Summary
Overview
Work History
Education
Skills
Timeline
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Tabetha Thomas

Anchorage,Alaska

Summary

Gifted communicator, conflict manager and relationship builder successful at offering providers positive and seamless experiences. Seeking opportunities to improve processes and workflows for team benefit. Conscientious, hardworking and excels at multitasking in fast-paced environments.

Overview

7
7
years of professional experience

Work History

Provider Relations Advocate

Optum
Anchorage, AK
04.2023 - Current
  • Compiled and maintained records of provider, claims processing issues, authorizations, and other related matters.
  • Developed and implemented strategies to improve provider relations by increasing communication with providers.
  • Enhanced client satisfaction by resolving disputes and partnering with healthcare providers to clarify issues.
  • Instructed providers on procedures and policy limitations for Alaska Medicaid and the Behavioral Health plans.
  • Provided technical assistance on claim adjudication processes to ensure accurate payments were made timely.
  • Maintained an up-to-date knowledge of industry standards for coding practices and reimbursement methodologies.
  • Cultivated strong relationships to maintain provider network knowledge and implement corrective actions for ongoing issues.
  • Investigated concerns such as billing and claims questions on behalf of providers.

Prior Authorization Supervisor

Conduent
10.2019 - Current
  • Directed and supervised team of 15 employees in daily operations.
  • Developed and implemented operational policies and procedures to ensure efficiency and accuracy of workflows.
  • Maintained accurate records of employee performance, attendance, leave requests, and disciplinary actions.
  • Tracked progress on projects and provided timely feedback to staff members.
  • Resolved customer complaints in a timely manner while ensuring customer satisfaction.
  • Conducted weekly meetings with team members to discuss upcoming tasks and project deadlines.
  • Recruited, hired, trained, mentored, coached, evaluated, and terminated staff as necessary.
  • Evaluated employee performance through periodic reviews and documented results accordingly. Provided additional training if needed.
  • Collaborated with other departments to coordinate workflow processes between teams.
  • Complied with company policies, objectives and communication goals.
  • Reviewed completed work to verify consistency, quality and conformance.

Prior Authorization Administrative Lead

Conduent
08.2017 - 10.2019
  • Managed department operations and procedures to ensure organizational effectiveness and efficiency.
  • Developed, implemented and maintained administrative systems, policies and procedures.
  • Provided direction and guidance to staff on administrative matters.
  • Assisted with the preparation of reports, presentations and other documents related to departmental activities.
  • Resolved issues or escalated them to the appropriate resource when necessary.
  • Ensured compliance with company guidelines and procedures by all team members.
  • Established communication channels between departments to facilitate efficient work processes.
  • Generated various forms of correspondence such as memos, letters, emails.
  • Managed physical and digital files, monitored spreadsheets and updated reports to coordinate project materials.
  • Developed administrative processes to achieve organizational objectives and improve office efficiency.

Education

Highschool Diploma -

Peninsula High School at Lakebay, WA
06.2005

Skills

  • Extensive knowledge of Alaska medicaid policies and procedures
  • New employee training
  • Existing employee continued training
  • Daily communication with providers regarding issues, questions and concerns
  • Service Authorization processing
  • Service Denial processing
  • Proficient with Word, Adobe, Excel, Orion, Clearquest, Enterprise, Saleforce, Doc360 and Tableau
  • Data entry and Inventory Maintenance
  • Review of service authorizations, regulations and policies
  • Well-versed in Alaska Medicaid regulations and laws
  • Excellent written and oral communication skills
  • Maintains positive workplace relationships with staff and clients/providers
  • Provider relationship management
  • Claims resolution

Timeline

Provider Relations Advocate

Optum
04.2023 - Current

Prior Authorization Supervisor

Conduent
10.2019 - Current

Prior Authorization Administrative Lead

Conduent
08.2017 - 10.2019

Highschool Diploma -

Peninsula High School at Lakebay, WA

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Tabetha Thomas