Tarolyn Mahone
Decatur,GA
Summary
Remarkable oral and written communication skills. Expert in prioritizing and efficiently managing multiple assignments. Limited supervision needed to execute projects and assignments with superb quality. Skilled at learning and implementing new concepts effectively under stressful circumstances. Strong interpersonal skills to ensure a healthy relationship with management, colleagues, and clients
Overview
13
13
years of professional experience
Work History
Provider Enrollment Specialist
Gainwell Technologies
10.2021 - Current
- Review and process Medicaid, credentialing, recredentialing, and revalidation applications
- Implements general insurance and health policies in accordance with state and federal laws
- Provides expertise to process provider enrollment applications according to established policy guidelines
- Responds to provider appeals and assist providers with resolving problems/issues
- Assists provider and works with organized healthcare groups on various medical issues related to insurance and healthcare programs
- Dedicated to maintaining strict patient confidentiality based on HIPAA regulations
Medicaid Outreach Representative
DXC Technology, Gainwell Technologies
02.2017 - 10.2021
- Developed marketing materials to encourage participation in the Medicaid Electronic Health Records (EHR) Incentive Program and adoption of certified EHR technology
- Assisted eligible providers with Patient Volume Calculator (PVC), Medicaid Incentive Program (MIP) policy and procedure questions, and Medicaid Assistance Provider Incentive Repository (MAPIR) functionality questions
- Presented materials regarding the Medicaid Incentive Program by webinars, association meetings, and presentations
- Corresponded with providers by phone, email, or onsite to resolve appeals and/or issues
- Conducted onsite visits with providers with the objective of marketing EHR
- Dedicated to maintaining strict patient confidentiality based on HIPAA regulations
Member Enrollment Specialist
Hewlett Packard Enterprise – DXC Technology
06.2015 - 02.2017
- Audited Member Enrollment Analysts’ communications for efficiency and accuracy as a Quality Assurance Specialist
- Educated state officials and organized healthcare groups on various medical issues related to insurance and healthcare programs
- Provided expertise to investigate and adjudicate claims that did not follow policy provisions
- Acknowledged and resolved discrepancies related to Medicaid Members
- Completed Medicaid eligibility updates for members including date of birth and social security numbers
- Approved any remedial and/or recoupment actions associated with escalated claims
- Completed complex assignments independently by providing resolution to provider appeals
Healthcare Insurance Representative
HP – Hewlett Packard Enterprise
02.2014 - 06.2015
- Assisted callers and colleagues in fast-paced call center environment by applying basic knowledge of medical billing of UB-04, CMS 1500, and Dental claim forms
- Responded to questions regarding member and provider eligibility, claim submission procedures, and claims processing
- Identified, prioritized, and resolved questions and issues independently by accurately and timely documenting the response to complex member and provider inquiries
- Complied with contract requirements, business unit rules, and related industry/legal regulations
Member Services Associate
Georgia Department of Community Health
08.2011 - 02.2014
- Responsible for reviewing and analyzing multiple reports to identify possible duplicate Medicaid members by using the Georgia Medicaid Management Information System (GAMMIS) and the System for the Uniform Calculation and Consolidation of Economic Support Services (SUCCESS) systems
- Navigated multiple systems to research and verify Medicaid member eligibility to resolve discrepancies related to the member files
- Identified system issues and submitted documented issues to Hewlett Packard Enterprise (HPE) for resolution
- Set priorities and worked on special projects as delegated by management
- Assisted in follow-ups with members and management once information is updated
Intern
DeKalb Medical Wellness Center
05.2010 - 07.2010
- Performed client analysis to ensure that demographic and insurance information was accurate in the company database
- Conveyed financial policies to all clients and collected appropriate payments
- Interpreted and communicated financial policies to clients
- Prepared EFT letters for delinquent payments from clients
- Addressed all member inquiries concerning the Wellness Center
- Provided and educated all members on safety regulations, policies and procedures
Education
Master Of Public Health Policy And Management (MPH) -
Capella University
Minneapolis, Minnesota03.2018
Bachelor of Science - Healthcare Management
Clayton State University
12.2011
Skills
- Computer Skills
- Microsoft Office
- Georgia Medicaid Management Information System (GAMMIS) Expert
- Effective Written and Verbal Communication
- Special Projects
- Practitioner Enrollment
- Validation of Discrepancies
- Provider Relations
- Customer Service Background
- Application Verification
- Data Entry Skills
- Data Compilation
- Applicant Engagement
- Program Knowledge
- Eligibility Determination
- Documentation and Paperwork
- Application Review
- Application Support
- Provider Enrollment
- Regulatory Compliance
- Eligibility Determinations
- Financial Eligibility Processes
- Remote Office Availability
- Team Building
- Credentialing Data Coordination
Additional Information
- Professional references available upon request.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Success is often achieved by those who don’t know that failure is inevitable.
Coco Chanel
Timeline
Provider Enrollment Specialist
Gainwell Technologies
10.2021 - Current
Medicaid Outreach Representative
DXC Technology, Gainwell Technologies
02.2017 - 10.2021
Member Enrollment Specialist
Hewlett Packard Enterprise – DXC Technology
06.2015 - 02.2017
Healthcare Insurance Representative
HP – Hewlett Packard Enterprise
02.2014 - 06.2015
Member Services Associate
Georgia Department of Community Health
08.2011 - 02.2014
Intern
DeKalb Medical Wellness Center
05.2010 - 07.2010
Master Of Public Health Policy And Management (MPH) -
Capella University
Bachelor of Science - Healthcare Management
Clayton State University
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