Tierra Bradshaw
Altamonte Springs,FL
Summary
A people-oriented individual who pays close attention to detail and has a positive attitude. Seeking the position of benefits verifications specialist or case manager at a prestigious company.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Patient Access Specialist
AssistRx
Orlando, FL
01.2024 - Current
- Ensure cases move through the process as required in compliance with company requirements and the organization's defined standards and procedures; in a manner that provides the best level of service and quality
- Conduct benefit investigations for patients by making outbound phone call to payers to verify patient insurance benefit information, navigate complex reimbursement barriers and seek resources to overcome the barriers
- Verify patient specific benefits and document specifics including coverage, cost share and access/provider options
- Identify any coverage restrictions and details on how to expedite patient access
- Document and initiate prior authorization process and claims appeals
- Report any reimbursement trends or delays in coverage to management
- Act as a liaison for field representatives, health care providers and patients
Benefits and Authorizations
Florida Hospital
07.2021 - 12.2023
- Maintained performance standards for account benefits and verifying authorizations for unscheduled patients.
- Reviewed error reports, denials, and made corrections as necessary
- Adhered to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account
- Monitored team mailbox and/or e-mail inbox, faxes, and/or phone calls, responding to all related account issues within defined timeframes
- Maintained a close working relationship with clinical partners and/or ancillary departments to ensure continual open communication between clinical, ancillary and patient access & patient financial services departments
- Verified J-codes, diagnosis codes and made sure that medications were within the Medicare/NCCN guidelines.
Patient Care Coordinator
Prime Therapeutics
10.2018 - 07.2021
- Received incoming calls from customers in accordance with department standards and other verbal and written training memorandums.
- Maintained professional and courteous communication resulting in high call quality, refill medication
- Made outbound calls as needed regarding enrollments, order status and benefit information, schedule deliveries
- Met and exceeded department employee performance standards, arranged payment, verified insurance and processed claims
- Followed proper procedures for accurate and timely documentation of customer concerns and other related issues
- Investigated and resolved phone inquiries in a timely manner. Forwarded escalated calls as needed to designated representatives or Supervisors
Member Service Representative
Catamaran
07.2012 - 07.2018
- Communicated with patient and/or guarantor regarding financial responsibility, verifying insurance coverage for Medicaid eligibility, process refills of patient medication, providing copay structures.
- Coordinated with other departments internally regarding billing, services, or administering of benefits.
- Provided general prescription information, educate members on program, renew, and enroll members.
Education
Associates of Science - Medical Billing & Coding
Seminole State Community College
01.2014
High school diploma - undefined
Ocoee High School
01.2011
Skills
- Customer Service
- Telephone support and communications
- Case management
- Multi-tasking
- MS Office proficiency
- Medical & Pharmacy Benefit Knowledge
- Excellent Verbal communication skills and grammar
- Salesforce system experience
- Typing 35 wpm
- Data entry
- Microsoft Office
- Banking
- Cash handling
- Medical terminology
- Insurance verification
- HIPAA
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Increased team productivity and efficiency
- Improved customer service satisfaction ratings by implementing better communication or service strategies
- Resolved high-volume client issues, reducing escalations by 15%
- Built and maintained long-term client relationships that leas to repeat business.
- Trained and mentored new employees, reducing onboarding time.
- Identified and solved recurring issues that improved quality or accuracy.
- Collaborated cross-departmentally to improve workflow and meet company objectives.
- Earned "Employee of the Month" and similar recognitions.
- Selected for special projects or leadership opportunities due to performance.
- Promoted within 4 months for strong contributions.
- Took Initiative to lead a team or step in as acting supervisor when needed.
- Maintained excellent attendance and punctuality record.
Certification
Microsoft, Word, Excel, Powerpoint
CCSP
Salesforce Certification
CPR
Languages
English
Native or Bilingual
Timeline
Patient Access Specialist
AssistRx
01.2024 - Current
Benefits and Authorizations
Florida Hospital
07.2021 - 12.2023
Patient Care Coordinator
Prime Therapeutics
10.2018 - 07.2021
Member Service Representative
Catamaran
07.2012 - 07.2018
High school diploma - undefined
Ocoee High School
Associates of Science - Medical Billing & Coding
Seminole State Community College