TESSAYE LOMON
Jacksonville,USA
Summary
Highly skilled in electronic health records and effective communication, with comprehensive experience in managing prior authorizations and resolving insurance claims issues. Adept at maintaining patient confidentiality and ensuring HIPAA compliance. Ready to leverage extensive expertise to support the new team as a Prior Authorization Specialist.
Overview
16
16
years of professional experience
Work History
AR Follow Up/Denials Specialist
Insight Global - Brooks Rehabilitation
Remote
09.2025 - Current
- Analyzed and resolved denied claims to ensure timely reimbursement and compliance with regulations.
- Utilized coding systems and billing software to identify discrepancies in claims submissions.
- Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
- Improved claim denial resolution by thoroughly researching and identifying root causes of denials.
- Specialize in Processing the Denial of Physical Therapy Claims
- Skilled at working independently and collaboratively in a team environment.
Prior Authorization Specialist
HCA Healthcare
Remote, Florida
02.2022 - 07.2025
- Achieved timely submission of medical records for preauthorization by conducting thorough reviews. Enhanced operational efficiency by staying informed on insurance policies and prior authorization requirements. Improved communication with providers by managing status update inquiries for pending authorizations. Drove collaborative efforts across departments to resolve issues, ensuring optimal patient care. Secured accurate patient demographic verification against submitted documentation for prior authorization submissions.
- Coordinated prior authorization requests to ensure compliance with insurance policies.
- Reviewed and analyzed clinical documentation for medical necessity and accuracy.
- Collaborated with healthcare providers to resolve authorization issues efficiently.
- Streamlined workflows for processing prior authorization requests, enhancing turnaround time.
- Mentored junior staff on best practices for navigating complex insurance requirements.
Customer Service Representative
CVS Health
Remote, Florida
08.2018 - 02.2022
- Demonstrated excellent communication skills, both verbal and written, in order to effectively interact with customers.
- Handled customer complaints and inquiries in a courteous and efficient manner.
- Maintained accurate records of patient interactions, including notes on billing concerns, insurance policies, medical procedures and other related topics.
- Performed data entry tasks accurately while adhering to company standards for quality assurance.
- Researched complex insurance claims issues in order to provide accurate solutions in a timely fashion.
- Provided excellent customer service to patients and their families.
- Resolved patient billing issues and collected payments.
Insurance Follow-Up Specialist
Baptist Health Hospital
Jacksonville, Florida
01.2016 - 08.2018
- Analyzed denials received from insurance companies and identified solutions for resolution.
- Researched billing codes used by providers to ensure accurate coding when submitting claims.
- Conducted audits of provider files to identify any potential errors or omissions in filing claims.
- Provided timely follow-up on insurance claims to ensure accuracy and completeness of information.
Patient Registration Specialist
UF Health Hospital (Shands)
Jacksonville, Florida
04.2010 - 12.2015
- Provided support with eligibility verification prior to patient registration process, ensuring all necessary documents were collected from patients timely.
- Conducted quality assurance checks on completed registrations forms to ensure accuracy of data entered into the system.
- Resolved any discrepancies between insurance carriers' electronic eligibility response and manual entry of demographic information within the EMR and EHR system efficiently.
- Managed incoming calls promptly and professionally while providing detailed instructions about appointment scheduling process or other related inquiries.
- Verified demographic information of patients accurately by cross-checking multiple sources including but not limited to hospital databases, insurance companies and other healthcare providers.
Education
Associate in Science (A.S.) - Business Administration
Thomas Edison State University
Trenton, NJ09.2021
High School Diploma - undefined
First Coast High School
Jacksonville, Florida05.2003
Skills
- Electronic health records proficiency
- Effective communication skills
- Patient confidentiality compliance
- HIPAA compliance
Timeline
AR Follow Up/Denials Specialist
Insight Global - Brooks Rehabilitation
09.2025 - Current
Prior Authorization Specialist
HCA Healthcare
02.2022 - 07.2025
Customer Service Representative
CVS Health
08.2018 - 02.2022
Insurance Follow-Up Specialist
Baptist Health Hospital
01.2016 - 08.2018
Patient Registration Specialist
UF Health Hospital (Shands)
04.2010 - 12.2015
Associate in Science (A.S.) - Business Administration
Thomas Edison State University
High School Diploma - undefined
First Coast High School