Tamela Buckner
Norfolk,VA
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Appeal Representative
OptumRx
Norfolk, Virginia
05.2012 - Current
- Assessed appeals and grievances to determine eligibility for reconsideration or review.
- Facilitated communication between members, providers, internal departments, and external organizations regarding appeals inquiries.
- Tracked all phases of the appeals process from intake through resolution.
- Provided education on the appeals process to staff members as needed.
- Reviewed medical records for accuracy prior to submitting an appeal decision.
- Updated departmental databases with information pertaining to each case reviewed.
- Collaborated with health care providers, members, and other stakeholders to resolve issues in a timely manner.
- Monitored incoming correspondence from members, providers, employers, state agencies. to ensure timely response to inquiries.
- Identified areas of improvement in the appeals process and developed strategies to enhance efficiency.
Independent Life Insurance Agent
Symmetry Financial
Cheaspeake, VA
01.2021 - 02.2024
- Performed financial calculations related to premiums, commissions, and renewals.
- Provided ongoing support to existing clients regarding their policy coverage or changes in regulations.
- Delivered presentations on the benefits of purchasing life insurance policies.
- Advised clients on the best life insurance policies for their needs.
- Explained complex life insurance concepts in a simple manner to clients.
- Assisted customers in filing claims when needed in a timely manner.
Prior Authorization Specialist
Apria Healthcare
Indianapolis, IN
08.2010 - 03.2012
- Facilitated communication between providers, payers and health plans regarding prior authorization processes.
- Educated healthcare professionals on how to properly submit a request for pre-authorization.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Ensured compliance with state and federal regulations pertaining to prior authorizations.
- Conducted quality assurance audits of prior authorization processes according to established standards.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Researched clinical criteria and determined eligibility for requested services based on plan provisions.
- Provided guidance to providers regarding the prior authorization process.
- Collaborated with internal staff members to resolve discrepancies or issues related to prior authorizations.
- Maintained accurate records of all authorization activities in the database system.
Customer Service Representative III
Anthem BCBS
Indianapolis, IN
04.2006 - 07.2010
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Developed positive relationships with customers through friendly interactions.
- Resolved complex problems by working with other departments to provide solutions that meet customer needs.
- Maintained a high level of professionalism when dealing with difficult customers.
- Maintained detailed records of customer interactions, transactions and comments for future reference.
- Developed strong relationships with customers by providing personalized assistance and support.
- Assisted customers with inquiries related to their accounts, including payment status updates and other issues.
- Researched claim denials and appeals to determine appropriate resolution.
- Reviewed medical claims for accuracy and completeness, verifying patient eligibility and coding.
Education
Some College (No Degree) -
Ivy Tech Community College of Indiana
Indianapolis, INSkills
- Time management abilities
- Effective Communication
- Policy Interpretation
- Microsoft Office
- Insurance knowledge
- Policy Knowledge
- Dispute Resolution
- Attention to Detail
- Grievance management
- Teamwork and Collaboration
- Problem-solving aptitude
- Time Management
- Analytical Skills
- Active Listening
Certification
- Life and Health License
Timeline
Independent Life Insurance Agent
Symmetry Financial
01.2021 - 02.2024
Appeal Representative
OptumRx
05.2012 - Current
Prior Authorization Specialist
Apria Healthcare
08.2010 - 03.2012
Customer Service Representative III
Anthem BCBS
04.2006 - 07.2010
Some College (No Degree) -
Ivy Tech Community College of Indiana
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