Summary
Overview
Work History
Education
Skills
Accomplishments
Work Availability
Timeline
BusinessAnalyst

Tanya Holmes

Missouri City,Texas

Summary

Adept at enhancing customer satisfaction and medical record processing efficiency, I leveraged my expertise in medical claim review at United Healthcare. By fostering teamwork and conducting thorough investigations. Successfully resolved complex claim issues and ensured compliance with regulations. Demonstrated strong analytical skills and attention to detail in evaluating claim validity and accuracy. I significantly reduced submission errors and improved interdepartmental communication, staying ahead with continuous professional development.

Overview

18
18
years of professional experience

Work History

Medical Claims Examiner

United Healthcare
09.2010 - 08.2018
  • Enhanced claim processing efficiency by conducting thorough investigations and maintaining accurate documentation.
  • Kept up-to-date on current industry practices, attending workshops and training sessions to continuously improve professional skills.
  • Improved interdepartmental communication by fostering a collaborative environment and sharing vital information regarding complex cases.
  • Reduced errors in claim submissions by meticulously reviewing patient information and verifying insurance eligibility.

Provider Relations Specialist

United Healthcare
05.2005 - 09.2010
  • Managed multiple projects simultaneously while maintaining attention to detail and meeting deadlines effectively.
  • Maintained up-to-date knowledge of industry regulations, updating policies as needed to ensure compliance.
  • Improved provider satisfaction by addressing concerns promptly and effectively.
  • Collaborated with internal departments to resolve provider disputes in a timely manner.

Customer Service Representative

United Healthcare
02.2001 - 05.2005
  • Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
  • Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
  • Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
  • Exceeded performance metrics consistently, earning recognition as a top performer within the team.

Education

Medical Assistant -

National Institute of Technology
San Antonio, TX
06-2000

High School Diploma -

Marshall High School
San Antonio, TX
06-1988

Skills

  • Customer service and support
  • Medical record review
  • Medical claims evaluation and processing
  • Medical terminology
  • Knowledge of ICD 10 and CPT coding
  • Proficiency in Microsoft Word and Excel
  • Critical Decision-making
  • Attention to detail
  • Adaptability and flexibility
  • Professionalism

Accomplishments

  • Utilized Microsoft Excel to develop inventory tracking spreadsheets.
  • Established medical group relationships and maintained excellent rapport, accuracy and efficiency.
  • Customer Relations - Earned highest marks for customer satisfaction, company-wide.
  • 15 years of dedicated service appreciation reward.

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline

Medical Claims Examiner

United Healthcare
09.2010 - 08.2018

Provider Relations Specialist

United Healthcare
05.2005 - 09.2010

Customer Service Representative

United Healthcare
02.2001 - 05.2005

Medical Assistant -

National Institute of Technology

High School Diploma -

Marshall High School

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Tanya Holmes