Summary
Overview
Work History
Education
Skills
Timeline
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Tessa George

Tampa,FL

Summary

Experienced Managed Care Insurance Specialist with 15+ years of successfully managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Seeking leadership position to apply years of skills and knowledge while exemplifying willingness to take on any challenge.

Overview

10
10
years of professional experience

Work History

Patient Account Specialist (Remote)

Atrium Health Navicent
Macon, Georgia
04.2023 - Current
  • Organized and maintained records by updating and obtaining both personal and financial information from patients.
  • Obtained necessary signatures for privacy laws and consent for treatment.
  • Processed patient responsibility estimate determined by insurance at pre-registration.
  • Pre-registered patients, verified insurance eligibility and benefits, identifies those services that require an insurance authorization, notification and/or Precertification.
  • Worked directly with nurses, medical staff, ancillary departments, insurance carriers and other external professionals to assist patients with obtaining health care and financial services.
  • Conduct accurate scheduling and registration processes by phone, fax, email or MyChart (Epic/Onbase) hospital base system.

Claims Analyst I (Remote)

Elevance Health/Anthem
Tampa, FL
06.2022 - 04.2023
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Diversified in processing claim across multiple states utilizing state specified guidelines and processing instructions.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
  • Identifies issues and abnormal trends in claims processing and brings them to the attention of th Manager.
  • Responsible for researching and analyzing issues across multiple systems and operation areas to resolve any error to successfully adjudicate the claim.

Appeals & Grievances Coordinator

Wellcare/Centene
Tampa, FL
01.2018 - 11.2021
  • Handled a daily workload of 20 Appeals & Grievances cases, from members, providers and or facilities when there was a discrepancy in either payment reimbursement or services not covered.
  • Independently conduct thorough investigations of member and provider correspondence by analyzing all the issues involved and obtaining responses and information from internal and external entities.
  • Prepared written response and determination letters that appropriately address the issue and that met all regulatory requirements within required timeframes.
  • Maintain knowledge of all system, contractual, compliance standard changes and policy updates, along with generating all reports related to Grievance & Appeal work process/department.
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
  • Contact physician offices according to Department guidelines to request missing information from authorization request or for additional medical information as requested by the Medical Director.

Appeals and Claims Specialist II

Cognizant Technologies (Cigna Healthcare)
Tampa, FL
05.2016 - 10.2017
  • Served as liaison in corresponding with providers, members, and member's representative as needed; gathered additional information such as medical records/office notes requesting waiver of liability; scheduled caseloads that would require external review by Maximus federal services.
  • Communicated with several departments (customer service, claims, pharmacy, membership, and billing along with utilization departments when needed to aide in rendering accurate decisions within the appeal request.
  • Worked as a Subject Matter Expert within Appeals Department-under the supervision of the department Manager delegating appeal cases to associates, answering urgent and escalated emails from providers, facilities, and state market administrators.
  • Analyzed reports to identify problematic trends followed by conducting team monthly meetings to address the trends and or possible changes that were happening within the department.
  • As a Subject Matter Expert I created spread sheets to identify stat cases by filtering from old to new to ensure deadlines were met.
  • Provided assistance to team of 15 associates provided clarity on compliance inquiries; new hire training, additional trainings such as one-on-one's, and any upcoming changes that would require training throughout the department.

Student Service Advisor

Ultimate Medical Academy Online
Tampa, FL
06.2014 - 05.2016
  • Assisted students with questions related to course navigation, academic policies, course expectations, technical support, and other student support services.
  • Assisted students with technology set up, host new computer workshops and maintains student receipt of laptop records.
  • Provided guidance to at-risk students to ensure student success.
  • Recorded general notes and dates surrounding interventions and recommendations made to ensure communication across the education team.
  • Served as the new student advisor and first point of contact to ensure questions are answered and concerns are resolved.
  • As student services advisor I was involved with various phases of the student life cycle, including new students, continuing students, and student re-entry.

Education

Bachelor of Science - Healthcare Administration

Wilmington University
New Castle, DE
01-2021

Certification - Medical Billing And Coding

Allstate Medical Academy
Essington, PA
05-2006

Skills

  • Exceptional communication skills both oral and written, and extraordinary problem-solving and analytical skills
  • Strong investigative, analytical and multi-perspective skills
  • More than 15 years of Managed Care experience working product plans such as (HMO, PPO, and EPO/IPA Plans)
  • Strong knowledge of processing medical and outpatient hospital claims for reimbursement
  • Expert knowledge/Background in Microsoft Word/Excel and Microsoft Outlook/Teams, Xcelys, On-Base/Parc, File bound and Members Edge, Care Central; Epic and Waystar Hospital base systems
  • Expert knowledge in Evicore, Healthhelp, Availity, CSE Communicator, Emma and DiamProd; Sharepoint, OneNote; Facets, Claims Workstation (CWS)

Timeline

Patient Account Specialist (Remote)

Atrium Health Navicent
04.2023 - Current

Claims Analyst I (Remote)

Elevance Health/Anthem
06.2022 - 04.2023

Appeals & Grievances Coordinator

Wellcare/Centene
01.2018 - 11.2021

Appeals and Claims Specialist II

Cognizant Technologies (Cigna Healthcare)
05.2016 - 10.2017

Student Service Advisor

Ultimate Medical Academy Online
06.2014 - 05.2016

Bachelor of Science - Healthcare Administration

Wilmington University

Certification - Medical Billing And Coding

Allstate Medical Academy

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