TANYA HOBBS
Virginia Beach,VA
Summary
Proactive and decisive professional skilled in identifying optimal solutions. Effective in both independent and collaborative environments, with a meticulous approach to tasks. Dedicated to advocating for others and delivering exceptional service and results.
Overview
28
28
years of professional experience
Work History
Medicare Outreach Specialist
Elevance Healthcare
Remote
12.2020 - Current
- Provides services to Medicare Advantage Private plan covered members nationwide
- Evaluates member medical data by reviewing Claims or directly communicating with Primary Care Physicians, Psychiatrists, and other healthcare professionals to determine if the criteria for requested services are met
- Supports special projects for multiple departments
- Participates in continuous education programs offered by CMS (Center of Medicare Services).
- Exclusively manages CareMore project approval transactions and provided support to department employees in handling issues and transactions related to Medicare Ancillary programs
- Oversees approval and payment process for four Major Program services, while also generating reports to forecast future membership and benefits.
- Developed relationships with nationwide agencies for the placement of members in short-term and long-term home care settings
- Achieves goals by following GBD guidelines and providing support to members with Medicare programs and benefits
Associate Configuration Analyst
Optima Health- Community Care
Norfolk, VA
05.2019 - 12.2020
- Provided configuration support and project-related activities for internal and external customers, vendors, consultants, and network educators
- Managed routine analysis, reports and system configuration
- Updated medical groups, practices, and hospitals by adding providers to existing groups, while also verifying provider licenses, certifications, sanctions, and restrictions.
- Developed provider databases to manage payments for rendered services
- Validated and synchronized multiple data sources including updates for claims and providers' databases.
- Consistently surpassed department quotas while maintaining a 98.9% quality rating with minimal errors.
Claims Processor II
Optima Health – Community Care
Norfolk, VA
05.2017 - 05.2019
- Assisted in the development of new team members, contributing to their success in exceeding job requirements.
- Supervised job-shadowing sessions and helped hone skills of multiple new hires
- Achieved departmental goals for processing and quality by 95%
- Effectively communicated with physicians’ offices and staff to ensure accurate claim processing
- Researched discrepancies between submitted documentation and actual records to identify errors or omissions.
- Adhered to all applicable laws, regulations, and company standards while processing claims.
- Processed a high volume of incoming claims in accordance with established policies and procedures.
Network Data Specialist II
Anthem Healthcare
Norfolk, VA
05.2015 - 04.2017
- Consistently achieved and surpassed quarterly departmental goals while maintaining error-free performance
- Satisfactorily resolved inquiry requests from providers
- Executed data synchronization among various claims systems to maintain integrity and compliance with applicable business rules.
- Ensured the completeness of contracts, amendments, and applications through careful review and updating prior to execution.
- Created automated reports from large datasets for senior management review.
- Maintained database security by setting up user accounts and granting access privileges as needed.
Credentialing Specialist
Value Options
Norfolk, VA
04.2014 - 02.2015
- Conducted comprehensive verification of provider credentials both verbally, in written form, and online. Verification encompassed diverse aspects, such as medical experience, references, licensure, certificates for prescribing medications and institutional affiliations.
- Prepared files for National Credentialing Committee's presentation, recommending approval, denial, or termination
- Achieved exemplary performance evaluations owing to adherence to departmental requirements for accurate and quality-driven credentialing files
- Maintained monitoring of the work queue to meet a 30-day turnaround time for processing applications
- Monitored compliance with established standards to deliver high quality service as a Practitioner Credentialing Specialist
Benefits Specialist
Xerox Corporation
Chesapeake, VA
09.2012 - 03.2014
- Provided prompt assistance to callers consisting of both employees and former employees who required clarification or guidance regarding their benefit plans (Health, Dental, Vision, 401K) including inquiries about pension eligibility and payments
- Maintained excellent attention to detail in tracking all HR and benefit transactions
- Resolved escalated issues, provided regular updates to participants on research status and claim resolution
- Applied and communicated conceptual elements of Benefits and Human Resources regulations, assisting team members upon request.
- Handled sensitive and confidential data in adherence to Data Privacy Requirements
Residential Sales Consultant: Business Consultant/Tisoc Associate
Bell Atlantic/Verizon Communications
Va Beach/Chesapeake, VA
12.1996 - 11.2010
- Performed as the first point of contact for inbound commercial clients concerning regulated and non-regulated data, voice, and video offerings.
- Reviewed problematic tickets and generated tailored plans for stabilization, resulting in efficient resolution and substantial cost and time savings.
- Ensured accuracy of orders and adjustments, promptly following up on commitments made during contact.
- Managed a team of 13 associates as temporary Team Leader for 8 months, overseeing payroll, training, and day-to-day operations.
- Solved customer and business disputes as a Grievance/Customer Complaint representative in compliance with company, guidelines and FCC rules.
Education
MBA - Human Resource Management
Troy University
Troy, AL01.2007
BA - English, Mass Communications
Virginia State University
Petersburg, VA01.1995
Skills
- Community Events
- Data Analysis
- Community Relations
- Customer Service
- Client Needs Assessments
- Analytical Skills
- Application Processes
- Professional Demeanor
- Problem-solving aptitude
- Teamwork and Collaboration
- Community Outreach
- Interpersonal Communication
- Professionalism
- Organizational Skills
Custom
- Being a servant of my community is extremely important as I do serve in it
Custom
- I take pride in serving in my community as I have with Autism, Suicide Awareness, American Diabetes Association and volunteering at my local food bank where needed
Timeline
Medicare Outreach Specialist
Elevance Healthcare
12.2020 - Current
Associate Configuration Analyst
Optima Health- Community Care
05.2019 - 12.2020
Claims Processor II
Optima Health – Community Care
05.2017 - 05.2019
Network Data Specialist II
Anthem Healthcare
05.2015 - 04.2017
Credentialing Specialist
Value Options
04.2014 - 02.2015
Benefits Specialist
Xerox Corporation
09.2012 - 03.2014
Residential Sales Consultant: Business Consultant/Tisoc Associate
Bell Atlantic/Verizon Communications
12.1996 - 11.2010
MBA - Human Resource Management
Troy University
BA - English, Mass Communications
Virginia State University
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