Summary
Overview
Work History
Education
Skills
Certification
Languages
References
Outbound calls
Timeline
AssistantManager

Osheia Tucker

pharmacy benefits Manager
Mobile,AL

Summary

Expert in insurance policy coverage and dedicated to providing exceptional customer service, my tenure at Continuum Solutions honed my ability to navigate complex claims and enhance patient satisfaction. Equipped with robust medical billing expertise and a compassionate approach, I excel in eligibility determination and maintaining HIPAA compliance. Motivated and conscientious individual skilled in scheduling appointments, verifying insurance, and managing patient records in healthcare settings. Experienced in utilizing electronic medical record systems to maintain patient profiles and billing information. Dedicated to improving satisfaction and providing an excellent healthcare experience. Experienced professional with a strong background in technology-related roles. Proficient in software development, system administration, and technical support. Skilled in problem-solving and optimizing performance. Capable of managing projects and collaborating effectively with teams. Committed to continuous learning and staying current with industry trends to contribute to organizational success.

Overview

10
10
years of professional experience
1
1
Certification

Work History

Pharmacy Benefits Manager

Continuum Solutions
Mobile, Alabama
02.2023 - Current
  • Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures
  • Supported accounts receivable operations within assigned functions
  • Identified, analyzed and researched systemic issues and made recommendations for resolution
  • Provided exceptional customer service to patients, answering questions and addressing concerns
  • Maintained designated portfolio of customer accounts by contacting customers behind on payment obligations
  • Handled customer service inquiries in person, via telephone and through email
  • Entered patient demographic and insurance data into electronic medical record system
  • Filed and maintained patient records in accordance with HIPAA regulations
  • Verified insurance eligibility and coverage for patients
  • Managed patient registration process, confirming data accuracy and completeness
  • Applied administrative knowledge and courtesy to explain procedures and services to patients
  • Resolved billing inquiries and disputes in timely fashion
  • Investigated insurance claims denials and appeals
  • Built and maintained positive working relationships with patients and staff
  • Handled customer inquiries and suggestions courteously and professionally
  • Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
  • Collaborated with internal staff members such as Billing Specialists, Medical Coders to resolve any discrepancies in patients' insurance information.
  • Ensured that the most current version of provider contracts were stored in the database.
  • Maintained accurate documentation on all pre-authorization requests, denials and appeals.
  • Evaluated policies and procedures related to Insurance Verification activities.
  • Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
  • Interpreted Explanation of Benefits statements from various insurers and communicated relevant information with other departments as needed.
  • Participated in trade shows and other events to promote products and services of the company.
  • Resolved customer complaints in a timely manner while maintaining a professional attitude.
  • Provided customer service support to existing clients and potential customers.
  • Attended regular meetings with internal stakeholders to discuss progress towards goals.
  • Identified customer needs and provided tailored solutions to meet their requirements.
  • Provided technical guidance on product installation or usage issues over the phone or via remote access tools.
  • Analyzed market trends, competitor strategies, industry developments. to formulate competitive selling strategies.
  • Achieved monthly sales targets set by management team.
  • Maintained an organized database of contacts and client information.
  • Prepared weekly progress reports on sales activities and results achieved.
  • Assisted in developing training materials for new employees in the department.
  • Actively participated in team meetings with other members of the organization's sales department.
  • Collaborated with marketing team to develop promotional materials such as brochures, flyers, emails.
  • Adhered to all company policies related to data security, privacy regulations and ethical standards in selling practices.
  • Assisted in developing pricing strategies based on cost analysis of products and services offered.
  • Developed new business opportunities by prospecting for leads and cold calling.
  • Conducted market research to identify potential customers and new business opportunities.
  • Conducted follow-up calls with prospects to identify needs, propose solutions and close sales.
  • Identified key decision makers within target organizations and developed relationships with them.
  • Monitored customer feedback regarding product performance and made appropriate adjustments accordingly.
  • Generated high quality sales leads through effective research methods.
  • Developed training programs for new employees on outbound sales techniques and best practices.
  • Followed up on sales leads through outbound calling.
  • Provided timely, courteous, and knowledgeable responses to information requests.
  • Generated sales by prospecting leads, cold calling and negotiating advantageous deals.
  • Documented sales call data in company software.
  • Developed new leads each day at or above quotas.
  • Cross-sold additional products and services to purchasing customers.
  • Communicated effectively with clientele to maintain customer satisfaction and loyalty.
  • Achieved established sales targets by generating new customer accounts.
  • Networked to build client base and promote products to new and existing clients.

