Tiunna Hayes
Casa Grande,Arizona
Summary
Dedicated Reimbursement Specialist with exemplary analyzation and negotiation abilities. Highly skilled in customer service and coverage evaluation. Specializing in medical and pharmacy insurance claims with a well-established knowledge of the general industry.
Overview
14
14
years of professional experience
Work History
Reimbursement Specialist
CareMetx
10.2021 - Current
- Collect and review patient benefit information, to the degree of the SOP.
- Complete and submit all insurance forms in a timely manner.
- Maintain frequent phone contact with pharmacy staff, third party representatives and provider representatives.
- Track and follow up on authorization request.
- Aids physician office staff and patients to complete and submit insurance forms.
- Contributed to increased team productivity by consistently meeting or exceeding individual processing goals.
- Managed multiple priorities effectively under high-pressure deadlines without compromising accuracy or quality of work output.
- Managed a high volume of cases simultaneously, prioritizing tasks effectively to meet strict deadlines and maintain high-quality service standards.
Correctional Officer
CoreCivic
01.2017 - 09.2021
- Managed high-risk situations with professionalism and composure, ensuring the safety of all involved parties.
- Observed and supervised inmates throughout visits, meal time, recreation, phone calls, and showers.
- Maintained inmate safety through vigilant monitoring of behavior and swift intervention during conflicts.
- Assisted in the training of new correctional officers, providing guidance on best practices and procedures.
- Prepared, processed and maintained forms, reports, logs, records, and activity journals.
- Improved communication between staff members by participating in daily briefings and sharing critical information about inmate activities.
- Ensured compliance with all applicable federal, state, and local laws, regulations, and policies governing correctional facilities.
- Observed behavior of residents individually and in groups.
- Completed intake paperwork, fingerprints, and searches.
Team Lead
United Health Group
04.2010 - 12.2016
- Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
- Trained new team members by relaying information on company procedures and safety requirements.
- Coached team members in techniques necessary to complete job tasks.
- Enhanced overall team performance by providing regular coaching, feedback, and skill development opportunities.
- Collaborated with other department leads to streamline workflows, improve interdepartmental coordination, and achieve business goals collectively.
- Worked different stations to provide optimal coverage and meet production goals.
- Developed comprehensive knowledge of various specialty medications, enabling informed recommendations for treatment options based on individual needs.
- Developed strong relationships with healthcare team members, fostering a collaborative approach to patient care.
- Provided exceptional customer service, addressing both patient and provider concerns promptly and professionally.
- Coordinated medication deliveries with external partners, ensuring timely receipt by patients.
- Managed incoming phone calls from customers seeking information about products or placing mail orders effectively and courteously.
- Handle complex issues where analysis of data require in-depth evaluation
- Independently and effectively resolves complex accounts with minimal supervision.
Education
Diploma -
SouthWest Texas High School
Skills
- Excellent organizational skills
- Strong negotiating skills
- Ability to problem solve
- Strong time management skills
- Interpersonal Communication and written skills
- Ability to multi-task and adapt to changing priorities
- Proficient in Microsoft office programs
- Collaborative and efficient
- Customer satisfaction focused
- Detail oriented
- Insurance verification/ Eligibility verification
- Healthcare analytics
Timeline
Reimbursement Specialist
CareMetx
10.2021 - Current
Correctional Officer
CoreCivic
01.2017 - 09.2021
Team Lead
United Health Group
04.2010 - 12.2016
Diploma -
SouthWest Texas High School
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