Hi, I’m
Taquechia Allen
Dallas,TX
Summary
Utilizing more than 20 years of experience in both managed care and traditional insurance, I have consistently attained remarkable outcomes in the healthcare domain. Over the course of my career, I have cultivated a deep dedication to nurturing robust customer relationships and ensuring patient fulfillment. Possessing strong analytical abilities and a penchant for teamwork, I excel in collaborative environments. I am enthusiastic about making meaningful contributions to companies like yours, aiding in the enhancement of staff performance and fostering business innovation, all while continuing to advance my professional growth.
Experienced Service Coordinator with [Number] years of responsibility in [Industry] agencies. Extensive professional network of service providers and proven history of effective work.
Overview
17
years of professional experience
Work History
Superior Health PlanDallas, TX
Service Coordinator
06.2023 - Current
Job overview
- Facilitated requests for Star-Plus services by coordinating with Provider Services and Case Management, ensuring waivers and verifying eligibility through TMHP
- Initiated tailored services for members based on their specific needs, including Respite care, Consumer Directed Services, Assisted Living Facilities, Meals on Wheels, Emergency Response Services, Adaptive Aids, and Durable Medical Equipment
- Managed membership and referral questionnaires, covering Crisis Management, Psychiatric services, and Internal Medicine
- Authorized services for members as per guidelines
- Supported providers in resolving unpaid claim issues and navigating medical claims appeals
- Assisted members in arranging medical transportation, locating service providers, and addressing medication-related inquiries for patients and pharmacies.
Mindlance Employment AgencyDallas, TX
Service Coordinator
02.2023 - 06.2023
Job overview
- Level one Service Coordinator, assist and educate Starplus members on their benefits and services, such as PCP changes, ID card management, and coordinating transportation and other related services
- Level 2
- Facilitated requests for Star-Plus services by coordinating with Provider Services and Case Management, ensuring waivers and verifying eligibility through TMHP
- Initiated tailored services for members based on their specific needs, including Respite care, Consumer Directed Services, Assisted Living Facilities, Meals on Wheels, Emergency Response Services, Adaptive Aids, and Durable Medical Equipment
- Managed membership and referral questionnaires, covering Crisis Management, Psychiatric services, and Internal Medicine
- Authorized services for members as per guidelines
- Supported providers in resolving unpaid claim issues and navigating medical claims appeals
- Assisted members in arranging medical transportation, locating service providers, and addressing medication-related inquiries for patients and pharmacies.
PC Home HealthDallas, TX
Patient Care Coordinator
10.2021 - 02.2023
Job overview
- Supervise, evaluate, and coordinate all facets of a member's care
- Work collaboratively with interdisciplinary teams to ensure smooth care provision from admission to discharge in home health services
- Serve as a patient advocate and intermediary for other social service and healthcare providers involved in patient care within the community
- Assume responsibility for managing patient records from intake to discharge or transfer to a nursing facility.
CareMetx, LLC (Temp Aston Carter)Dallas, TX
Patient Advocate
10.2021 - 12.2021
Job overview
- Assist patients with applying for the patient assistance program to reduce the cost of their heart medication
- Daily tasks included addressing inquiries from patients and healthcare professionals regarding application status for medication assistance approval or denial
- Reviewed incoming faxes from patients and healthcare providers, and made outbound calls to update patients on their application status and gather necessary information for expedited processing
- Additionally, initiated outbound calls to insurance companies to confirm insurance coverage.
Superior Health PlanDallas, TX
Program Coordinator
02.2017 - 03.2021
Job overview
- Medicare, Medicaid, Medicaid Waiver and Non-Waiver Benefits, Initiate authorization requests for outpatient inpatient and pharmacy in keeping with the prior authorization list
- Research claims due to denial or billing issues
- Perform tasks necessary to promote member compliance such as verifying appointments, assess and monitor inpatient census
- Screen for eligibility and benefits
- Screen members by priority for case management (CM) assessment
- Perform transition of care) for information pertaining to special needs
- Reviewed MNLOC, H2060 , H6516 and 2067 for completion for authorizations.
Molina HealthcareIrving, TX
Care Review Processor
11.2010 - 02.2017
Job overview
- Responsible for efficiently directing members and pertinent information to the appropriate Health Care Services personnel to ensure the provision of integrated, high-quality, and cost-effective healthcare services in compliance with State and Federal regulations, ultimately aiming for optimal member outcomes
- Verifies eligibility and benefits for Medicare, Medicaid, Medicaid Waiver, and Non-Waiver Benefits
- Conducts assessments, surveys, and interventions primarily through telephone and fax communication, collaborating with other members of the care team as needed
- Supports care coordination by continually assessing member needs, executing necessary interventions, and meticulously documenting all interactions
- Coordinates the provision of healthcare services within the parameters of available benefits, employing sound medical, long-term care, and financial management principles
- Processes authorizations for Personal Assistance Services (PAS), Day Activity and Health Services (DAHS), Durable Medical Equipment (DME), Home Delivered Meals (HDM), Emergency Room (ER) services, and Skilled Nursing Facility (SNF) care.
United HealthcarePlano, TX
Intake Coordinator
01.2007 - 12.2009
Job overview
- Engaged with customers over the phone to facilitate the precertification of medical procedures
- Managed a high volume of inbound calls from affiliated healthcare providers and group members
- Addressed medical insurance inquiries regarding coverage options and facilitated procedures
- Collaborated closely with Utilization Management staff and registered nurses to handle case-specific information
- Maintained meticulous records of transactions, including customer inquiries, coverage updates or adjustments, and precertification documentation.
Education
Ruleville Central High School
High school diploma from College Prep
05.1996
El Centro CollegeDallas, TX
Mississippi Delta Community CollegeMoorhead, MS
Associate of Arts from Biology
Skills
- Prior Authorization
- ICD-10
- Triage
- Microsoft Office
- Medicare
- Medical Terminology
- Utilization Management
- Medicaid Medicare (10 years)
- Case Management
- Managed Care
- Analysis skills
- Insurance Verification
- Data collection
- Administrative experience
- Hospital experience
- Behavioral health
- HIPAA
- Acute care
- Hospice care
- Discharge planning
- Intake
- Patient service
- Training & development
- Family Service Plans
- Program Follow-Up and Assessment
- Resource Utilization
- Community Resource Expertise
- Client Advocacy
- Team Leadership
Timeline
Service Coordinator
Superior Health Plan
06.2023 - Current
Service Coordinator
Mindlance Employment Agency
02.2023 - 06.2023
Patient Care Coordinator
PC Home Health
10.2021 - 02.2023
Patient Advocate
CareMetx, LLC (Temp Aston Carter)
10.2021 - 12.2021
Program Coordinator
Superior Health Plan
02.2017 - 03.2021
Care Review Processor
Molina Healthcare
11.2010 - 02.2017
Intake Coordinator
United Healthcare
01.2007 - 12.2009
Ruleville Central High School
High school diploma from College Prep
El Centro College
Mississippi Delta Community College
Associate of Arts from Biology
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