Tieronay Watson
Columbia,,SC
Summary
Professional Customer Service Representative with +7 years of Healthcare insurance, office and data entry experience with a desire to take on new challenges.
Overview
7
7
years of professional experience
Work History
Pre-Certification Specialist (Hybrid)
BlueCross BlueShield
01.2025 - 04.2025
- Verify and confirm all member's health insurance coverage and benefits by phone and/or online to determine if prior authorization is required for specific treatments and/or procedures.
- Obtain, initiate, and process all PA requests from insurance providers. Ensure all requests are obtained before services are provided to patients.
- Pay close attention to PA detail, and use accurate CPT (procedural) and ICD-10 (diagnoses) coding for each request.
- Review patient records and keep track of PA status. Provide authorization status to providers, follow up on denials and educate providers on necessary requirements
- Maintain records and document all aspects of the authorization process, including requests, all communication with providers, status updates on approvals, and denials, etc.
- Adhere to PA guidelines, educate providers on what information is needed and how to submit authorization request by phone or online to ensure authorizations and patient information is submitted correctly to prevent denials.
- Ensure authorizations are processed in a timely and accurate manner.
- Communicate, keep track, and follow up with the UM department regarding all authorization requests to ensure all necessary documents are received and processed in a timely and accurate manner.
- Obtain clinical documentation to support all PA requests.
- Investigate denials, resubmit request, and initiate appeal request when needed to ensure all members receive the care required
- Use appropriate database such as Citrix Storefront, Rumba Sessions, Document Database System and Microsoft Software.
- Completes daily mail. Scan and fax required mail to appropriate department.
Business Office Representative
Prisma Health
Columbia, SC
02.2024 - 09.2024
- Perform various administrative tasks, such as checking patients into scheduled appointments, complete patient/family registration, ensuring all proper forms are completed, signed and scanned into patient's chart, respond to voicemails, fax and emails, organize, sort and file documents.
- Monitor and keep track of each doctor's schedule to ensure that all patient appointments are scheduled.
- Ensure the pre-authorization process is completed prior to scheduled appointments.
- Enter all incoming information into the company database. Navigate through Epic, the EMR system, and all Microsoft software.
- Adhere to HIPAA federal laws to ensure all patient information is protected
- Assist patients with understanding their coverage, benefits, payments, and/or any balance applied to their account.
- Maintain medical and office records.
- Multi-task and prioritize office duties to ensure all task are completed daily. Ensure office remains organized.
- De-escalate and report any patient complaints about the office.
- Order and keep track of office supplies and doctor supply needs.
Concierge Specialist (Call Center/WFH)
The Anthem Companies
05.2018 - 02.2024
- Perform prompt, timely, and accurate responses to all Medicare and Medicaid members and providers inquiries through multiple company databases.
- Work independently in a fast-paced environment, handling multiple calls. Answer inbound calls and make outbound calls in a timely manner.
- Assist members and providers with insurance coverage, plan information, benefits, medications, claims and billing, prior authorizations, etc.
- Adhere to AHT (average handle time).
- Review, identify, answer, and document all inquiries via phone systems, web, fax, and emails.
- Update and make changes to member's policies.
- Verify, modify, review and enter member demographic information, primary, secondary and any other insurance information.
- Adhere to company escalation protocols, completes and follow up on grievance cases, submit appeals and/or single case agreements.
- Follow all company laws, regulations and guidelines
- Prioritize and manage multiple projects assigned.
Education
High School Diploma -
Richland One Middle College
06.2013
Skills
- Medical Coding
- Medical Terminology
- Data Entry and processing
- Proficient Microsoft Skills
- Strong, clear, effective communication
- Empathy
- Computer/phone Skills
- Detail-Oriented
- HIPAA Compliance
- Fraud, Waste and Abuse
- Problem-Solving
- Adaptive
- Policy adherence
- Time management
- Team player
- Documenting and Reporting
Timeline
Pre-Certification Specialist (Hybrid)
BlueCross BlueShield
01.2025 - 04.2025
Business Office Representative
Prisma Health
02.2024 - 09.2024
Concierge Specialist (Call Center/WFH)
The Anthem Companies
05.2018 - 02.2024
High School Diploma -
Richland One Middle College
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