TONYA MACKLIN
Boston,MA
Summary
Experienced with managing provider relations and addressing inquiries effectively. Strong focus on team collaboration and achieving results. Known for adaptability and reliability. Proficient in communication, conflict resolution, and data management. Personable and dedicated to fostering positive working relationships.
Overview
29
29
years of professional experience
Work History
Provider Services Representative
Commonwealth Care Alliance
Boston, MA
04.2018 - 02.2026
- Collaborated with healthcare providers to resolve billing inquiries and enhance satisfaction.
- Facilitated communication between providers and internal departments to streamline service processes.
- Managed provider enrollment and credentialing documentation to ensure compliance with regulatory standards.
- Analyzed provider feedback to identify trends and implement process improvements for service delivery.
Switchboard Operator
Massachusetts General Brigham
Boston, MA
05.2008 - 05.2023
- Provided exceptional customer service, addressing concerns and facilitating communication between patients and staff.
- Managed incoming calls, directing inquiries to appropriate departments and personnel.
- Strengthened company reputation by upholding confidentiality when dealing with sensitive information during call transfers.
- Announced important information and emergency notifications over PA system.
- Assisted colleagues with achieving task requirements, aiding team productivity and performance.
Provider Services Specialist
Tufts Health Plan
Watertown, MA
08.1997 - 01.2018
- Provided accurate and thorough information on THP benefits, claims eligibility, and policies to providers, prospective providers, and internal customers.
- Performed medical billing and coding; read/analyzed patient records, assigned correct codes, billed insurance providers, tracked patient data, and maintained patient confidentiality.
- Took ownership of all customer interactions; quality service enhanced client experience and customer loyalty.
- Stayed current on all new and revised THP plans, policies, procedures, and products.
- Helped members navigate complex healthcare system.
- Resolved customer/provider complaints with patience and tact; identified root cause of issues and provided resolution aligned with THP policies & procedures; escalated to management, as necessary.
- Served as liaison between members and various departments to address concerns.
- Updated provider/member information in database.
- Tufts Health Plan (THP) is nationally recognized for providing innovative, high-quality healthcare coverage.
Education
Bachelor of Business Administration -
Bay State College
Boston, MASkills
- Problem-solving skills
- Effective Multitasking
- Excellent communication
- Quick-learning
- Savvy in Healthcare industry
- Customer service
Core Competencies
- Data Entry (Type 55wpm)
- Front Desk Functions
- Administrative Skills
- Relationship Building
- Customer Satisfaction
- Efficiency/Time Management
- Cross-functional Teamwork
- Analytical Problem Solving
- Clear Communications
Languages
English
Timeline
Provider Services Representative
Commonwealth Care Alliance
04.2018 - 02.2026
Switchboard Operator
Massachusetts General Brigham
05.2008 - 05.2023
Provider Services Specialist
Tufts Health Plan
08.1997 - 01.2018
Bachelor of Business Administration -
Bay State College