MICHELLE TAYLOR
Mississippi State,MS
Summary
Human Resources Coordination/Administration Professional offering 5 years of strong background in employee training and development, new hire orientations and employee relations; Well-versed in employment regulations and records management requirements. Proficient in HRIS, Workday, ADP, SAP, and Ultra Time software systems with expertise in policy development and documentation.
Overview
15
15
years of professional experience
Work History
Scheduling/Prior Authorization Specialist
Department Of Veterans Affairs/Optum
01.2020 - Current
- Scheduled over 200/wk appointments with applicants to gather information and explain benefits processes.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Verified eligibility and compliance with authorization requirements for service providers.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Analyzed medical records and other documents to determine approval of requests for authorization.
HR Coordinator/Admin
Peco Foods Inc.
07.2018 - 07.2020
- Developed and maintained documentation for new hires, training materials and benefits
- Reviewed employee time sheets for accuracy and maintained accurate records in company system; Managed payroll processing duties for 400-employee team
- Helped management improve appraisal, counseling and performance optimization techniques to maximize workforce satisfaction and productivity; Reconciled payroll accounts
- Oversaw workers compensation insurance and related workplace programs and compliance
- Conducted all employee hiring and exit interviews; Oversaw new employee on-boarding procedures from initial training to skill development
- Utilized HRIS to document and organize benefit data for 400 accounts
- Addressed inquiries from employees and management regarding new-hire activity and ongoing employee relation issues; Conducted benefits administration for 200 benefit-eligible employees.
Clinical Research /Imaging
St Jude Children Research Hospital
12.2016 - 07.2018
- Managed 200/wk electronic medical record system, scanning patient lab and x-ray information to provide instant results for physicians
- Supported team in developing research protocols
- Updated and maintained information accuracy within patient database
- Collected, processed and delivered specimens from trial participants
- Conducted informed consent presentations and maintained documentation
- Assessed records of each patient, reviewed databases and checked referrals to locate potential research study participants
- Pulled patient records and transferred information to appropriate parties.
Eligibility Specialist/Benefits
UBC/Express Scripts
12.2015 - 12.2016
- Experienced with Medicaid/Medicare Part B, and with durable medical equipment billing
- Make 200/day outbound calls to members to gather Enrollment Data with ability to work cross-functional to resolve complex client issues to analyze and process data accordingly: Handle inbound member calls and written correspondence regarding member eligibility
- Make independent judgments in order to respond to complex or critical member issues: Work collaboratively with Eligibility Systems Analysts, other Eligibility Associates, Eligibility Managers and Account Managers to reach solutions for management of all facets of UBCs programs
- Serve as first point of contact for internal clients and members during enrollment process
- Conducted interviews with applicants, explaining benefits process and which programs were available
- Reviewed employee enrollments to verify accuracy, inputting all information into company's database, Provided assistance to plan participants by explaining benefits information to ensure educated selections, ,Filed and submitted insurance claims
- Performed insurance verification, pre-certification and pre-authorization.
Human Resources Specialist/Admin
Volunteers of America
08.2015 - 12.2015
- Provided administrative support to VP of HR/Generalist on all personnel matters and assisted with payroll processing
- Performed CSR functions by answering employee requests and questions, conducted benefits enrollment for new hires, verified I-9 documentation and maintained book current, submit online investigation requests and assisted with new hires background checks, conducted random drug screens on current employees
- Reconciled benefit statements, performs payroll/benefit-related reconciliations to General Ledger and other accounts.
