Tara Griffiths
Coral Springs,FL
Summary
Organized and dedicated individual with proven track record of providing exceptional customer service in fast-paced environments. Offering keen attention to detail and strong decision making skills to manage multiple, concurrent tasks. Self-motivated work ethic to perform effectively in independent or team environments.
Overview
17
17
years of professional experience
Work History
Administrative Coordinator
Gripearl Investment Group
01.2014 - Current
- Prepared detailed documents and reports in adherence administrative processes.
- Monitored and directed incoming mail and prepared outgoing mail.
- Collaborated in timely processing of billing and accounts receivables.
- Worked closely with others to accomplish timely invoicing and accounts receivables.
- Supported HR functions with emphasis on record keeping, data entry and general HR tasks.
- Completed background and reference checks to facilitate hiring and onboarding of employees.
- Maintained human resources information system and kept employee files up to date and accurate.
- Completed employee employment verifications and unemployment paperwork prior to hire or termination.
- Assisted with recruitment process by posting job ads, filtering applications, scheduling interviews, assisting in interview process and drafting offer letters.
Case Management Coordinator
Sedgwick Claims Management
08.2021 - 11.2022
- Managed and monitored program activities and evaluated quality for improvement recommendations
- Streamlined, standardized and implemented case management processes and techniques to maximize revenue cycle
- Served as corporate resource for compliance and audits to facilitate legal process and appeals
- Collaborated with multidisciplinary teams to facilitate client care and reduce case management barriers
- Created care plans that addressed clinical and financial challenges, family requirements and facilitated patient quality of life
- Obtained case history and gathered triage information to determine appropriate avenue for care
- Reached out to insurance carriers to obtain prior authorization for testing and procedures
- Tracked referral submission during facilitation of prior authorization issuance.
- Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.
- Made contact with medical providers to discuss policies and individual patient benefits.
Claim Coordinator
Bank Of America
07.2020 - 12.2021
- Checked documentation for accuracy and validity on updated systems
- Carried out administrative tasks by communicating with clients, distributing mail and scanning documents
- Verified client information by analyzing existing evidence on file
- Generated, posted and attached information to claim files
- Compiled data and reviewed information for accuracy prior to input
- Completed data entry tasks with accuracy and efficiency.
- Analyzed losses and current claim statuses to determine need for updated loss runs.
- Evaluated insurance policies and analyzed financial damages to determine coverage.
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
LTSS Case Manager
Anthem
02.2019 - 10.2019
- Helped patients receive appropriate, high-quality care with reasonable results
- Partnered with physicians, social workers, activity therapists, nutritionists and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems
- Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations and procedural costs
- Evaluated treatment plans against individual goals and healthcare standards
- Managed support services and fostered communication among social workers, therapists, hospital staff and patients
- Consulted with clinicians to devise and manage ongoing care plans for at-risk patients
- Increased referral rates by providing excellent service and building meaningful relationships with patients and caregivers
- Educated patients and loved ones about different treatment options and outside care approaches to reduce burden on hospital resources
- Reduced care costs without sacrificing quality through service coordination and multidisciplinary collaboration
- Addressed delays in discharge, postponed procedures and discharge equipment unavailability
- Improved staff performance by recreating disciplinary procedures commensurate with level of infraction
Case Management Associate
Aetna
03.2018 - 02.2019
- Communicated with supervisor regarding issues related to case management, resourcing, service collaboration and development of new resources
- Served as case coordinator, assuming responsibility for complex, high-volume assignments and guiding endeavors to successful completion
- Provided safety planning, crisis intervention, and case management to clients
- Made appropriate referrals, monitored client services in appropriate time frames, sought supervisory guidance as required, documented services provided and completed departmental billing procedures
- Informally mentored new case managers and service coordinators, answering questions, offering opportunities to shadow and observe and explaining basic information about company procedures
- Created well-written, effective care plans appropriately matching needs of clients following standards and guidelines of funders, contractors and governmental regulations
- Handled caseload of more than 75 clients
- Evaluated diagnostic data to determine eligibility and needed services
- Mobilized case management system to document service delivery and case progress
- Customized vocational exploration activities to identify self-determined rehabilitation needs and goals.
Provider Services Representative
United Health Group
07.2014 - 11.2017
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences
- Investigated and resolved customer inquiries and complaints quickly
- Recommended products to customers, thoroughly explaining details
- Responded proactively and positively to rapid change
- Exhibited high energy and professionalism when dealing with clients and staff
- Managed workflow scheduling, data entry and accuracy verification for large data projects
- Identified data entry errors and reported to necessary departments
- Tracked referral submission during facilitation of prior authorization issuance
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures
- Performed prior authorization review of services requiring notification
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Conducted full claim investigations and reported updates and legal actions.
- Utilized appropriate cost containment techniques to reduce overall claim costs.
Education
Associate of Science - Nursing Science
Broward College
Davie, FL05.2023
Skills
- Strategic Planning
- Office Supply Management
- Database and Client Management Systems
- Document Sorting
- Record Sorting and Filing
- Strong Organizational Skills
- Data Gathering
- Records Management Software
- Advanced MS Office Suite Knowledge
- Case Planning and Management
- Correcting Discrepancies
- Upbeat and Positive Personality
Timeline
Case Management Coordinator
Sedgwick Claims Management
08.2021 - 11.2022
Claim Coordinator
Bank Of America
07.2020 - 12.2021
LTSS Case Manager
Anthem
02.2019 - 10.2019
Case Management Associate
Aetna
03.2018 - 02.2019
Provider Services Representative
United Health Group
07.2014 - 11.2017
Administrative Coordinator
Gripearl Investment Group
01.2014 - Current
Associate of Science - Nursing Science
Broward College
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