CNA/Secretary

Springhill Medical Hospital
Mobile, Alabama
01.2018 - 04.2021
  • Delivered direct care to patients, assisting with bathing, feeding, and grooming tasks
  • Completed daily documentation and charts regarding patient care and input reports into practice databases
  • Prepared residents for meals and assisted with feeding
  • Utilized PPE appropriately and followed patient safety and infection control guidelines
  • Measured patient vital signs, recording body temperature, blood pressure, and heart rate
  • Followed HIPAA regulations to maintain confidentiality of sensitive medical and personal information
  • Lifted and repositioned non-ambulatory patients to prevent accidents and falls
  • Observed changes in patient status and response and immediately communicated concerns to nursing staff
  • Developed trusting relationships and provided emotional support to patients and families
  • Answered call lights to provide emergency treatment and assistance to patients
  • Stocked patient rooms and supply areas to meet patient care needs
  • Completed in-service training and attended performance improvement meetings
  • Observed infection control procedures and guidelines to safeguard patients and teams
  • Utilized restorative care techniques to promote patient independence
  • Cleaned and sanitized medical equipment and rooms
  • Participated in educational activities to stay up-to-date with best practices in nursing
  • Assisted with admission and discharge processes to provide continuity of care
  • Followed manufacturer's instructions when using selected equipment, accounting for patient's size, preexisting conditions, and age
  • Interpreted and explained medical instructions to patients and family members
  • Utilized critical thinking skills to prioritize tasks based on patient needs
  • Respected patient privacy rights while providing care services
  • Performed basic nursing procedures such as catheterization and wound cleaning and dressing changes
  • Assisted with range of motion exercises, ambulation and positioning of bedridden patients
  • Developed positive relationships with residents by providing compassionate care
  • Maintained a clean environment for the safety of patients by following infection control protocols
  • Participated in educational sessions related to professional development
  • Provided emotional support and encouragement to enhance self-esteem of patients
  • Demonstrated proficiency in patient transfer techniques using wheelchairs, gurneys and lifts
  • Assessed patient needs for additional services or equipment requirements
  • Collaborated with nursing staff to ensure quality care delivery to patients
  • Monitored vital signs such as pulse rate, respiration rate and blood pressure
  • Contributed positively to team environment through effective problem solving strategies
  • Managed multiple tasks effectively while maintaining composure under pressure situations
  • Assisted in admission, discharge and transfer activities as needed
  • Ensured proper documentation of all treatments provided per hospital policies and standards
  • Administered medications according to physician's orders accurately and timely
  • Provided personal care and hygiene assistance to patients, including bathing, grooming, dressing and toileting
  • Recorded daily observations regarding patient condition in medical records
  • Reported any change in patient condition promptly to the nurse supervisor
  • Exhibited excellent communication skills when interacting with patients and their families
  • Answered patient call signals, signal lights or bells to determine patient needs
  • Checked vital signs and recorded intake information to monitor patient stability.
  • Contacted customers after sales process to drive ongoing customer satisfaction and resolve issues and complaints.
  • Opened new accounts and documented personal, demographic, and payment information in system.
  • Negotiated pricing and payment terms with customers when possible to close deals.
  • Overcame objections using friendly, persuasive strategies.
  • Made average of [Number] outbound and inbound calls per day.
  • Followed up with customers to confirm satisfaction with purchases and resolve last-minute issues.
  • Generated leads and established relationships with potential customers through outbound telephone calls.
  • Utilized sales techniques to build customer interest and close sales.
  • Provided information about available products and services, membership details, and purchase advantages.
  • Collaborated with marketing teams to develop and execute promotional strategies.
  • Documented customer interactions and transactions, maintaining accurate records of all dealings.
  • Observed and learned changing customer requirements and adapted sales strategies as needed.
  • Developed extensive knowledge of products and services to better assist customers.
  • Delivered scripted sales talks to customers reached via manual and automatic dialing systems.
  • Explained product prices and packages as well as answered questions and addressed concerns of customers.
  • Set up appointments with interested customers according to schedule availability.
  • Asked relevant questions to assist customers with selecting needed or requested products and services.
  • Educated customers on product and service benefits, explaining features and answering questions.
  • Pitched products and services to potential customers, securing new deals and sales opportunities.
  • Attained $[Amount] in sales targets on monthly basis.
  • Implemented upselling techniques to increase revenue and move product.