Human Resources Admin/Office Manager
Community Counseling Services
08.2014 - 08.2015
- Performed recruiting activities at area and regional universities and job fairs, relay job information to all interested applicants and pre-screened potential employees
- Maintained agency job posting, posts job openings on job boards, websites, and newspaper
- Created and edited Monthly Newspaper along with HR Coordinator; reviewed resumes, and pre-screened candidates along with scheduling interviews with hiring manager
- Once hired, created personnel folders and profile in ABRA system
- Daily dated, stamped and logged all applications into ABRA database
- Generated interview response letters
- Performed thorough reference check on candidates, completed pre-employment paperwork; Conducted pre-employment drug screens on candidates
- Reported new hire information to social security business online
- Conducted background, criminal, and child abuse reports on all new employees, was also responsible for getting their fingerprints information to appropriate agency
- Also ran DMV report on all employees who were to use CCS vehicles
- Maintained and updated employee related database , route appropriate data to payroll, A/P, A/R, and accounting, assisted with Payroll as needed, (input time and hours in People Soft system)
- Analyzed and ran query report monthly to ensure personnel files/required training was complete and up to date (CPI, CPR, Therapy licenses, Auto Insurances, and School Documents), and required documentation was present and accurate, if not, sent out memos to all employees for updates
- Maintained confidentiality of personnel records, also maintain employee handbook, policy and procedure manual.
- Devised hiring and recruitment policies for [Number]-employee company
Reimbursement (Medicare/Medicaid)
University of TN Medical Group
07.2012 - 08.2014
- Audited insurance claims and search for underpayments, negotiated with insurance companies for settlement payments
- Collected insurance claims data for review to ensure timely resolution on existing and outstanding issues
- Reviewed claims to determine which claims required an appeal, send letters to patient requesting appeal authorization, writes appeal letters to insurance companies to resolve denials; Maintained a call log inside the patient electronic file, worked from generated Excel Spreadsheet
- Resolved patient and medical facility complaints, resubmit claim as required, cross-trained in the billing claims process, resolve billing inquiries and enter patient information into the system; Requested and sent medical records with denied claims as needed
- Edited and Modified ICD-9 codes; also developed extensive knowledge of CPT, ICD-9, and HCPCS coding documentation guidelines for medical service provision, patient care management, follow-up, and billing for Medicare/Medicaid and BCBS
- Followed up with denials of Credentialing, Modifiers Codes, and Bundle claim denials for resubmission.
Billing Workers Compensation
Stone River Pharmacy Solutions
11.2008 - 05.2011
- Contacted all appropriate parties to obtain, verify, and validate correct claim information for workers compensation claims by telephone, fax, and email to resolve unpaid and denied claims
- Detailed and tasked oriented associate that assisted in resolution of outstanding receivables for unpaid and denied workers compensation prescription claims in outbound call center environment
- Developed effective relationship with insurance carriers and pharmacy clients
- Responded to incoming calls from carriers, pharmacies, attorneys, employers, patients and regulatory agencies
- Completed all company insurance renewals including property, Workers' Compensation, general liability claims.
Education
Bachelor of Science - Business Management in HR
Bellevue University
Bellevue, NE09.2009
Bachelor of Science - Health & Kinesiology/Physical Therapy
Mississippi University For Women
Columbus05.2002
High School Diploma -
Columbus High School
Columbus, MSSkills
- Excel
- Payroll Processing
- Personnel records maintenance
- New hire orientation
- Hiring and Retention
- Labor Agreements
- Policies Implementation
- Personnel Recruitment
- Benefits Administrator
- Project multitasking and prioritization
- Talent Acquisition
- Social Media marketing
- SAP
- Human Resources Information Systems (HRIS)
- Advanced Excel modeling
Timeline
Scheduling/Prior Authorization Specialist
Department Of Veterans Affairs/Optum
01.2020 - Current
HR Coordinator/Admin
Peco Foods Inc.
07.2018 - 07.2020
Clinical Research /Imaging
St Jude Children Research Hospital
12.2016 - 07.2018
Eligibility Specialist/Benefits
UBC/Express Scripts
12.2015 - 12.2016
Human Resources Specialist/Admin
Volunteers of America
08.2015 - 12.2015
Human Resources Admin/Office Manager
Community Counseling Services
08.2014 - 08.2015
Reimbursement (Medicare/Medicaid)
University of TN Medical Group
07.2012 - 08.2014
Billing Workers Compensation
Stone River Pharmacy Solutions
11.2008 - 05.2011
Bachelor of Science - Business Management in HR
Bellevue University
Bachelor of Science - Health & Kinesiology/Physical Therapy
Mississippi University For Women
High School Diploma -
Columbus High School
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