Summary
Overview
Work History
Education
Skills
Timeline
Generic

Tanisha GORDON

Forney

Summary

Provides seamless customer service to providers in fast-paced call center environments. Excellent communication, relationship-building and problem-solving abilities. Diligent, attentive and quality-driven.

Overview

17
17
years of professional experience

Work History

Sr. Operations Specialist

Schneider
04.2015 - Current
  • Coordinate and manage the schedules of truck drivers to ensure products and goods are picked up and delivered in a timely manner
  • Collaborate with management to modify daily routes to accommodate the needs of customers
  • Verify transactions, product orders and shipping dates and entered information into databases and reports.
  • Act as a communication liaison through system tracking software, delivery drivers and our customers to achieve a cohesive result
  • Report emergencies, weather delays and carrier schedule changes to customers and supervisors.
  • Cultivate strong relationships with drivers and customers to reduce the stress that comes with last minute schedule changes
  • Develop efficient driver schedules to maximize profits
  • Maintain department records and polices compliance
  • Prepare daily shipping documents and invoices for drivers and our customers
  • Ensured all product is accounted for and claims are either approved or denied within policy timeframe
  • Provide direct assistance and clerical support to account manager including operational functions (emailing, data entry and answering multi-line phone system)
  • Record shipping data, such as weight, charges, space availability, damages, and discrepancies for accounting and record keeping purposes
  • Respond to customer inquiries regarding bill of ladings and provide proof of delivery invoices by contacting other departments and/or terminals to trace shipments
  • Assist in researching discrepancies on cycle counts
  • Responsible for locating overages, shortages, and damaged freight and providing disposition.

Prior Authorization Representative

Health Net Federal Service
06.2014 - 02.2015
  • Updated patient (Veteran) medical authorizations with clinical notes and diagnosis codes
  • Followed the proper policies and procedures to stay compliant with HIPAA laws
  • Paid or denied medical claims based upon established claims processing criteria.
  • Approved/denied pre-authorizations
  • Answered calls, scheduled, rescheduled, cancelled, and confirmed specialty appointments with patient (Veteran) and providers office
  • Identified, analyzed, and resolved a variety of scheduling issues
  • Reviewed computerized appointment templates to determine the availability of appointment types and slots
  • Documented transactions in appropriate medical management systems
  • Contacted medical provider offices by telephone, collected medical notes and forwarded to the VA.
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Evaluated clinical criteria for approval or denial of services requiring pre-authorization.

Provider Relations Representative

Optima Health Insurance
11.2013 - 04.2014
  • Determined if pre-authorization was needed for inpatient/outpatient procedures and services
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Examined patient’s insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under polices when applicable
  • Assessed medical claims for compliance with regulations and corrected discrepancies.
  • Answered provider inquiries via email, telephone and written correspondence.
  • Evaluated medical claims for accuracy and completeness and researched missing data.
  • Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate parties.
  • Compiled and maintained patient medical records to keep information complete and up-to-date.
  • Followed document protocols to safeguard confidentiality of patient records.
  • Answered incoming calls, scheduled appointments and filed medical records.
  • Verified patient insurance eligibility and entered patient information into system.
  • Provided excellent customer service to patients and medical staff.

Tier 2 Technical Support Representative

AT&T
12.2012 - 04.2013
  • Assisted AT&T U Verse customers using different methods of troubleshooting software and company database to resolve technical issues
  • Assisted customers with installations, troubleshooting, and assigned technicians out to residents
  • Answered billing/credit questions and concerns.
  • Received inbound phone calls transferred from Tier 1 specialists to research and resolve advanced technical issues.
  • Assessed technical complexity of tickets to escalate to Tier 3 team.

Cash Office Associate

Tom Thumb Food & Pharmacy
06.2007 - 01.2011
  • Maintained petty cash records of debits and credits in accordance with established policies and procedures.
  • Balanced safe, prepared tills, and prepared register bags for next sales date.
  • Prepared bank deposits and corporate cash shipments.
  • Sorted and counted coin and currency to make change for associates.
  • Processed both cash and card purchases and returns.
  • Performed store opening, closing, and shift-change actions and kept accurate shift-change logs.
  • Led opening and closing procedures and conducted cashier drops, cash control and vault monitoring.

Education

No Degree - Early Childhood Education

Tarrant County College District
Fort Worth, TX

Certificate - Medical Office Management

Arlington Career Institute
Grand Prairie, TX

High School Diploma -

Rubidoux High School
Riverside, CA
06.2006

Skills

  • Claims Handling and Coverage Verification
  • Benefits Explanations
  • Clerical and Filing Support
  • Multi-Line Telephone Systems
  • Insurance Verification
  • Patient Insurance Authorizations
  • Medical Coding
  • Verbal and Written Communication
  • CPT Coding
  • Calm and Professional Under Pressure

Timeline

Sr. Operations Specialist

Schneider
04.2015 - Current

Prior Authorization Representative

Health Net Federal Service
06.2014 - 02.2015

Provider Relations Representative

Optima Health Insurance
11.2013 - 04.2014

Tier 2 Technical Support Representative

AT&T
12.2012 - 04.2013

Cash Office Associate

Tom Thumb Food & Pharmacy
06.2007 - 01.2011

No Degree - Early Childhood Education

Tarrant County College District

Certificate - Medical Office Management

Arlington Career Institute

High School Diploma -

Rubidoux High School

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Tanisha GORDON