Summary
Overview
Work History
Education
Skills
Timeline
Generic

Tamara Walker

Orlando

Summary

Claims professional well-versed in intricacies of claim management and resolution. Known for strategic approach to resolving disputes and ensuring compliance with industry standards. Reliable team collaborator with focus on achieving optimal outcomes and adapting to changing requirements. Skilled in negotiation and critical thinking.

Overview

8
8
years of professional experience

Work History

Revenue Recycle Claims Specialist

INDOTRONIX/ATOS-Remote
12.2024 - 08.2025
  • AR collections and follow-up
  • Working knowledge of third-party payers, billing requirements, medical terminology, and system applications.
  • Ability to work remotely in a secure home office location.
  • Medicare, Managed Care, Blue Cross, Work Comp, and other payer experience preferred.
  • Patient Accounting/EHR/billing systems experience with FACS, EPIC, Cerner, Meditech, Paragon, Eprems Hospital coding and billing.
  • Communicate with appropriate party (insurance company, attorney, place of employment, insured, etc.) for prompt account resolution.
  • Accurately document accounts with correct information received and take appropriate system action. Inform Team Supervisor of any payor or other issues effecting collections.
  • Audit assigned work to assure accounts are addressed timely. Identify trends found during follow up process.
  • Navigate insurance portals and upload medical records. Analyze and interpret insurance denials.
  • Write and upload appeals and reconsiderations
  • Processed and audited revenue recycle claims with precision to ensure accurate billing adjustments, resulting in a 15% reduction in claim disputes and accelerated revenue recovery for INDOTRONIX/ATOS.

Lead Adjudication Specialist/Fact Finder

Coresstaff/Maximus-Remote
08.2022 - 11.2024
  • Research UI claims for the state of Colorado and respond to written and telephone inquiries from customers regarding unemployment claim status, program requirements and procedures. Make determinations on eligibility on 50 and 40 issues and complete written decisions to parties of interest following policy, legal precedents and state and federal law.
  • Review reports on unemployment insurance activity; identify and correct errors and conduct follow-up with appropriate parties as necessary.
  • Conducted thorough analysis and validation of claimant documentation to determine eligibility in complex adjudication cases, ensuring compliance with regulatory standards.
  • Led investigative fact-finding efforts by coordinating with multiple agencies and stakeholders to gather accurate information and resolve discrepancies in claims.
  • Mentored and trained junior specialists on best practices for evidence evaluation and case management, improving team accuracy and efficiency.

Prior Authorization Specialist

CMT Solutions/Cover My Test-Remote
07.2020 - 08.2022
  • Work assigned prior authorizations; initiate requests, follow-up to provide additionally required information, track progress and expedite responses from insurance carriers and other payers.
  • Ensure that all work is processed in compliance with our client service level agreements and company policies and procedures.
  • Track, report and escalate service issues arising from requests for authorizations, program eligibility or other issues that delay service, to ensure patient access and avoiding delays that interrupt therapy.
  • Document case activity, communications, and correspondence in computer system to ensure completeness and accuracy of patient contact records in compliance with company requirements and the Service Level Agreements.
  • Perform or assist with any operations, as required to maintain workflow and to meet schedules and quality requirements.
  • Accept additional responsibilities and/or projects as directed by leadership.
  • Implemented automated testing frameworks to enhance the accuracy and efficiency of software validation processes.
  • Collaborated with development teams to identify and resolve critical defects, reducing issue resolution time by 30%.
  • Developed and maintained comprehensive test cases and documentation to support continuous integration and delivery pipelines.

Account Receivable Billing and Reimbursement

Prime Therapeutics
02.2018 - 06.2020
  • Account Receivable Billing and Reimbursement
  • Processed and reconciled high-volume healthcare claims to ensure accurate and timely reimbursement in compliance with regulatory standards.
  • Collaborated with payers and providers to resolve billing discrepancies, reducing accounts receivable aging and improving cash flow efficiency.
  • Utilized specialized billing software to generate detailed reports and analyze payment trends, enhancing revenue cycle management strategies.
  • Managed timely and accurate billing processes, resolved reimbursement discrepancies, and optimized accounts receivable workflows to enhance cash flow and reduce outstanding balances at Prime Therapeutics.
  • Managed accurate billing processes and optimized reimbursement cycles by coordinating with payers and resolving discrepancies, resulting in improved cash flow and reduced accounts receivable aging at Prime Therapeutics.

Education

Associate's degree - Medical Billing & Coding

Everest University-South Orlando
Orlando, FL
05.2022

Skills

  • Data analysis skills
  • Proficient in medical terminology
  • Skilled in Microsoft Office applications
  • Precise data entry
  • Effective organizational skills
  • Client support
  • Medical claims processing
  • Skilled in Microsoft Outlook communication tools
  • Customer service experience
  • Skilled in formatting and editing with Microsoft Word

Timeline

Revenue Recycle Claims Specialist

INDOTRONIX/ATOS-Remote
12.2024 - 08.2025

Lead Adjudication Specialist/Fact Finder

Coresstaff/Maximus-Remote
08.2022 - 11.2024

Prior Authorization Specialist

CMT Solutions/Cover My Test-Remote
07.2020 - 08.2022

Account Receivable Billing and Reimbursement

Prime Therapeutics
02.2018 - 06.2020

Associate's degree - Medical Billing & Coding

Everest University-South Orlando

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