERVICES
02.2014 - 04.2017
  • Followed all company policies and procedures to deliver quality work.
  • Improved customer satisfaction rates through proactive problem-solving and efficient complaint resolution.
  • Collaborated with cross-functional teams to achieve project goals on time and within budget.
  • Implemented new training programs for staff, leading to higher employee retention rates and better overall performance.
  • Responsible for the support of the management staff in working with medical providers and insurance adjustors to assist with the completion of utilization review cases
  • Worked with utilization management staff and nurses regarding medical cases and additional interfacing with external customers for problem resolution
  • In addition, data entry, filing, answering phones, and working multiple systems

Assistant Marketing Service Rep

BCBSTX
02.2010 - 08.2013
  • Conducted market research to identify emerging trends and opportunities for business growth.
  • Boosted brand awareness by developing and executing targeted marketing campaigns.
  • Created visually appealing collateral materials that captured attention while conveying key messages consistently throughout all touchpoints in the customer journey.
  • Expanded company''s reach into new markets through extensive competitor analysis, enabling informed decisions on potential expansion opportunities.
  • Responsible for supporting account management personnel in the reviewing of group business including handling plan
    changes, handling agent/broker changes, conducting research, servicing customers, and problem resolution as well as participating in group enrollment sessions
  • Position required the mastering of the numerous BCBS systems and platforms as well as expertise in CRM tools such as Salesforce and others
  • Developed long-lasting relationships with key clients by providing exceptional customer service and support.
  • Collaborated with sales teams to develop effective strategies for achieving revenue targets.

Wellness Customer Advocate

BCBSTX
08.2008 - 02.2010
  • Handled difficult customer situations with grace and professionalism, consistently meeting first-call resolution metrics.
  • Provided exceptional customer service to high-volume customer base, resolving issues, answering inquiries and providing product information.
  • Listened to customers in actively to assess issues and provide accurate information.
  • Developed and maintained strong customer relationships by promptly addressing and resolving customer concerns.
  • Developed strong relationships with clients, promoting trust and loyalty through excellent service.
  • Maintained comprehensive records of all client interactions, allowing for efficient follow-up and enhanced overall service quality.
  • Documented customer concerns and inquiry resolutions in internal computer system.
  • Educated customers about billing, payment processing and support policies and procedures.

Customer Advocate

BCBSTX
11.2001 - 08.2008
  • Conducted thorough research to provide accurate information and resolve complex issues for customers.
  • Managed multiple priorities effectively while ensuring a high level of accuracy and attention to detail in all tasks performed.
  • Generated higher customer loyalty by consistently meeting or exceeding service-level agreements and performance metrics.
  • Enhanced customer satisfaction by promptly addressing concerns and providing effective solutions.
  • Made outgoing calls for follow-up and education of high-risk pregnancies to help with a source of communication and
    knowledge of health care benefits
  • Evaluated high-risk medical needs and requested referrals and authorizations for treatment
  • Communicated and escalated for review to Case management Rn
  • Followed up to ensure both baby and mom were being treated for the best outcome of lower-risk
    Senior Customer Advocate
  • Customer service specialist responsible for the administering and review of all medical and surgical services
  • Responded to telephone and written inquiries in a prompt accurate and objective manner
  • Data entry knowledge of various lines of business such as Medicare, CDHP, Wellness, and Disease management
  • Evaluated customer's situations, made decisions, and responded quickly to questions and knowledge

Education

MARSHALL HIGH SCHOOL
MARSHALL TX

CERTIFIED MEDICAL ASSISTANT

PCI HEALTH TRAINING
Dallas, TX
08-1997

Skills

  • Claims analysis
  • Interpersonal and written communication
  • Policy interpretation
  • Utilization Management
  • Case Management
  • Salesforce
  • CRM Software
  • Medical Records
  • Negotiation
  • Account Management
  • Managed CarE
  • Typing
  • Proficient in Excel, MS office
  • Claim investigation
  • Document workflow
  • Claims processing
  • Customer service and support
  • Critical thinking

Timeline

Claims Analyst Project Clean up Addison GRP

PLATINUM DERMATOLOGY
04.2025 - 05.2025

Denial Resolution Specialist

GUIDEHOUSE
01.2024 - 04.2025

Latch/Work Comp Collector

Post Acute Medical
03.2021 - 11.2023

Collector Workcomp

CONCENTRA
08.2019 - 04.2020

Denial Resolution Specialist

CARENOW CORP
04.2017 - 08.2019

Utilization Specialist

GENEX SERVICES
02.2014 - 04.2017

Assistant Marketing Service Rep

BCBSTX
02.2010 - 08.2013

Wellness Customer Advocate

BCBSTX
08.2008 - 02.2010

Customer Advocate

BCBSTX
11.2001 - 08.2008

MARSHALL HIGH SCHOOL

CERTIFIED MEDICAL ASSISTANT

PCI HEALTH TRAINING

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Galina Tamplin