Shyniya Toliver
Columbia,SC
Summary
Adept at claim research and fostering process improvement strategies, I have significantly enhanced operational efficiency in roles at Firstsource and other leading healthcare organizations. My professionalism and ethical approach, combined with expertise in HIPAA compliance and patient contact, have consistently improved patient satisfaction and streamlined insurance processes.
Overview
3
3
years of professional experience
1
1
Certification
Work History
Prior Authorization Specialist
Firstsource
Remote , SC
06.2024 - 01.2025
- Advised provider offices on proper coding practices that are necessary for successful claim submission.
- Processed appeals in a timely manner as per policy guidelines.
- Provided customer service to patients and healthcare providers, answering questions related to prior authorization and insurance coverage.
- Followed up on pending prior authorization requests to ensure timely processing.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
Medical Appointment Scheduler
Carenet Health
Remote, United States
05.2023 - 03.2024
- Serves customers effectively with attention to detail and hardworking approaches.
- Handled incoming calls and inquiries from patients, providing timely and accurate information.
- Entered new patient data into an electronic health record system.
- Coordinated with other departments within the hospital to ensure timely treatment of patients.
Collections Agent
United Healthcare Group
Remote, United States
01.2022 - 03.2023
- Contacted customers and explained debt management to encourage timely debt payments.
- Researched customer accounts for any discrepancies or outstanding payments.
- Received payments and posted amounts to customer accounts.
- Investigated historical data for each debt or bill to identify concerns and determine optimal course to bring account current.
- Resolved billing discrepancies and customer credit issues.
Education
Bachelor - Nursing, African American Studies
North Carolina Agricultural Technical State University
Greensboro, North Carolina05.2024
High School Diploma -
Glenn High School
Kernersville, North Carolina06.2020
Skills
- Claim research
- Process improvement strategies
- Medical appeals handling
- Professionalism and ethics
- Benefit coverage
- HIPAA compliance
- Patient contact
- Data integrity
Certification
- Licensed CNA
- First Aid/ Basic Life Support (BLS) certified
- CPR
Timeline
Prior Authorization Specialist
Firstsource
06.2024 - 01.2025
Medical Appointment Scheduler
Carenet Health
05.2023 - 03.2024
Collections Agent
United Healthcare Group
01.2022 - 03.2023
Bachelor - Nursing, African American Studies
North Carolina Agricultural Technical State University
High School Diploma -
Glenn High School
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