TANYA L. HOBBS
Virginia Beach,VA
Summary
Devoted professional proactively and quickly identifies best course of action for given scenarios. Confident handling tasks independently and in teams with highly organized approach to work. Strong advocate for those in need and committed to providing best possible service.
Overview
27
27
years of professional experience
Work History
Medicare Outreach Specialist
Elevance Healthcare
12.2020 - Current
- Investigates member medical information by Claims or by contacting Primary Care Physicians, Psychiatric and other medical professionals to verify that member meets criteria for services and approval
- Participate in CMS (Center of Medicare Services) Continuous education programs
- Increased accuracy to 99%
- Processed hundreds of cases per week for plan supplemental benefits
- Exclusively handled CareMore project approval transactions and assisted that department employees with issues and transactions for Medicare Ancillary programs
- Responsible for approval and payment or denial of four Major Program services and Runs reports for forecasting of new members, enrollment and benefits offered
- Creates relationships with nationwide agencies to place members for placement of in-home short term and long-term care and provides professional, responsive and accurate customer service while responding to inquiries regarding Medicare services, benefits and program
- Adheres to GBD (Government Business Division) guidelines to meet goals and assist members with Medicare programs and benefits.
Associate Configuration Analyst
Optima Health- Community Care
05.2019 - 12.2020
- Provided configuration support and project-related activities for internal and external customers, vendors, consultants and network educators
- Updated medical groups, practices and hospitals by adding providers to existing groups also verify provider licenses, certifications, sanctions & restrictions
- Created provider databases for providers who billed services & paid for those services
- Synchronized data among multiple claims & update systems; validate data housed on provider data bases
- Met and exceeded quotas set by department with little errors and quality at 98.9%.
- Implemented change control, configuration status accounting and configuration audits
- Analyzed existing systems and databases and recommended enhancements to solve business needs
- Worked effectively in fast-paced environments
Claims Processor II
Optima Health – Community Care
05.2017 - 05.2019
- Mentored and trained new employees to assist and advise them to meet and exceed their job expectations
- Analyzed and reviewed claims to ensure no missing or incomplete information in order to pay claim
- Met and exceeded departmental goals by 95% for processing and quality
- Utilized specialized software to process incoming claims, enter data and generate reports
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards
- Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes
Network Data Specialist
Anthem Healthcare Norfolk
04.2015 - 04.2017
- Achieved and exceeded all goals set by department without errors quarterly
- Requested by providers to get resolutions to inquiries
- Provided accurate, timely maintenance of critical provider information on all claims while synchronizing data among multiple claims systems and applications of business rules as they apply to each database-
- Reviewed and updated contracts, amendments and applications determining completeness, effective dates and ready to be executed.
- Instructed users on software and hardware use
Credentialing Specialist
Value Options
04.2014 - 02.2015
- Performed verbal, written and online verification of provider credentials including but not limited to medical experience, personal/professional references, state licensure, prescribing certificates, medical education, and institutional affiliations
- Prepared files for presentation to National Credentialing Committee for approval, denial, or recommendation for termination
- Exceeded departmental standards on credentialing files accurately and meeting quality standards
- Monitored work queue to ensure that applications were processed within 30-day turnaround time
- Maintained production levels and quality scores of 99% in accordance with set standards for Practitioner Credentialing Review/ Primary Source Verification Review
- Prepared records for site visits and file audits
- Conducted primary source verifications such as background checks and board certifications
- Obtained NPI numbers for providers and facilities and updated existing profiles
Benefits Specialist
Xerox Corporation
09.2012 - 03.2014
- Answered and responded to incoming calls from employees and retirees with inquiries about their benefit plans (Health, Dental, Vision, and 401K plans), including pension eligibility and payments
- Performed, tracked, and log all transactions performed related to Human Resources and/or Benefits processes
- Followed up on outstanding issues to ensure resolution, kept participant informed on the status of research, status, and resolution of claim
- Applied and communicated conceptual elements of Benefits and/or Human Resources rules, regulations and help other team members as requested
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email, and in-person interactions
Residential Sales Consultant: Business Consultant/Tisoc Associate
Verizon Communications Va Beach
12.1996 - 11.2010
- Served as initial point of contact of inbound business customers for regulated and non-regulated voice, data, and video products and services
- Reviewed chronic problem tickets, developed stabilization action plans, and took appropriated steps for resolution to save company man hours and dollars
- Ensured orders and adjustment accuracy, completed, and followed-up promptly on any commitments made during contact
- Served role of Team Leader temporarily (8 months) with teams of 13 associates with payroll, training, management duties and led team meetings
- Served role of Grievance/Customer Complaint to resolve consumer and business issues while staying within company policies, guidelines, FCC guidelines for resolution of complaints.
- Developed new business and managed new and existing clients
Education
MBA - Human Resource Management
Troy University
Troy, AL05.2007
BA - English, Communications
Virginia State University
Petersburg, VA05.1995
Skills
- Dynamic Communication Skills
- Community Health
- Compile Data
- Client Engagement and Assistance
- Outreach Initiatives
- Data Collection and Entry
- Educational Outreach
- Outreach Strategies
- Confidential Case Documentation
- Timelines and Milestones
- Data Analysis
- Medical Records Review
- Eligibility Requirements
- Customer Satisfaction
Affiliations
Delta Sigma Theta Sorority, Inc
Order of Easter Star
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
Anthem Healthcare Norfolk
04.2015 - 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
Verizon Communications Va Beach
12.1996 - 11.2010
MBA - Human Resource Management
Troy University
BA - English, Communications
Virginia State University
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