Tammy Trapp
Greenville,SC
Summary
Experienced Provider Representative proficient in efficiently and accurately handling medical claims. Demonstrated success in resolving complex claims and ensuring regulatory compliance. Strong communication and problem-solving skills. Skilled at navigating the intricacies of the healthcare industry to deliver exceptional service and support to patients and providers.
Overview
3
3
years of professional experience
Work History
Member Service Representative
VXI Global
11.2024 - Current
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Provided exceptional service through active listening, understanding member needs, and offering appropriate solutions.
- Enhanced customer satisfaction by efficiently addressing and resolving inquiries and concerns.
- Maintained high-quality service by adhering to company policies and standards in all member interactions.
- Verified customer identification and documentation for compliant transactions.
- Assisted members with account management, including updating personal information and setting up automated payments.
- Served as a liaison between customers and tech support teams when needed.
Support Analyst
Prisma Health
01.2024 - 07.2024
- Improved customer satisfaction by promptly addressing and resolving support issues.
- Managed high call volumes efficiently while maintaining a professional demeanor and providing exceptional customer service to both internal staff members and external callers alike.
- Worked closely with referring physicians'' offices to coordinate timely referrals for diagnostic imaging services, expediting patient care when necessary.
- Improved patient satisfaction with timely and accurate appointment confirmations and reminders.
- Developed a strong understanding of various radiology procedures and their prerequisites, allowing for accurate scheduling and patient education.
- Maintained strict adherence to HIPAA guidelines while handling sensitive patient information during the scheduling process.
- Upheld HIPAA regulations and standards for protecting patient information.
- Enhanced customer satisfaction with timely and accurate appointment confirmations and reminders.
- Communicated with patients to confirm appointments and provide preparation instructions.
- Coordinated patient appointments, balancing urgent and routine cases.
- Provided detailed explanations to patients regarding radiology procedures and preparation requirements.
- Provided excellent customer service to patients, answering inquiries about radiology procedures and billing processes promptly and accurately.
Provider Claims Representative
Aston Carter (Tricare)
07.2023 - 11.2023
- Complete research and provider final resolution to inquiries within contractual requirements.
- Obtain and analyze claims data to determine specific problem area including external communication to obtain data.
- Communicate with inquirer to determine appropriate authorization or referral of services.
- Submit claims for adjudication, correction, payment, or review as appropriate.
- Educate providers on billing requirements of TRICARE to reduce claim problems.
- Deal tactfully with people in a wide variety of situations to convey a favorable corporate image.
- Respond to Inquirer using various forms of communication (written letter, telephone, web or email) within time frames to exceed contractual standards.
- Collect and record data for Customer Service records and computer analysis.
- Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
- Improved claim denial resolution by thoroughly researching and identifying root causes of denials.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Educated providers on the importance of maintaining up-to-date credentials, leading to higher levels of compliance in the organization.
Member Service Representative
FirstSource (Molina Medicaid)
02.2023 - 07.2023
- Answer inbound calls regarding eligibility and benefits, medical/pharmacy claims, prior authorizations and changes to PCP from Medicaid members.
- Submit tickets for insurance verification.
- Complete detailed documentation on member's account during every call.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Provided exceptional service through active listening, understanding member needs, and offering appropriate solutions.
- Enhanced customer satisfaction by efficiently addressing and resolving inquiries and concerns.
- Assisted members with account management, including updating personal information and setting up automated payments.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Educated customers about billing, payment processing and support policies and procedures.
Voice Practitioner (Benefit Verification Specialist)
Manpower (IBM)
09.2021 - 12.2022
- Performed timely verification of insurance benefits prior to patient medication shipment.
- Resubmitted claims after editing or denial to achieve correct processing.
- Contacted patients, providers, pharmacies and insurance companies to get or confirm medication policy benefits including verifying co-pays
- Displayed empathy when speaking with policy holders, as well as understood their need for efficient turnaround times.
- Navigated several applications and programs during calls.
- Managed high-volume caseloads while maintaining strict deadlines for completing benefit verifications and authorizations.
- Ensured compliance with HIPAA regulations during all aspects of the benefit verification process, protecting patient privacy.
- Reduced claim denials with thorough insurance eligibility assessments prior to service provision.
- Maintained up-to-date knowledge of insurance regulations, enabling accurate benefit verifications for various plans.
- Expedited urgent cases by prioritizing workload and utilizing effective time management strategies, meeting tight deadlines consistently.
- Streamlined claim processing procedures for faster resolution times and improved client experience.
- Kept up-to-date with industry trends and regulations to ensure compliance during claim processing tasks.
- Maintained thorough knowledge of policy coverage to accurately interpret and apply benefits during claim processing.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Determined appropriateness of payers to protect organization and minimize risk.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
Education
No Degree - Criminal Justice
Benedict College
Certification - Phlebotomy
Centura College
05.2016
Skills
- Data Entry and Maintenance
- Medical Terminology/ ICD/CPT
- Knowledge of HIPAA Regulations
- Electronic Health Records Systems
- Call Center Customer Service (Member/Provider)
- Attention to Detail
- Ability to use multiple applications at one time
- Claim processing experience
- Experience in quality and production environment
- Provider Enrollment
- Problem-Solving Skills
- Conflict Resolution Techniques
- Experience using Epic
- Salesforce
- Active listening
- Strong empathy
- Customer engagement
- Claim denial resolution
- Insurance verification
- Multitasking
- Appointment scheduling
Accomplishments
Circle of Excellence Top QPH Performance (Manpower)
Circle of Excellence Top 2 QPH Performers (Manpower)
Timeline
Member Service Representative
VXI Global
11.2024 - Current
Support Analyst
Prisma Health
01.2024 - 07.2024
Provider Claims Representative
Aston Carter (Tricare)
07.2023 - 11.2023
Member Service Representative
FirstSource (Molina Medicaid)
02.2023 - 07.2023
Voice Practitioner (Benefit Verification Specialist)
Manpower (IBM)
09.2021 - 12.2022
Certification - Phlebotomy
Centura College
No Degree - Criminal Justice
Benedict College
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