Tiera Price

Lehigh Acres,Fl

Summary

Dedicated Healthcare Administrative professional with history of meeting company goals utilizing consistent and organized practices. 6+ years of healthcare experience handling complaints, grievances for claims, services, and authorizations via phone and email. Gather patient information, charts, summaries, provider notes, discharge reports Investigate claims and denial reasons, research and resolve. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.

Overview

years of professional experience

Work History

Utilization Management Coordinator

United Healthcare Specialty Benefits

Fort Lauderdale , Fl

2018.09 - Current

Ensure Medicaid treatment requests are processed according to contractual obligations outlined by each state
Serve as subject matter expert on policies and benefits to providers and proactively identify problems and develop solution strategies
Function as liaison between providers and MCNA; providing guidance on utilization related issues
Coordinate pre-authorization for dental service requests for members; ensuring efficient resource management
Provide training and/or re-education for providers and staff as needed
Serve as backup Manager of Utilization Management
Monitor quality of care and service for potential problems
Work closely with Case Management dept to create treatment plans for disabled member’s
Updated Excel spreadsheets on daily basis to ensure all required information is easily accessible

Practice Coordinator

Team Health

Tamarac , FL

2016.12 - 2018.08

Handle member issues, complaints, and grievances regarding claims, services that were not authorized
Create cases, gather patient information, charts, summaries, provider notes, discharge reports,
Review denied claims and investigate denial reasons: lack of authorizations, missing/incorrect information
Responsible for obtaining, reconciling, and forwarding all required documents of each in-patient medical record to designated Billing Center
Access hospital information systems and work with facility staff to procure patient demographic and insurance data
Identify and retrieve missing or incomplete patient records in a timely manner
Maintain accurate data to report the number of records being sent and specific key measures from those visits

Patient

Orthopedic Associates

Plantation , FL

2016.04 - 2016.11

Verify patient demographics, current insurance, and obtain patient consent to treat to ensure accurate billing
Assist patients with various forms, and obtains insurance waiver signatures as necessary
Compile data for regular and special reports as requested by Practice Administrator
Process appropriate forms, and copies insurance card information to ensure accurate billing and medical record information

Pharmacy Technician

University of Maryland Medical Center

Baltimore , MD

2011.07 - 2016.07

Process patient prescriptions through insurance/verify insurance
Create new patient accounts/add and update patient demographics
Process payments for medications

Education

Medical Assistant Certification -

Fortis Institute

2011

Skills

HIPAA Guidelines
Health Information Systems

Patient Advocacy
Performance Monitoring

Timeline