Summary
Overview
Work History
Education
Skills
Timeline
Generic

Tahnysha Adams

Parma,OH

Summary

Understanding Insurance Verification Coordinator with 8 year background in the medical insurance industry. Looking to tackle new responsibilities and build upon skills as revenue cycle management. Responsible and diligent to complete all duties associated with revenue cycle management.

Overview

8
8
years of professional experience

Work History

Insurance verification

Cardinal Health
04.2019 - Current
  • Processes routine customer orders according to established demand plans, schedules and lead times using SAP and other internal systems
  • Enters all necessary order information, reviews order contents, and ensures that orders are closed once completed
  • Responds to inquiries from internal customers, such as Distribution Centers, regarding order tracking information as well as on-hold, back order and high priority statuses
  • Identifies and communicates resolutions to order delays, missing information, and product availability based on customer profiles
  • Uses dashboards and reporting from internal systems to identify causes of order issues, such as lack of inventory or invalid measures or requirements in the order
  • Creates visuals and conducts analyses as necessary to understand and communicate order data and issues
  • Coordinates with a variety of internal stakeholders, including Planners and externally-facing Customer Service Representatives, regarding customer issues
  • For international shipping and in cases of special order requirements, coordinates with Quality and Global Trade teams in order to ensure compliance of orders
  • Processes orders for product samples and trials, coordinating with Marketing teams as necessary to understand the purpose and requirements of the samples.

Residential Treatment Specialist

OhioGuidestone
05.2018 - Current
  • Member of the Residential Treatment team
  • This responsibility necessitates building and maintaining strong, nurturing relationships with the residents and staff of the Residential Treatment Center (RTC); observing professional boundaries at all times; effectively communicating with all; and proving leadership in advocacy and support for residents in care
  • Plans and organizes activities and educational groups for residents
  • Handle emergency situations such as environmental, weather related, physical injury
  • Complete all required training, both in person and online through the agency’s learning management system
  • Appropriately utilizes PAARR and PAARR physical techniques
  • Maintained regular and reliable attendance
  • Planning, organization, and implementation of special events or department specific projects or seasonal program changes.

Billing specialist Pharmacy

Cleveland Clinic
12.2017 - 04.2019
  • Responsible for reviewing and researching entered claims, assisting in adjudication, working and resolving unpaid claims, generating patient statements, and maintaining accounts receivable records
  • Evaluates accounts and prepares adjustments to refund payments and correct discrepancies as necessary
  • Identifies and assists patients who may qualify for patient assistance programs or copay assistance
  • Performs manual and/or electronic processing of claims in a prompt and timely manner
  • Maintains and applies knowledge of current requirements relative to managed care contracts, Medicare, Medicaid, and departmental policies regarding timely filing of claims
  • Addresses insurance, reimbursement, and payment issues as appropriate by communicating with insurance, providers, patients, and pharmacists
  • Prepares manual/electronic claims and submits with appropriate documentation
  • Verifies benefits and eligibility and submits prior authorizations as needed
  • Maintains accurate records of outstanding claims and/or past due balances
  • Communicates with Reimbursement Manager and/or Finance Director regarding accounts receivable discrepancies
  • Participates and supports department initiatives, meetings and training of staff
  • Responsible for resolving denied claims.

Payment Recovery Specialist

Human Arc
11.2015 - 04.2017
  • Follow-up with insurance providers to verify patient coverage
  • Strategically organizes assigned work to maximize efficiency
  • Performs initial contacts online or by phone with health insurance companies to validate cause of denial and options for appeal
  • Uses resources to obtain authorization/pre-certification information necessary to resolve claims
  • Data enters account notes
  • Issues appeal letters on non-clinical/technical denials
  • Communicated pertinent payer trends to department management
  • Performs filing/scanning as needed on assigned accounts
  • Accountable for meeting established productivity measures or goals
  • Participates in special denial projects as assigned
  • Trains new employees on department functions as well as direct role training.

Education

CUYAHOGA COMMUNITY COLLEGE
Cleveland, OH
12.2016

YOUNGSTOWN STATE UNIVERSITY
Youngstown, OH
12.2013

High School Diploma -

Bedford High School
Bedford, OH
06.2011

Skills

  • Denied Claims Resolution
  • CPT Codes (ICD-10)
  • Multi-line phone operation proficiency
  • Explanation of Benefits
  • Strong problem-solving aptitude
  • Insurance Verification/Follow-Up
  • Superior verbal and written communication skills
  • Excellent interpersonal skills
  • EPIC/Evolve/Soarian
  • Experience with both electronic, and manual invoicing
  • Understanding of Medical Terms
  • Analytical Thinking
  • Attention to Detail
  • Insurance Coverage Verification

Timeline

Insurance verification

Cardinal Health
04.2019 - Current

Residential Treatment Specialist

OhioGuidestone
05.2018 - Current

Billing specialist Pharmacy

Cleveland Clinic
12.2017 - 04.2019

Payment Recovery Specialist

Human Arc
11.2015 - 04.2017

CUYAHOGA COMMUNITY COLLEGE

YOUNGSTOWN STATE UNIVERSITY

High School Diploma -

Bedford High School

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