Tanisha Samuels
Columbia,SC
Summary
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
12
12
years of professional experience
Work History
HEALTHY CONNECTIONS ELEGIBILTY SPECIALST
TEKSYSTEMS
02.2024 - Current
- Served as the primary point of contact for clients requesting medicaid coverage, processing annual reviews for the state.
- Enhanced Medicaid eligibility determinations by thoroughly analyzing applicants'' financial and personal information.
- Resolved eligibility discrepancies by carefully reviewing regulations and collaborating with relevant parties to reach accurate determinations.
- Managed high caseloads efficiently, prioritizing tasks effectively and utilizing time-management skills to meet deadlines consistently.
- Reduced errors in eligibility decisions with meticulous attention to detail and thorough documentation of applicant information from the calls taken within the call center.
- Maintained up-to-date knowledge of relevant laws, regulations, and policy changes affecting Medicaid eligibility determinations.
- Working remotely
Customer Service Advocate II
Blue Cross and Blue Shield
12.2022 - 01.2024
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Verified eligibility and compliance with authorization requirements for service providers.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- utilized knowledge of ICD-10-CM, CPT, and HCPCS codes to process authorizations.
- Working remotely
Unitedhealthcare Customer Service Advocate
Sitel Group
10.2021 - 11.2022
- Answering service for United Healthcare; determined billing discrepancies; processed appeals for medications and medical services; collected payments; processed dis-enrollments and reinstatement requests; assisted members navigating the company site and troubleshooting personal devices.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Responded to customer requests for products, services, and company information.
- Working remotely
Cashier
Michaels Cleaners
10.2019 - 06.2021
- Sorted items daily for further processing; conducted close examination of items; collected payments; performed daily safe deposits.
Front Office Receptionist/Operator/Billing Clerk
Columbia Urological Associates
06.2018 - 02.2019
- Prepared charts for nurses and doctors; collected payments; updated patient information; answering service for the private practice; assisted patients with changes or questions; forwarded calls; took messages for physicians; submitted charges for services; balanced charges for accuracy.
- Reduced wait times for callers, promptly answering phone lines and directing calls as needed.
- Interacted with customers by phone, email, or in-person to provide information.
- Maintained clean reception area to promote positive, professional environment for clients.
- Greeted incoming visitors and customers professionally and provided friendly, knowledgeable assistance.
- Researched and resolved billing discrepancies to enable accurate billing.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Provided exceptional customer service to patients, addressing their concerns regarding insurance claims or billing issues with empathy and professionalism.
- Developed a comprehensive understanding of ICD-10-CM, CPT, and HCPCS codes to ensure proper use in medical coding assignments.
- Collaborated with healthcare providers to obtain necessary documentation for accurate code assignment and claim submission.
- Communicated with insurance companies to research and resolved coding discrepancies.
Job Shadowing/Volunteer - Department of Occupational Therapy
Palmetto Health
06.2016 - 08.2016
- Shadowed with physical, speech and rehab therapists to learn job specifics; observed patient/therapist interactions and patient progress.
Cashier
Burger King
06.2015 - 05.2016
- Provided customer service; greeted customers and answered questions about the menu; rang up purchases; handled cash payments; balanced cash register at end of shift; stocked merchandise.
Summer Intern - Computer Clerk
Columbia Urban League
06.2013 - 06.2013
- Performed computer software setup.
Cashier
USC - Center Plate
08.2012 - 11.2012
- Volunteer seasonal concession stand cashier; provided customer service; took food and drink orders; handled cash payments; balanced cash register; stocked merchandise.
Education
Freshman Status -
Claflin University
Orangeburg, SC05.2018
Diploma -
Westwood High School
06.2017
Skills
- 1-3 years experience in high volume, interactive customer service call center environment
- Working knowledge of medical terminology
- Exercise good judgment while following all company rules and regulations
- Reliable team player and motivator
- Excellent multi-tasking skills
Timeline
HEALTHY CONNECTIONS ELEGIBILTY SPECIALST
TEKSYSTEMS
02.2024 - Current
Customer Service Advocate II
Blue Cross and Blue Shield
12.2022 - 01.2024
Unitedhealthcare Customer Service Advocate
Sitel Group
10.2021 - 11.2022
Cashier
Michaels Cleaners
10.2019 - 06.2021
Front Office Receptionist/Operator/Billing Clerk
Columbia Urological Associates
06.2018 - 02.2019
Job Shadowing/Volunteer - Department of Occupational Therapy
Palmetto Health
06.2016 - 08.2016
Cashier
Burger King
06.2015 - 05.2016
Summer Intern - Computer Clerk
Columbia Urban League
06.2013 - 06.2013
Cashier
USC - Center Plate
08.2012 - 11.2012
Diploma -
Westwood High School
Freshman Status -
Claflin University