Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic
Thalia Brice

Thalia Brice

E Providence,RI

Summary

Excellent communicator and dependable team player with strong understanding of insurance industry. Adept at building relationships with clients, brokers and other stakeholders while delivering outstanding service. Highly organized and detail-oriented with strong ability to identify potential risks and develop solutions.

Overview

11
11
years of professional experience
4
4
Certification

Work History

Direct Care Professional

Jammat Housing & Community Development Corp
02.2023 - Current
  • Monitor Supervise and Document Resident Activities
  • Communicate Verbal and Written Reports Daily
  • Dispense and Document Resident Medication
  • Correspond with DCYF Guardians and Medical Staff
  • Complete New Resident Intake Packets
  • Resident Advocate
  • Implement Life Skills
  • Attended CPR Training
  • Safety Requirement Training
  • Demonstrated strong work ethic abilities as a passionate, self-driven professional with a natural desire for helping to make a difference in people's lives while performing the following duties.
  • Maintained office management practices and procedures according to company policy.

Appeals Coordinator

Lifespan
07.2022 - 12.2022
  • Assist department manager with reconciliation of provider liable claim denials.
  • Investigate claim denials sent to the radiology department in EPIC for resolution.
  • Submit retro-authorizations for radiology service claims denied for no authorization.
  • Submit appeal requests/letters with medical records to insurance companies.
  • Assist with reviewing charges and authorizations post appointments prior to billing.
  • Experience in health insurance denials management, health insurance appeals, hospital billing, diagnostic imaging, insurance authorizations.
  • HIPPA / PHI trained.

COVID Screener- Office Receptionists

The Steere House
03.202 - 04.2022
  • Screens all visitors, guests and participants and maintains strict confidentiality.
  • Provide general office support with a variety of B/O duties and related tasks.
  • Responsible for answering incoming calls, directing calls to appropriate staff, mail distribution, as well as additional assignments.
  • Sanitize Reception.
  • Prep Log& Daily Data Sheets.
  • First Contact with a smile.
  • Inform demonstrate ow to use N95 KN95 Surgical PPE.
  • Answer general questions about the CVC Covid Vaccine Cards.
  • Update all entering into the facility of any new requirements for completing necessary health screening all visitors, guests contractors, vendors and patrons entering the facility.
  • Prepare & Complete Weekly Residential Covid Testing Kits_aprox125residents.
  • Prep Testing Packages.
  • Individual labeling kit.
  • Individual labeling files.
  • Individual swab.
  • Individual lab forms. (This process is completed by Alphabetic Order & Unit)
  • Logs visitors, guests, contractors, vendors and activities participants in and out.
  • Answers telephone and route calls to appropriate personnel.
  • Provides appropriate program information and update's on daily activities.
  • Supervise reception area.
  • Maintain clean, welcoming and comfortable environment.
  • Receiving and sorting daily mail and packages.
  • Perform data entry or other administrative tasks as assigned.
  • Assist staff and visitors with the operation of copy and fax.
  • Other duties as assigned by supervisor or management.
  • Excellent interpersonal and soft skills and the ability to multi task, handling busy reception area and representing professional hospitality.

Member Services Specialist

Virgin Pulse
05.2019 - 10.2020
  • Responsible for resolving members' issues and educating them on all facets of the Sponsored Wellnes program
  • Delivering diligent attention to each inquiry resulting with timely resolutions to service while creating positive experiences by understanding individual needs.
  • Demonstrating value and enthusiasm through professional and personal involvement supporting the exchange for options that support well-being, growth & goal progress, participating with over all wellness awareness.
  • Playing an important role in providing feedback that shapes the product.

Provider Services Representative

NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND
09.2018 - 05.2019
  • Provide accurate and thorough interpretation of Neighborhood Health Plan benefits, claim processes and eligibility to our providers and staff.
  • Research, review and respond to complex provider inquiries received in the call center via escalation process including the following:
  • Claims related issues.
  • Submitting and tracking application support tickets related to provider issues.
  • Benefit/ Eligiblity/Clarifications.
  • Contact Providers for follow up and/or closure to escalated issues as necessary.
  • Support call center staff using applied knowledge of Neighborhoods benefits, policies and procedures.
  • Identify issues/trends to reduce provider escalations.
  • Collaborates with other departments on issue resolution.
  • Represents Neighborhood to internal and external customers in a professional manner.
  • Answering inbound provider calls as needed.
  • Performs other assigned tasks as needed.
  • Corporate Compliance Responsibility.

Outpatient Office Administrative Assistant

PHOENIX HOUSE
03.2017 - 06.2018
  • Worked with Out Patient Services for Substance Abuse Mental and Behavioral Health recovery.
  • Interacted with clients, vendors and visitors in a respectful, professional manner and prioritized workflow to achieve efficient completion of multiple tasks including:
  • Answering and transferring telephone calls to the relevant persons.
  • Researched, compiled data, documentation and reports for presentation to staff/clients.
  • Performed insurance appeals and denials and Handled checks, cash & cc payment processing.
  • Organized and scheduled meetings and appointments, developed and maintained a filing system while adhering to efficient and effective office management practices and procedures.
  • Admissions /Intake Specialist.
  • Verified patient's Insurances by telephone and email communications.
  • Working with Affiliate Associations as Program Support.
  • Confidentiality training according to the HIPAA Act.
  • Outpatient scheduling.