CNA

Lynwood Healthcare And Rehabilitation Center
Mobile, Alabama
11.2016 - 06.2017
  • Delivered direct care to patients, assisting with bathing, feeding, and grooming tasks
  • Completed daily documentation and charts regarding patient care and input reports into practice databases
  • Prepared residents for meals and assisted with feeding
  • Utilized PPE appropriately and followed patient safety and infection control guidelines
  • Completed in-service training and attended performance improvement meetings
  • Observed infection control procedures and guidelines to safeguard patients and teams
  • Utilized restorative care techniques to promote patient independence
  • Followed manufacturer's instructions when using selected equipment, accounting for patient's size, preexisting conditions, and age
  • Interpreted and explained medical instructions to patients and family members
  • Assessed patient needs for additional services or equipment requirements
  • Exhibited excellent communication skills when interacting with patients and their families
  • Participated in educational sessions related to professional development
  • Monitored vital signs such as pulse rate, respiration rate and blood pressure
  • Ensured proper documentation of all treatments provided per hospital policies and standards
  • Administered medications according to physician's orders accurately and timely
  • Assisted in admission, discharge and transfer activities as needed
  • Provided emotional support and encouragement to enhance self-esteem of patients.
  • Collaborated with interdisciplinary team members to ensure quality patient care was delivered at all times.
  • Answered patient call lights promptly and responded to requests appropriately.
  • Recognized signs, symptoms of abuse, neglect and reported them per policy.
  • Assisted patients in ambulation and transfers using proper body mechanics.
  • Assisted with range of motion exercises and other rehabilitative activities per physician orders.
  • Provided assistance with activities of daily living, including bathing, dressing and grooming.
  • Performed vital sign assessments, such as taking blood pressure and temperature.
  • Transported residents within the facility as needed.
  • Monitored vital signs such as pulse rate, respiration rate, and blood pressure.
  • Participated in educational programs designed to improve knowledge of health care practices.
  • Ensured compliance with HIPAA regulations regarding confidentiality of information.
  • Utilized appropriate safety measures when handling hazardous materials or waste products.
  • Monitored food intake and output as directed by nursing staff.
  • Assisted in preparing meals according to prescribed diets while monitoring food consumption levels.
  • Observed patients for any physical or emotional changes, reported findings to medical staff immediately.
  • Documented patient care services by charting in designated areas.
  • Provided emotional support to family members during difficult times.
  • Educated patients on self-care techniques that would help them maintain their independence.
  • Maintained a clean, safe environment for the patient by adhering to infection control policies and procedures.
  • Administered medications under supervision of a licensed nurse.

Cashier

Walmart Neighborhood
Mobile, Alabama
06.2014 - 05.2016
  • Operated cash register and accurately processed payments, returns, and exchanges
  • Maintained cleanliness of the checkout area by cleaning counters, shelves and windows
  • Performed opening and closing procedures, such as counting cash register, restocking, and cleaning
  • Built and maintained positive working relationships with co-workers
  • Demonstrated excellent customer service skills while interacting with customers in a friendly manner
  • Provided excellent customer service by greeting customers and offering assistance
  • Helped restock shelves when necessary to maintain an organized display area
  • Developed strong customer service skills by providing efficient and accurate service
  • Accurately processed customer payments using cash, credit cards, and checks
  • Managed large amounts of cash accurately during busy hours in a fast-paced environment
  • Provided efficient and courteous service to customers
  • Developed strong customer relationships to support satisfaction and loyalty
  • Handled customer complaints and inquiries in a courteous and efficient manner
  • Counted and balanced cash drawer at the beginning and end of each shift
  • Utilized problem solving skills to effectively handle difficult situations
  • Assisted with training and mentoring new team members
  • Delivered exceptional customer service at all points of contact
  • Greeted and informed customers of products, fostering positive store experiences
  • Processed customer orders and ensured the accuracy of their purchases
  • Enforced store safety and cleanliness standards, reducing hazards
  • Performed opening and closing duties such as counting money, balancing registers and reconciling discrepancies
  • Assisted customers with locating items throughout the store when needed
  • Resolved customer complaints professionally in accordance with company policy
  • Operated the POS system efficiently to ensure accurate transactions
  • Supported other departments within the store by providing assistance when needed
  • Used POS system to complete purchases for customers
  • Maintained inventory and store visual presentation to meet customer needs
  • Provided customers with product information and responded to inquiries courteously and promptly.

Education

High School Diploma -

Murphy High School
US
01.2014

Skills

  • Eligibility Determination
  • Understanding of Medical Terms
  • Attention to Detail
  • Coverage and Authorizations
  • Documentation and Correspondence
  • Data Entry and Review
  • Insurance Coverage Verification
  • Claims Processing
  • Insurance Policy Coverage
  • Knowledge
  • Policy Investigations
  • Data Entry
  • Scheduling
  • Call Management
  • Complaint Resolution
  • Technical Support
  • Appointment Scheduling
  • Empathy and compassion
  • Customer Service
  • HIPAA Compliance
  • Medicaid knowledge
  • Secure data practices
  • Understanding of medical terms
  • Patient Rapport
  • Electronic Medical Records
  • Medical Billing
  • Medical Terminology
  • Insurance knowledge

Certification

Adjuster license- FLw838326

Languages

English
Full Professional

References

valencia dailey coworker known for 10 years 251-303-3472.

meagan Petite coworker known for 10 years 251-525-7194

Outbound calls

Making calls to customers and providers to verify information. Take about 40 outbound calls and 60 inbound calls, also handle prior authorization. Doing override for claims if the Insurance allows it . Been doing outbound calls for continuum solutions and Springhill Hospital as a secretary.

Timeline

Pharmacy Benefits Manager

Continuum Solutions
02.2023 - Current

CNA/Secretary

Springhill Medical Hospital
01.2018 - 04.2021

CNA

Lynwood Healthcare And Rehabilitation Center
11.2016 - 06.2017

Cashier

Walmart Neighborhood
06.2014 - 05.2016

High School Diploma -

Murphy High School

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Osheia Tuckerpharmacy benefits Manager