TAISHA HUGHES
PALM BAY
Summary
Detailed-oriented Claims Processor with 5+ years of experience handling Medicaid, Medi-Share, COB, and commercial insurance claims. Skilled in researching and re-adjudicating denied or rejected claims, ensuring compliance with policies, and maintaining high accuracy under strict deadlines. Proficient in QNXT and other claims systems, with a proven track record of meeting production goals and contributing to process improvements. I am very skilled in verifying information, processing transactions, and utilizing Excel for client updates. Proven track record in providing technical support and handling complex inquiries with limited supervision..
Overview
19
19
years of professional experience
Work History
Claims Processor
Christian Care Ministry
Melbourne
08.2024 - 08.2025
- Assist providers, ensuring efficient claim resolutions and improved service delivery.
- Facilitated communication between providers and departments, enhancing collaboration.
- Supported successful surgical procedures by coordinating communication between surgeons, anesthesia providers, and other team members.
- Expedited accurate clinical documentation completion by promptly responding to queries from healthcare providers and support staff, offering timely guidance and support.
- Provided timely support to healthcare providers in coordinating care plans, resulting in better patient outcomes.
- Served as a trusted clinical resource for patients, caregivers, and healthcare providers, delivering evidence-based information to support informed decision-making processes.
- Processed and reviewed medical claims for accuracy and compliance with insurance policies.
- Collaborated with healthcare providers to resolve claim discrepancies and ensure timely payments.
Transaction Processing Associate II
Conduent- US Bank
El Paso, TX
01.2023 - 08.2024
- Facilitate client enrollment in benefit programs during designated periods, ensuring seamless integration of services.
- Address and resolve multifaceted client inquiries via various communication platforms, operating with minimal oversight.
- Maintain and update client records utilizing proficiency in Excel, while effectively representing client interests in all transactions.
- Processed high-volume transactions with precision and attention to detail.
- Ensured compliance with banking regulations and internal policies.
- Reviewed and resolved transaction discrepancies efficiently.
Prior Authorization Claims Specialist
CVS / Caremark
Melbourne, FL
01.2022 - 01.2023
- Processed and approved authorization requests for medical services, ensuring compliance with healthcare regulations and patient needs.
- Conducted thorough reviews of patient medical histories to inform treatment authorization decisions.
- Confirmed and validated patient insurance coverage details to facilitate accurate billing and minimize service disruptions.
Customer Service Rep
Ashley Furniture
Tampa, FL
01.2019 - 01.2022
- Delivered high-quality customer service by efficiently verifying customer information and assisting with product selection.
- Managed a high volume of inbound and outbound calls to address customer inquiries and resolve issues.
- Overserved online chat agents, ensuring prompt and effective customer communication and support.
Customer Service Rep
Quest Diagnostics
Tampa, FL
01.2015 - 01.2019
- Delivered comprehensive technical training and support to new hires, enhancing team proficiency and operational excellence.
- Assumed interim supervisory responsibilities, ensuring continuity of service and adherence to performance standards as outlined in the NCS Scorecard.
- Collaborated with cross-functional departments to address and resolve process inefficiencies, contributing to improved accuracy in test processing and client data management.
Enrollment Specialist
Continental Benefits
Tampa, FL
01.2012 - 01.2014
- Resolved operational issues and prepared monthly COBRA premium reports, ensuring accurate administration and compliance.
- Managed member enrollments, payments, and refunds, maintaining financial transactions for over 50 COBRA participants daily and addressing client-specific benefits and service inquiries.
Patient Account Specialist
Care Centrex
Tampa, FL
01.2009 - 01.2012
- Managed patient inquiries through inbound and outbound calls, ensuring resolution and documentation in adherence to company policies and procedures.
- Processed refunds, adjustments, and appeals, identifying overpayments and coordinating effectively with stakeholders to secure required medical documentation.
- Prepared accurate payment plan agreements and corresponded with patients, demonstrating strong interpretative skills and a comprehensive understanding of contractual details.
Assistant Director
AJ's Angels
Tampa, FL
01.2007 - 01.2009
- Managed payroll, staffing coordination, and classroom material distribution, ensuring operational continuity in the absence of the Director.
- Facilitated the collection of parent payments and contributed to the development and implementation of monthly staff meetings and training sessions, including CPR certification.
Education
High School Diploma -
Wharton High School
US05-2007
Skills
- Microsoft Word (Experienced)
- Excel (Experienced)
- PIVOT Tables
- VLOOKUP
- COBRA Administration, Customer Service (Expert)
- Problem Solving (Expert)
- Medical Claims (Experienced)
- Financial Analysis,
- Data Entry (Expert)
- Transaction Processing (Experienced)
- Claims review
- Attention to detail
Timeline
Claims Processor
Christian Care Ministry
08.2024 - 08.2025
Transaction Processing Associate II
Conduent- US Bank
01.2023 - 08.2024
Prior Authorization Claims Specialist
CVS / Caremark
01.2022 - 01.2023
Customer Service Rep
Ashley Furniture
01.2019 - 01.2022
Customer Service Rep
Quest Diagnostics
01.2015 - 01.2019
Enrollment Specialist
Continental Benefits
01.2012 - 01.2014
Patient Account Specialist
Care Centrex
01.2009 - 01.2012
Assistant Director
AJ's Angels
01.2007 - 01.2009
High School Diploma -
Wharton High School