Tawonna Hull
Dallas
Summary
To secure a position that will capitalize on my administrative, customer relations and problem solving skills in an organization that offers growth and advancement.
Highly skilled Verification Specialist with background in risk assessment, data analysis, and document verification. Demonstrated ability to streamline processes for increased efficiency and accuracy. Exhibits strong problem-solving skills, integrity, and discretion while handling sensitive information. Notable impact includes successfully implementing new procedures that improved overall verification process in previous role.
Overview
17
17
years of professional experience
Work History
Major Medical Verification Specialist
Walgreen's Pharmacy
10.2019 - 03.2024
- Verified Benefits
- Processed Prior Authorization Requests and scheduling.
- Maintain compliance to HIPPA requirements
- Maintain the PHI and Provider information under compliance guidelines
- Researched and evaluated customer information for compliance with internal policies and procedures.
AllianceRx Walgreens Pharmacy
01.2019 - 01.2024
Molina Healthcare
Populus Group
11.2015 - 06.2018
- Data PHI in secured folders
- Members Services
- Responsibilities also include verifying benefits, processing authorization requests, scheduling, and maintaining patient and provider information while adhering to company policies and HIPAA regulations.
- Completed day-to-day duties accurately and efficiently.
Populus Staffing/ Molina Healthcare
01.2016 - 01.2018
Ad A Staff/ Dallas County/ DISD
01.2015 - 01.2017
Clerk
Ad A Staffing
10.2014 - 11.2015
- Verified benefits for Medicaid
- Maintain managing correspondence
- Scan and file government documents
- Adhering to the company’s policies and guidelines
- Assisted customers with inquiries and complaints in a professional manner.
Director
Life Span of Health Resources of Tx
Dallas
07.2012 - 05.2015
- Managed budgeting and financial planning processes for the organization.
- Ensured compliance with all relevant regulations, policies and procedures.
- Monitored market conditions and competitor activities to inform business decisions.
Lifespan Resources of Texas Inc.
01.2012 - 01.2014
Roth Staffing/HMS
01.2007 - 01.2008
Education
Insurance Claims Examiner Certification -
Richland Community College
Skills
- Benefits verification
- Prior authorization processing
- HIPAA compliance
- Data management
- Claims processing
- Medical terminology
- Patient scheduling
- Provider relations
- Compliance auditing
- Problem solving
- Effective communication
- Attention to detail
- Team collaboration
- Document verification
- Documentation and correspondence
- Follow-up procedures
- Insurance terminology
Subject Matter Expertise
- Adaptive Aids
- Adult Day Care
- Appeals/Reconsiderations & Complaints/Grievances (Member, Provider, HHSC, and TDI)
- Behavioral Health
- Benefits
- COBRA
- Centers for Medicare & Medicaid Services
- Claims
- Commercial Insurance (HMO, PPO, POS, EPO, and HSA)
- Contracting
- Cost Recovery
- Credentialing
- Dental
- Disease Management
- Durable Medical Equipment
- Early Childhood Intervention
- Eligibility/Enrollment
- HEDIS
- HIPAA
- Health & Human Services Commission
- Health Insurance Marketplace
- Home Health Care & Modifications
- Hospice
- Intellectual & Developmental Disabilities
- Long Term Care
- Long Term Services & Supports
- Managed Care
- Medical Coding
- Meals-on-Wheels
- Member Services
- Nursing/Skilled Nursing
- Pension & Retirement Plans (401k)
- Pharmacy (Mail Order, Retail, and Specialty)
- Prior Authorizations
- Provider Services
- Infusion Services
- Qualified Domestic Relations Orders (QDROs)
- Radiology (including High-End Radiology)
- Referrals
- Respite Care & Services
- Service Coordination
- Subrogation
- Supplemental Security Income
- Texas Department of Aging & Disability Services
- Texas Department of Insurance
- Texas Health & Human Services
- Texas Healthy Steps
- Texas Medicaid & Healthcare Partnership
- Texas Vaccines for Children Program
- Transportation
- Utilization Management
- Value Added Benefits
- Vision
- Waiver Services
Program System Experience
- AHIQA
- Appeals & Grievance Software
- ADP iPay
- AS400
- Adobe Acrobat & Reader DC
- Availity
- Blue Source
- Blue Star
- Centers for Medicare & Medicaid Services
- Copy Machine
- Claim Viewer
- Check Tracer
- CISCO Jabber Instant Messaging
- Concur
- CyraCom Translation Services
- Document Imaging
- Dashboard
- Emdeon
- Encoder Pro
- Epic
- Fax Machine
- Finesse PG-15
- Google Chrome
- Health Care Insight
- IMNU
- IHealth
- ILearn
- Internet Explorer
- Kronos
- Laminating Machine
- Lotus Notes
- Master Provider File Viewer
- Microsoft Office (Excel, Outlook, PowerPoint, and Word)
- Mozilla Firefox
- Net Access
- Nitro Pro 9 & 10
- Office of the Inspector General
- PDF Creator
- QNXT
- RTB
- Scanning Machine
- SharePoint
- SnagIt
- Snipping Tool
- Texas Medicaid & Healthcare Partnership
- Typing (10-key-by-touch)
- UMK2
- Video Relay Service Deaf Network of Texas
- WebEx
Desired Occupation
- Medical Insurance Verification Specialist
- Claims Analyst
- Customer Service Representative/ Clerk 1
- File Clerk
- Data Entry
- Front Office/Reception
Timeline
Major Medical Verification Specialist
Walgreen's Pharmacy
10.2019 - 03.2024
AllianceRx Walgreens Pharmacy
01.2019 - 01.2024
Populus Staffing/ Molina Healthcare
01.2016 - 01.2018
Molina Healthcare
Populus Group
11.2015 - 06.2018
Ad A Staff/ Dallas County/ DISD
01.2015 - 01.2017
Clerk
Ad A Staffing
10.2014 - 11.2015
Director
Life Span of Health Resources of Tx
07.2012 - 05.2015
Lifespan Resources of Texas Inc.
01.2012 - 01.2014
Roth Staffing/HMS
01.2007 - 01.2008
Insurance Claims Examiner Certification -
Richland Community College