Tammy Baisy

• Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
• Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
• Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
• Developed strong relationships with external organizations, leading to increased cooperation during verification processes.
• Provided exceptional customer service to both internal and external stakeholders, addressing inquiries promptly and professionally.
• Safeguarded confidential provider information by adhering to strict data privacy regulations and company policies.
• Conducted primary source verifications such as background checks and board certifications.
• Received and evaluated applications to look for missing and inaccurate information.
• Contributed positively to team dynamics by fostering a collaborative and supportive work environment.
• Achieved greater accuracy in database management by regularly updating provider records and tracking status changes.
• Facilitated communication between departments, resulting in improved collaboration during the credentialing process.

• Asked fact-finding questions to determine customer needs and expectations and recommended specific products and solutions which can include but not limited to reaching out to primary care doctor and local pharmacies
• Adhered to company policies and scripts to consistently achieve call-time and quality standards.
• Provide information on authorizations and claims including but not limited to time frames,claim status,denial and reconsideration guidelines
• Answered over 35 calls per shift to meet fast-paced call center demands.
• With member approval submitted Organization determinations on upcoming medical procedures through CSIM for determination and Coverage determinations for medications using PA hub
• Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
• Placed outbound customer service or customer satisfaction calls to follow up on issues.
• Strong ability to multi task using several different systems to resolve questions and concerns
• Maintained and managed customer files and databases.
• Researched issues through identification of similar past problems and recommended most appropriate solution.

High volume call center
Process call in orders for prescriptions

• Working remotely for Humana Pharmacy for 2 years
• Average of 50 calls per day answered by addressing customer inquiries, solving problems, and demonstrating empathy
• Asked open-ended questions to assess customer needs
• Investigated and resolved customer inquiries and complaints
• Collected co-payments or full payments from customers
• Reviewed and verified customer information and insurance provider information. Educated members on insurance coverage and different stages
• Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs
• Consulted with outside parties to resolve discrepancies and create effective solutions.
• Answered live online chats to give quick answers and solve problems faster.

Taking over escalated calls that threaten Better Business Bureau, Attorney General, or Texas Real Estate Commission.

• First point of contact for attorneys.
• Worked all accounts that were escalated in my case load until completely resolved.
• Responded to customers and attorney letters by researching all concerns pertaining to contract, guidelines ,rules and regulations. Responding back via email, letter or telephone call in timely and empathetic manner.
• Assisted with financial assistance programs for customers when needed.
• Mentored and provided back-up for other customer service representatives when needed.
• Worked under strict deadlines and responded to unusual service requests when needed.
• Negotiated new or existing contracts
• Set up and explained new membership contracts.