TIA WHITE
Winter Haven,USA
Summary
Resourceful and detail-oriented administrative professional with expertise in claims adjudication, customer service, and facilitating smooth workflows within healthcare environments. Strong team player with experience in resolving claims, managing relationships with healthcare providers, and supporting pharmacy/facility operations. Proficient in claims processing, denial management, and improving operational efficiency in a remote setting. Committed to providing excellent support and training to team members while maintaining HIPAA compliance.
Overview
10
10
years of professional experience
Work History
Senior Enrollment/Medical Billing Specialist
Cigna
07.2024 - Current
- Processed and reviewed insurance claims to ensure billing accuracy, adhering to payer requirements
- Analyzed complex Explanation of Benefits (EOB) forms and resolved discrepancies with insurance providers
- Worked closely with patients, insurance companies, and billing teams to ensure accurate and timely claim submission
- Managed claims follow-ups and denials, enhancing revenue collection through diligent research and resolutions
- Assisted with tasks related to claims adjudication, including resolving payment issues and applying payments to accounts
Pharmacy Prior Authorizations Specialist
Cigna
09.2023 - 07.2024
- Managed a high volume of incoming calls
- Facilitate resolution of drug coverage issues and proactively address, research and resolve issues while maintaining accurate and complete documentation of all inquiries for continuous improvement.
- Improved patient satisfaction with timely and accurate processing of prior authorizations for medications and procedures.
- Verified eligibility and compliance with authorization requirements for service providers.
Insurance Verification Specialist
GEICO
09.2022 - 09.2023
- Reduced claim handling errors by thoroughly reviewing policy coverages and applying accurate
- loss evaluations.
- Utilized advanced software programs to streamline claim data entry and document management,
- resulting in increased efficiency.
- Built strong working relationships with insurance adjusters, attorneys, medical providers, and
- other stakeholders involved in the claims process.
- Provided empathetic support to customers during difficult situations while maintaining
- professional boundaries as an Auto Claim Specialist representative.
- Enhanced claim resolution times by effectively coordinating with repair shops, appraisers, and
- other involved parties.
- Maintained high levels of accuracy in data entry, ensuring proper documentation for each claim
- processed.
Medical Claims Representative
Kaiser Permanente
02.2020 - 09.2021
- Improved patient satisfaction by efficiently processing medical claims and addressing inquiries.
- Demonstrated adaptability by handling various types of medical claims across multiple specialties Improved patient satisfaction by efficiently processing medical claims and addressing inquiries.
- Demonstrated adaptability by handling various types of medical claims across multiple specialties while maintaining accuracy.
- Collaborated with healthcare providers for timely resolution of discrepancies, ensuring accurate reimbursement.
- Ensured prompt payment from insurance companies through diligent follow-up on outstanding claims balances.
- Prevented fraudulent claims by performing rigorous investigations into suspicious cases, safeguarding company resources.
- Built strong relationships with key stakeholders such as healthcare providers, insurers, patients, and colleagues for seamless coordination.
- Secured proper payment for services rendered by thoroughly reviewing insurance coverages and applying appropriate codes while maintaining accuracy.
- Collaborated with healthcare providers for timely resolution of discrepancies, ensuring accurate reimbursement.
- Ensured prompt payment from insurance companies through diligent follow-up on outstanding claims balances.
- Prevented fraudulent claims by performing rigorous investigations into suspicious cases, safeguarding company resources.
- Built strong relationships with key stakeholders such as healthcare providers, insurers, patients, and colleagues for seamless coordination.
- Secured proper payment for services rendered by thoroughly reviewing insurance coverages and applying appropriate codes.
Enrollment Specialist
Aetna
05.2015 - 02.2020
- Increased team productivity through effective workload delegation among team members according to individual strengths and skillsets.
- Collaborated with cross-functional teams to ensure smooth communication and efficient workflow in the enrollment process.
- Provided exceptional customer service during application submission, addressing any concerns or issues promptly and professionally.
- Ensured timely completion of daily tasks by setting priorities based on urgency levels.
- Improved data integrity within the system through diligent verification of applicant information, reducing errors and discrepancies.
Education
Associate of Arts - Health Administration
Maricopa Community Colleges, Rio Salado Community College
Tempe, AZ08.2025
Certificate of Technical Studies - Health Sciences Management
Cornell University
Remote12.2024
Skills
- ICD-10 proficiency
- HIPAA compliance
- Denial management
- Claims research and resolution
- Claims adjudication (Pharmacy and Medical)
- Insurance verification
- Prior authorization processing
- Data entry proficiency
- Microsoft Excel
- Microsoft Word
- Office management
- Clerical support
- Customer service excellence
- Team collaboration and training
Timeline
Senior Enrollment/Medical Billing Specialist
Cigna
07.2024 - Current
Pharmacy Prior Authorizations Specialist
Cigna
09.2023 - 07.2024
Insurance Verification Specialist
GEICO
09.2022 - 09.2023
Medical Claims Representative
Kaiser Permanente
02.2020 - 09.2021
Enrollment Specialist
Aetna
05.2015 - 02.2020
Associate of Arts - Health Administration
Maricopa Community Colleges, Rio Salado Community College
Certificate of Technical Studies - Health Sciences Management
Cornell University
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