Customer Engagement Specialist

OPTUM
08.2014 - 04.2016
  • Expressed confident, professional, pleasant phone presence while engaging in solutions with customers resolving account and billing conflicts and maintained outstanding interpersonal communication during the process in the following areas:
  • Account management involving creation, updating, troubleshooting, process payment's.
  • Educating consumers on their health benefits.
  • Responsible for enrolling consumers into the Affordable Care Act.
  • Explaining to customers tax responsibilities in regards to the Affordable Care Act.
  • Further communicated through Health Source RI.
  • Attended management through consumer care meetings.
  • Provided specialized navigator support for escalated healthcare billing/ account(s) issues.

Account Executive

BRADY ROGERS
08.2010 - 03.2012
  • Account management for personal and commercial lines of business.
  • Built and strengthened relationships with new and existing accounts to drive revenue growth.
  • Qualified leads, built relationships and executed sales strategies to drive new business.
  • Executed successful sales strategies to convert leads into customers.
  • Resolved issues promptly to drive satisfaction and enhance customer service.

Community Organizer

Clean Water Action
01.2008 - 12.2009
  • Performed independently and as part of a team in developing and supporting local and volunteer leadership teams for environmental activism while implementing various strategies relating to grassroots and community based campaigns for fundraising and public support including the following:
  • Planning campaign events and attendef trainings.
  • Mapping territories to enhance on-the-ground organizing efforts.
  • Assist with all aspects of fundraising and community awareness.
  • Multi-tasked, prioritized and utilized available resources to overcome challenges.
  • Interacted with representatives and advocates at City Hall.

Education

Certificate - Life Coaching Health & Wellness

The Transformation Academy
Clearwater, FL

RI State Insurance Producers License

Rhode Island College
Providence, RI
08.2010

Certificate - Alternative Holistic Medicine

LINCOLN TECHNICAL INSTITUTE
Lincoln, RI
10.2008

Skills

  • CSR (10 years)
  • Clerical Experience
  • Data entry (10 years)
  • Sales (10 years)
  • Computer literacy
  • Office Management
  • Medical Office Experience
  • Organizational Skills
  • Insurance Verification
  • Filing
  • Addiction counseling
  • Problem solving (10 years)
  • Google Docs
  • Typing (10 years)
  • Epic
  • Microsoft Outlook
  • Documentation review
  • Behavioral Health (5 years)
  • Communication Skills
  • Microsoft Excel
  • Microsoft Word
  • DocuSign
  • Motivational interviewing
  • Medical records
  • Quality assurance
  • English
  • Administrative Experience (5 years)
  • Call Center (10 years)
  • Microsoft Office
  • Medical scheduling
  • Front desk
  • Time management
  • Hipaa (10 years)
  • Supervising experience (5 years)
  • Customer Care (10 years)
  • Microsoft Windows
  • Hospitality
  • Mentoring (10 years)
  • Research
  • Conflict Management (5 years)
  • Customer service (10 years)
  • Process improvement
  • ICD coding
  • Customer Support (10 years)
  • CPT Coding
  • Crisis Intervention
  • EMR Systems
  • Insurance Product Promotion
  • Call Center Customer Service
  • Insurance Terminology
  • Oral and Writing Communication
  • Team Meetings
  • Customer Follow-Up
  • Consultative Selling Techniques
  • Process Applications
  • Medicare Compliance
  • New Client Acquisition
  • Client Account Management
  • Revenue Generation
  • Prospecting and Cold Calling
  • Critical Thinking
  • Consultative Sales Approach
  • Insurance Requirements
  • Quote Information
  • Claims Information Gathering
  • Reading Comprehension
  • Creative Solutions
  • Insurance Recommendation
  • Professional Relationships
  • Sell Policies
  • Cross-Promote Products
  • Premium Collection
  • Clerical Support
  • Operational Efficiency
  • Patient Profiles
  • Business Transactions
  • Upselling
  • Benefits Explanations
  • Health Insurance Industry Knowledge
  • Persuasive Negotiations
  • Sales Expertise
  • New Business Solicitation
  • Insurance Procedures

Certification

  • Licensed Insurance Producers - 2010
  • Area of certification Life Coaching 2021- current

Timeline

Direct Care Professional

Jammat Housing & Community Development Corp
02.2023 - Current

Appeals Coordinator

Lifespan
07.2022 - 12.2022

Member Services Specialist

Virgin Pulse
05.2019 - 10.2020

Provider Services Representative

NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND
09.2018 - 05.2019

Outpatient Office Administrative Assistant

PHOENIX HOUSE
03.2017 - 06.2018

Customer Engagement Specialist

OPTUM
08.2014 - 04.2016

Account Executive

BRADY ROGERS
08.2010 - 03.2012

Community Organizer

Clean Water Action
01.2008 - 12.2009

Certificate - Life Coaching Health & Wellness

The Transformation Academy

RI State Insurance Producers License

Rhode Island College

Certificate - Alternative Holistic Medicine

LINCOLN TECHNICAL INSTITUTE

COVID Screener- Office Receptionists

The Steere House
03.202 - 04.2022

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Thalia Brice