Microsoft Office 365
Presentations
Spreadsheets
Operating Systems
Video Conferencing
TAYA HARDIN
Haines City,FL
Summary
Knowledgeable and dedicated customer service professional with extensive experience in medical & insurance industries. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses. Adjusting orthopedic devices, maintaining aseptic procedures and monitoring patient progress. Outstanding knowledge of medical terminology and human injury treatment plans. Consistently complying with federal, state and local laws and regulations. As well as joining an established Employer with growing and complex frontline customer service needs, which will allow myself to use previously attain workplace skills. Flexible and versatile able to maintain under pressure. Poised and competent with demonstrated ability to easily transcend cultural differences. Thrive in deadline-driven environments.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Orthopedic Medical Technician/DME Technician
Med Star Health
04.2022 - 12.2023
- Performed patient service duties by communicating directly with patients, answering questions, and assisting with concerns.
- Maintained patient confidence and protected hospital by keeping information confidential.
- Assisted patients in understanding their coverage limitations or non-covered services, promoting transparency and patient satisfaction during the billing process.
- Interacted with patients and families while demonstrating high standards of performance, teamwork, and compassion.
- Reduced errors in patient billing by carefully verifying insurance information during the registration process.
- Monitored inventory levels of supplies, equipment, and reagents used and placed orders for replacements.
- Inspected, tested and calibrated medical equipment before installing.
- Applies and educates patients on durable medical equipment (DME)/bracing to protect or prevent injuries as ordered by physician.
- Applies and educates patients on bandages, casts, and splints to protect or prevent injuries as ordered by physician.
- Self-motivated, with strong sense of personal responsibility.
- Proven ability to develop and implement creative solutions to complex problems.
- Handled sensitive patient information with confidentiality while upholding HIPAA regulations at all times.
- Investigated and resolved customer inquiries and complaints quickly.
- Input data into computer programs and filing systems.
- Developed effective communication channels with insurance companies to facilitate prompt resolution of claim inquiries and disputes.
- Streamlined medical record retrieval by implementing an efficient filing system.
Orthopedic Technician/DME Technician
The Centers For Advanced Orthopedics
06.2020 - 03.2022
- Set up orthopedic fracture tables for casting procedures and applied variety of plaster and fiberglass casting, splints, braces, soft goods and skin and skeletal traction.
- Prepared and passed instruments, sutures and supplies needed in operative procedure and maintained correct count.
- Assessed patient comfort related to cast and splints and assisted with comfort measures.
- Collaborated with billing department staff to ensure accurate coding and charge entry, minimizing future claim denials.
- Measured and fit crutches and canes and instructed patients on proper crutch and cane walking.
- Maintained consistent work environment, overseeing intricate daily tasks with minimal supervision.
- Maintained organized, neat workspace and removed all waste and debris to promote efficiency and optimal productivity.
- Documented medical claim actions by completing forms, reports, logs and records.
- Passionate about learning and committed to continual improvement.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Calculated adjustments, premiums and refunds.
- Enhanced payer relationships by maintaining professional and effective interactions during the denial resolution process.
- Followed up with medical staff regarding missing information in patient records.
- Worked closely with physicians to accurately assign ICD-10 diagnostic codes for optimal reimbursement rates from insurance companies.
- Communicated with insurance companies to research and resolved coding discrepancies.
Plan Benefit Specialist
Ehealth
11.2018 - 07.2021
- Role consisted of assisting with mail delivery of prescriptions
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
- Also assisted Pharmacists, Physicians and insurance specialists with needs pertaining to clients within the guidelines of HIPAA
- Reduced denial rates with comprehensive documentation and accurate coding practices.
- Continuously optimized appeal templates based on feedback from payers, leading to more successful resolutions of disputed claims.
- Researching, responding, or interpreting company procedures or policies with the goal of delighting valuable customers
- Observed strict procedures to maintain data and plan participant confidentiality.
- Checked employees' benefits enrollment for accuracy and inputted all data into company software.
- Built relationships with vendors to foster quality service delivery.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Assisted patients with understanding their insurance coverage and financial responsibilities, fostering positive relationships and trust between the practice and its clients.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Verified insurance of patients to determine eligibility.
- Enhanced claim processing efficiency by thoroughly reviewing and analyzing denial trends.
Claims Adjuster
Compass Adjusting
01.2015 - 10.2018
- Investigate, assess, negotiate, and settle auto liability claims involving first party bodily injury
- Initiate claims and coverage investigations, set reserves, and make payments under medical payments and/or personal injury protection coverage
- Resolves assigned claims within authority or seeks additional authority as needed
- Collaborated with billing team to address issues, resulting in fewer denials and increased revenue.
- Served as a subject matter expert on claim denials, providing guidance and support to colleagues across departments.
- Documented medical claim actions by completing forms, reports, logs and records.
- Assists in investigation and evaluation of pre-litigated cases (pip) Participated in depositions of litigation claims
- Improved communication between departments, expediting the resolution of denied claims.
- Developed strong understanding of insurance policies and legal issues .
- Respond to written legal correspondence
- Respond to DFS complaints and Civil Remedies o Prepare files for trial while working with attorneys to ensure appropriate documents are obtained for sake of trial.
- Verified insurance claims and determined fair amount for settlement.
- Answered customer questions regarding deductibles.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Tracked and monitored requests for medical records release.
- Verified signatures and checked medical charts for accuracy and completion.
Education
Bachelor of Science - Health Sciences
Howard University
Washington, DCSkills
- Conflict Resolution
- Medical Billing Processing
- EMR Systems
- Communication
- Customer Service
- Utilization review
- Critical Thinking
- Collaboration talent
- HIPAA Compliance
- Computer proficiency
- Administrative and Office Support
- Insurance Billing
Additional Information
- Licenses , Life and Health Insurance License Property and Casualty License (6-20 All lines) Licensed States
Software
Microsoft Excel
EMR System - MOD MED
Certification
First Aid and CPR/AED
Timeline
Orthopedic Medical Technician/DME Technician
Med Star Health
04.2022 - 12.2023
First Aid and CPR/AED
11-2020
Orthopedic Technician/DME Technician
The Centers For Advanced Orthopedics
06.2020 - 03.2022
Plan Benefit Specialist
Ehealth
11.2018 - 07.2021
Claims Adjuster
Compass Adjusting
01.2015 - 10.2018
Bachelor of Science - Health Sciences
Howard University
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