Tami Carpenter

*Worked remotely during tenure

• Navigating patient access to treatment, including contacting the Pharmacy benefits manager
• Assisting patients with prior authorizations
• Helping patients with savings card assistance
• Copay assistance programs
• Took about 20 inbound calls (routine for this business) and assisted patients with any issues/questions they had.
• Make outbound calls to patients to go over their benefits and assist with savings cards/debit cards
• Met Q and A service levels and productivity
• Route calls to other departments if needed
• Utilized electronic health record systems to track patient information and improve data accuracy.
• Maintained detailed records in compliance with agency standards and regulations.
• Participated in team meetings and trainings to stay updated on best practices and new developments in care management.
• Maintained strict adherence to professional ethics and confidentiality guidelines, safeguarding sensitive information and promoting trust.

*Worked remotely during tenure

• Hired on as a Patient Services Representative until I was promoted to a specialist in May 2022

• Met provider call guidelines for service levels, handle time, and productivity

• Educated providers on payment processing and support policies and procedures

• Delivered excellent customer service, resulting in consistent 100% Q and A scores required by the company

• Utilized organizational skills to manage multiple projects simultaneously within established timelines

• Researched discrepancies between submitted claims and expected reimbursements utilizing problem-solving techniques

• Demonstrated advanced knowledge of provider services policies and procedures, as well as relevant industry regulations

• Maintained accurate records of all provider service activities in an organized database system

• Assisted providers with enrollment processes, claim submission issues, reimbursement questions, and other related matters

• Responded promptly to emails sent by providers seeking assistance with their accounts or billing statements

• Provided excellent customer service to clients, resolving inquiries and complaints promptly

• Built sustainable relationships and trust with customer accounts using open and interactive communication

• Processed customer adjustments to maintain financial accounts

• Delivered exceptional provider and patient service to every provider or patient by leveraging extensive knowledge of products and services and creating a welcoming, positive experience

• Collections in secondary claims for TX Medicaid and multiple MCO's for TX. Worked some primary TX insurer's

• Worked denials via Microsoft Excel spreadsheet, 0-30, 31-60, 61-90 and 90+ A/R, appeals, correspondence, submitting corrected claims.

• Responded proactively and positively to rapid change

• Educated providers and patients about billing / payment, payment processing and support policies and procedures

• Promoted superior experience by addressing provider concerns, demonstrating empathy and resolving problems swiftly

• Cross-trained and provided back up for other provider service representatives

• Collections in primary and secondary insurance. Billed claims with accuracy on HCFA1500/UB92 form
• Review and resolve insurance denials. Follow up with insurance companies regarding unpaid, denied, or rejected claims
• Resolved Medicare claims in DDE system. Submitted corrected claims as needed. Experience in working with Microsoft Excel spreadsheets
• Resolved billing inquiries, ensuring timely responses to providers.
• Analyzed account data to identify trends and enhance operational workflows.
• Promoted a positive work environment by actively participating in team meetings and contributing ideas for process improvements.