Tamyka Elliott

• Process initial credentialing, re-credentialing, demographic updates, and suspension notification for physicians & practitioners. Verifies electronic files are completed timely, accurate, and in compliance with regulations and requirements.
• Verify potential and existing provider's licensure, NPI, insurance, DEA certificate, education, hospital privileges, and board certification.
• Gathered and analyzed patient feedback and experience regarding provider's quality and metrics.

Revenue Cycle Specialist

• Served as a valuable resource to patients providing them with pertinent information regarding their coverage.
• Utilized various databases and payer sites to verify insurance coverage, benefits, and informed about price estimates.
• Researched and corrected invalid patient demographic information such as incorrect name spelling, date of birth or insurance policy number to ensure proper billing and clean claim initiatives.
• Reviewed accounts with outstanding balances and communicated out-of-pocket obligations. Also, explained EOB and copayment details.

• Provided information and guidance regarding health insurance eligibility and benefit coverage.
• De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
• Fielded customer complaints and queries, fast-tracking them for problem resolution.
• Upheld strict quality control policies and procedures during customer interactions.
• Coordinated and scheduled medical transportation to members, collaborating with third party agents.

• Fielded inbound calls from customers inquiring about alternative insurance options to generate sales opportunities.
• Managing inquiries from active, terminated, and prospective members problems. Resolving issues concerning enrollment, billing, claims, and pharmacy.
• Receive multiple awards of exceptional service satisfaction
• Explained coverage options to potential policyholders, answering questions or concerns. Also, assisted navigating insurance coverage via company website.

• Gathered copies of pertinent documents such as education certificates; State licensure; DEA#; immunization records; previous employers; malpractice entities.
• Performed primary source verifications such as criminal histories, licenses and board certifications. Also, checked applications for missing information and organized all paperwork.
• Addressed credentialing requests, overseeing compliance with governmental and organizational guidelines regarding tiered data access.
• Maintained (CAQH) Council for Affordable Quality Healthcare informational resources, tracking and documenting requests for updates, certification and credentialing.
• Processed documents and status-change requests, conducting followup assessment regarding enrollment inquiries.
• Reduced process lags by quickly processing personnel actions, awards, flags, legal incidents, sponsorship, evaluations, morale and welfare documentation.