Tammie Y. Robinson
Operations Supervisor
Rockford,IL
Summary
Versatile Operations Supervisor successful at taking on routine and complex business challenges with resourceful and creative approach. Recognized as driven, dedicated and hardworking leader with history of streamlining operations and increasing results.
Overview
24
24
years of professional experience
Work History
Operations Manager
First Source Solutions Ltmited
2014.04 - Current
- Provide direction, leadership and mentoring for staff.
- Interacts with the client daily to resolve any issues, answer questions, and provide the production and performance information as required.
- Actively seeks to add value added options for clients.
- Assists employees with the development of Individual Development Plans.
- Provides recommendations for hiring and conducts performance reviews.
- Review and analyze daily staff processing of claims, which includes reviewing quality and production reports.
- Participates in the development of operating goals and objectives for the unit; recommends, implements, and administers policies and procedures to enhance operations and production.
- Supervises and researches appeals and reprocessing of claims; reviews and resolves claims problems.
- Researches and prepares scheduled and special reports.
- Responsible to monitor and reduce expenses.
- Prepares monthly billings/invoices to be sent to the client.
- Enters appropriate personnel information into HR Office for employees within units/teams.
- Responsible for administering any discipline that may be needed ensuring that appropriate procedures are followed.
- Attends meetings and workshops, and participates on committees, as assigned.
- Performs miscellaneous job-related duties as assigned including processing payroll for employees.
Sr Resolutions Coordinator
Essence Healthcare
2009.03 - 2014.04
- Develop and implement policy and procedures regarding claims processing, perform root cause analysis and present findings
- Process Level III claims from medical providers in accordance with provider contracts and CMS guidelines, Including Inpatient / Outpatient Hospital claims, ESRD claims, Home Health, and Miscellaneous J Code Drug reimbursement claims
- Provider payment disputes relating to contract rate discrepancies and/or PPS pricing, reimbursement/payment policies, audit reviews and analysis
- Problem resolution and contract review, including system set up issues and resolutions
- Trained new hires on medical claim processing (all claims levels)
- Cross trained tenured claims processors on new and updated claims processing procedures
- Observed each employee's individual strengths and initiated mentoring program to improve areas of weakness.
Customer Service Representative
Great West Healthcare
2000.02 - 2007.12
- Answered incoming calls and e-mails from members, pharmacies, and health care providers regarding: primary care and specialist selections and changes; general pharmacy questions; ID card requests; member/ provider demographic changes; and general provider/ network status inquiries
- Handled requests received via e-mail, internet, voicemail, and Provider Contact Management System (PCMS) from Providers and internal departments
- Requests may include submitting provider demographic changes to Data Maintenance, verifying provider participation status, setting up requests to join the network in PCMS from non-participating providers
- Processed medical claims in accordance with contract provisions, using established policies and procedures up to a designated payment authority level.
Education
High School Diploma -
Hammond High School
Hammond, IN06.1989
Skills
- Microsoft Office
- Develop, plan, and implement short- and long-range goals.
- Gather data, compile information, and prepare reports.
- Foster relationships with business partners.
- Employee development and performance management skills.
- Excellent Multitasking Abilities
- Multi-Unit Operations Management
- Staff Management
- Process Improvement Strategies
- Workflow Planning
- Strategic Partnership
- High-Pressure Environments
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
There is a powerful driving force inside every human being that, once unleashed, can make any vision, dream, or desire a reality.
Tony Robbins
Timeline
Operations Manager
First Source Solutions Ltmited
2014.04 - Current
Sr Resolutions Coordinator
Essence Healthcare
2009.03 - 2014.04
Customer Service Representative
Great West Healthcare
2000.02 - 2007.12
High School Diploma -
Hammond High School
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