Janya White
Tampa,US
Summary
Detail-oriented healthcare operations professional with 4 years of experience in high-volume settings. Expertise in claims processing, eligibility verification, and provider coordination across diverse healthcare platforms. Proven ability to resolve complex issues while ensuring compliance and enhancing customer satisfaction.
Overview
4
4
years of professional experience
Work History
Healthcare Operations/Clinical Support Specialist
TRICARE TRIWEST
12.2024 - Current
- Provide high-volume support to providers and members, ensuring accurate documentation across multiple healthcare systems
- Assist providers with eligibility verification and network participation updates
- Process and correct referrals and authorizations, ensuring proper coding (CPT/HCPCS) and routing
- Assign Primary Care Managers (PCM) based on eligibility and program requirements
- Coordinate peer-to-peer reviews between clinical staff and providers for complex cases
- Maintain compliance with healthcare regulations, documentation standards, and quality requirements
- Research and resolve claims discrepancies, including payment corrections and reprocessing requests
- Ensure timely communication and resolution of inquiries while maintaining customer satisfaction
Patient Care Coordinator
Tricare Humana Military
, Remote
02.2022 - 12.2024
- Supported provider and member services by managing referrals, eligibility verification, and PCM assignments
- Verified provider credentialing status and network participation to ensure accurate care coordination
- Scheduled appointments and coordinated follow-ups with providers and members to support continuity of care
- Processed, updated, and corrected referrals and supporting documentation in compliance with established guidelines
- Conducted outreach to obtain additional information or clarification as needed to complete cases
- Documented all interactions accurately across multiple healthcare systems while maintaining compliance standards
- Collaborated with internal departments and provider offices to resolve issues and ensure timely resolution
- Maintained productivity, quality, and compliance standards in a high-volume, fast-paced environment
- member services by managing referrals, eligibility verification, and PCM assignments.Verified provider credentialing status and network participation to ensure accurate care coordination.
- Processed, updated, and corrected referrals and spting documentation in compliance with established guidelines.
Education
ASSOCIATE OF SCIENCE - BUSINESS ADMINISTRATION AND MANAGEMENT
Hillsborough Community College
Tampa, FL12-2023
HIGH SCHOOL DIPLOMA -
Wesley Chapel High School
Wesley Chapel, FL06-2022
Skills
- Healthcare Operations Support
- Provider & Member Services
- Claims Processing & Dispute Resolution
- Eligibility Verification
- Referral & Authorization Management
- Provider Coordination & Communication
- Data Entry & Documentation Accuracy
- Multi-System Navigation
- Problem Solving & Issue Resolution
- HIPAA Compliance & Data Security
- Microsoft Office (Excel, Word, Outlook)
Timeline
Healthcare Operations/Clinical Support Specialist
TRICARE TRIWEST
12.2024 - Current
Patient Care Coordinator
Tricare Humana Military
02.2022 - 12.2024
ASSOCIATE OF SCIENCE - BUSINESS ADMINISTRATION AND MANAGEMENT
Hillsborough Community College
HIGH SCHOOL DIPLOMA -
Wesley Chapel High School