Tammy Michele Sparks

• Provide case management services to individuals receiving services through IDD Service Coordination including developing and monitoring the implementation of individual’s Person Directed Plan (PDP).
• Monitor services on PDP through assessments, site-based visits, and collateral telephone contacts.
• Coordinate and monitor delivery of services to ensure they meet the needs of individual.
• Frequent face-to-face and collateral contacts (telephone or face-to-face contact) with individual, guardian, and other collaterals to meet monthly targets.
• Responsible for completing accurate documentation within timeframes set forth by t unit and Health and Human Services Commission (HHSC).

Worked for the same company (formerly Prime Therapeutics) from 2014 to 2023.

• Verified Pharmacy and Major Medical insurance in a timely manner to ensure patients get the medication they need, when they need it. Interacted with patients, doctor's offices, and insurance companies to obtain, verify, and explain coverage and cost of specialty medications.
• Adjudicated claims according to policy and contract requirements
• Determined customer claims resolutions within prescribed guidelines for the purpose of meeting contract requirements.
• Researched, problem solvied, and when necessary, referring complex issues to the appropriate department.
• Assured completion of claims adjudication in a timely manner with attention to quality and accuracy.
• Met all metrics including turnaround time, individual productivity, quality, and accuracy of work completed.
• provided a point-of-contact for patients, doctors offices, and insurance companies through inbound calls.
• Made contact with insurance carriers through outbound calls to discuss policies and individual patient benefits.
• Observed strict procedures to protect sensitive patient information, medical records, and payment data.
• Verified client information by analyzing existing evidence on file.
• Resubmitted claims after editing or denial to achieve financial targets.
• Received and addressed incoming and outgoing communication via telephone and email.
• Coordinated referrals through insurance and other medical specialists and documented details in patient charts.

• Provided exemplary customer service based on individual wants and needs
• Processed credit applications and financial processing
• Responsible for money handling and reconciling of cash drawer
• Ordered merchandise for each customer ticket

• Investigated reports of abuse, neglect or exploitation of elderly or disabled adults to assess the urgency of the problem by interviewing clients, family members and other to gather social, functional, physical and mental-emotional information for evaluation
• Determined temporary or long-term action to be taken to remove or lessen immediate threat to life or health of adult protective services clients to include counseling clients and caregivers, providing information and referral services,
• Developed individualized service plans to meet the needs of the adult protective services client and maintains detailed documentation on each case.