Tamara Avery
Rochester,NY
Summary
Highly organized and dedicated administrative professional with a proven track record of delivering exceptional customer service in fast-paced environments. Possessing a keen attention to detail and strong decision-making skills, excels at managing multiple concurrent tasks efficiently. With a self-motivated work ethic, consistently performs effectively whether working independently or as part of a team.
Overview
19
19
years of professional experience
Work History
Credentialing Specialist I
Excellus BCBS
02.2022 - 05.2024
- Re-credentialed all practitioners and conducted primary source verifications such as background checks and board certifications. Review practitioner applications for designated health care professionals for the purpose of determining adherence to the Health Plan Credentialing Policies
- Re-credentialed 30-80 practitioners monthly
- Communicate with all state, federal and other regulatory agencies to obtain and/or validate information submitted by providers
- Research and investigate all issues involved in the re-credentialing process
- Prepare findings and recommendations for the Medical Director to present to the Health Plan Credentialing Committee
- Conduct follow-up Credentialing Committee decisions and for further investigation
- Review, maintain and update credentialing database as appropriate
E-ROC Select Dedicated Customer Care Advocate
Excellus BCBS
01.2020 - 10.2020
- Provide white glove customer service to members and providers of the Health Plan
- Responded to customer requests, offering excellent support and tailored recommendations to address needs.
- Responded to customer needs through competent customer service and prompt problem-solving
- Responded proactively and positively to rapid change.
- Provide outreach related to claims
- Document, research, interpret and respond to inquiries
- Maintain high regard for member privacy
- Utilize appropriate resources to resolve customer inquiries accurately and efficiently
- Willingness to adapt and be flexible to changes and business needs
- Participate in meetings, training and skill development to support career path and individual development
Data Entry/Credentialing
The Monroe Plan
11.2019 - 01.2020
- Company Overview: (Temporary)
- Process practitioner applications for individual providers, groups and facilities
- Worked on project collecting and gathering provider demographic information
Customer Service Representative
Continuum Global Services
07.2019 - 10.2019
- Investigated and resolved customer inquiries and complaints quickly.
- Research and resolve customer problems by navigating through multiple computer applications with speed and accuracy
- Responded to customer requests for products, services, and company information.
Release of Information Specialist
Verisma
04.2019 - 06.2019
- Process request for medical release of information in a timely manner using Verisma Software Applications
- Reproduced protected health information by using data extraction and file management techniques.
- Read and interpret medical record, forms and authorizations
- Ensure compliance and confidentiality is always maintained
- Navigated within patient records to locate requested documentation, successfully completing several requests per day.
- Handled phone calls from attorneys, insurance companies and patients.
- Followed exact procedures for handling transfers and other releases of medical records.
Appointment Coordinator
Rochester Regional Health
07.2018 - 04.2019
- Received inbound calls at high volume
- Provide courteous, attentive and prompt customer service to patients, health care providers and payors
- Utilized Electronic Medical Records (Epic) to communicate with patients, caregivers, physicians and the community to schedule appointments, complete registrations and respond to inquiries
- Worked well with others in different departments
- HIPAA compliant
Consumer Service Specialist III
Maximus
09.2016 - 02.2017
- Received incoming calls from the public, prospective enrollees and people assisting enrollees
- Processed application for healthcare coverage via telephone
- Transfer/refer consumers to appropriate entities according to established guidelines
- Process life event changes, demographic updates, disenrollment requests and special enrollment periods as requested
- Facilitated fulfillment of caller requests for materials via mail, email or download
- Facilitated translation services for non-English speaking callers according to procedures
- Escalated calls or issues to appropriate designated staff for resolution
- Attended meetings and training as requested and maintained up to date knowledge of all programs and systems
- Met quality assurance and other key performance metrics
- Performed other duties as assigned
Cash Management Teller
Loomis Armored
10.2015 - 05.2016
- Completed highly accurate, high-volume money counts via both manual and machine-driven approaches.
- Arranged monies received in cash boxes and coin dispensers according to denomination.
Communications Representative
UR Medicine
08.2012 - 04.2016
- Scheduled appointments for multiple healthcare departments per department protocol
- Correspond and provide information to patients, healthcare providers and staff via phone and Electronic Record
- Verify and update patient registration and health insurance information
- High call volume fast paced environment
- Enhanced knowledge of HIPAA regulations and violations
Deployment Assistant
Rochester Regional Health Information Organization
04.2009 - 06.2010
- Received calls on information line and directed them to the appropriate department
- Responsible for preparing and shipping out information kits and training packets
- Provide general technical support for user
- Assisted medical users on how to navigate online system
- Scheduled demonstrations and training classes
- Maintained CRM (Salesforce)
- Other duties included scanning, data entry and handling confidential information
Administrative Assistant
ConServe
04.2005 - 04.2009
- Promoted from Skip Tracer to Administrative Assistant within 6 months
- Worked with several departments within the company and performed a variety of miscellaneous tasks
- Responsible for updating and distributing the company weekly work schedule for 300+ employees
- Generated daily reports that tracked the department’s performance
- Scheduled interviews
- Obtained government security clearance and evaluated Department of Education bankruptcy accounts
- Handled consumer disputes using E-Oscar
- Updated demographic information on accounts
- Verified client’s payments via email or telephone
- Obtained switchboard knowledge
- Handled sensitive documents and information
Education
Community Business Alliance Certificate - Business
Urban League of Rochester
Rochester, NY06.2024
Unit Health Clerk Program -
SUNY REOC
Rochester, NY05.2004
Diploma -
East High School
Rochester, NY06.2000
Skills
- Communication skills
- Analytical skills
- Problem-solving skills
- Microsoft Office
- Adobe
- Attention to detail
- Organizational skills
- Multitasking
- Proofreading
- License verifications
- Credentialing documentation
Timeline
Credentialing Specialist I
Excellus BCBS
02.2022 - 05.2024
E-ROC Select Dedicated Customer Care Advocate
Excellus BCBS
01.2020 - 10.2020
Data Entry/Credentialing
The Monroe Plan
11.2019 - 01.2020
Customer Service Representative
Continuum Global Services
07.2019 - 10.2019
Release of Information Specialist
Verisma
04.2019 - 06.2019
Appointment Coordinator
Rochester Regional Health
07.2018 - 04.2019
Consumer Service Specialist III
Maximus
09.2016 - 02.2017
Cash Management Teller
Loomis Armored
10.2015 - 05.2016
Communications Representative
UR Medicine
08.2012 - 04.2016
Deployment Assistant
Rochester Regional Health Information Organization
04.2009 - 06.2010
Administrative Assistant
ConServe
04.2005 - 04.2009
Community Business Alliance Certificate - Business
Urban League of Rochester
Unit Health Clerk Program -
SUNY REOC
Diploma -
East High School
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