Summary
Overview
Work History
Education
Skills
Timeline
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Tia N. Cole

Baltimore,MD

Summary

Paralegal motivated to continually improve and extend personal skills and knowledge to attain increased responsibility and opportunities for professional growth.

Overview

21
21
years of professional experience

Work History

Law Firm, Paralegal

Sellers, Fox, Kahn & Bender, P.A
10.2019 - Current
  • Conducts detailed client intakes and enters information into company database.
  • Manages accounts and client records of clients, observing confidentiality, and extreme discretion.
  • Researches and analyzes legal issues and cases to provide accurate advice to clients.
  • Investigates claims and prepares processing documentation.
  • Manages accounts and client records of clients, observing confidentiality, and extreme discretion.
  • Edited and proofread legal documents to verify accuracy.
  • Conducts detailed client intakes and enters information into company database.
  • Communicates with clients, opposing counsel and court personnel to keep all parties informed on case updates.
  • Assists in preparation of settlement proposals and agreements to help attorneys negotiate settlement in best interest of client.
  • Monitors changes in laws, regulations and other legal matters to keep firm compliant with requirements.
  • Reviews, edits and proofreads litigation for proper grammar, spelling and punctuation.


Case Manager/Enrollment Navigator

Health Care Access Maryland
05.2014 - 01.2017
  • Developed and implemented comprehensive case management plans to address client needs and goals.
  • Utilized MMIS, MABS, CARES, and SVES to screen ACA applications.
  • Maintained knowledge of ACA program eligibility practices and procedures.
  • Provided outreach and education to clients
  • Assisted with simple to complex network application failures.
  • Provided assistance and high-quality customer service.
  • Developed and implemented comprehensive case management plans to address client needs and goals.

Care Coordinator/Case Manager

Total Health Care, Inc, Qualified Health Center
01.2012 - 12.2013
  • Secured monthly reports of females in the targeted age group who accessed primary care in the Immediate Care Center.
  • Used patient information to generate lists of female patients in the applicable age group who are due for cervical cancer screening visits.
  • Performed patient assessments in an effort to provide care coordination and referrals for services
  • Used clinical data to establish a patient registry and reminders for providers for patients that are due for cervical cancer screening visits.
  • Maintained detailed records in compliance with agency standards and regulations.
  • Furnished insurer with information to approve payment for hospitalization and worked to prevent insurance claim denials.
  • Evaluated clients progress and adjusted service plans to address areas of concern.
  • Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing, and other enabling services for patients.

Quality Data Analyst (Team Lead)

Bravo Health
11.2006 - 12.2011
  • Evaluated large datasets for quality and accuracy.
  • Reviewed, troubleshot and corrected mismatches identified on the enrollment capitation reports for the daily and monthly Medicare/CMS enrollment files.
  • Utilized QNXT and other databases to reconcile membership data.
  • Analyzed and resolved problems presented by internal reports.
  • Reviewed and analyzed claims data.
  • Identified trends in data entry.
  • Developed programs and files for analyzing enrollment data.
  • Handled urgent/priority enrollment issues, diagnosed and resolved 95% of assigned Help Desk tickets within 72 hours.
  • Assisted with special projects to meet corporate and departmental needs.

Enrollment Representative/Complaint Liaison

Maryland Physicians Care
04.2002 - 11.2006
  • Accurately researched and resolved enrollment and eligibility issues.
  • Reported finance information that had impact on capitation, recovery and reconciliation.
  • Accurately recorded and updated enrollment and eligibility information in the appropriate databases.
  • Performed patient account audits, determined eligibility for case management and other programs.
  • Assisted with annual HEDIS initiatives.
  • Maintained above average knowledge base of Medicaid policies and procedures, HIPAA regulations, desktop procedures and followed guidelines consistently.
  • Data entry of Prior Authorization requests as needed in an effort to assist the PA department.
  • Consistent and demonstrated use of excellent and interpersonal, reasoning and communication skills.
  • Achieved a minimum of 95% accuracy in consistently meeting service standards and quality measures.
  • Reconciled data, updated QNXT and other appropriate databases.

Education

Bachelor of Business Administration (B.B.A - Business Management

Strayer University
Baltimore, MD
06.2024

Skills

  • Trial Proceedings
  • Case File Preparation
  • Counsel Clients
  • Case Coordination
  • Legal Research
  • Data Collection
  • Client Intakes
  • Settlement Support
  • Document Control Support
  • Daily Reports
  • Team Oriented
  • File and Records Management
  • Administrative Support
  • Case Management
  • Legal Case Files
  • Online Databases
  • Electronic Filing Familiarity
  • Office Administration
  • Strong Research Skills
  • Data Research
  • Microsoft Word
  • Client Correspondence
  • Legal Compliance
  • Healthcare Terminology
  • Federal Guidelines
  • Reading Comprehension
  • Proofreading
  • Documenting
  • Power of Attorney
  • Assisting Lawyers
  • Legal Jargon Knowledge
  • Proficiency in MS Office

Timeline

Law Firm, Paralegal

Sellers, Fox, Kahn & Bender, P.A
10.2019 - Current

Case Manager/Enrollment Navigator

Health Care Access Maryland
05.2014 - 01.2017

Care Coordinator/Case Manager

Total Health Care, Inc, Qualified Health Center
01.2012 - 12.2013

Quality Data Analyst (Team Lead)

Bravo Health
11.2006 - 12.2011

Enrollment Representative/Complaint Liaison

Maryland Physicians Care
04.2002 - 11.2006

Bachelor of Business Administration (B.B.A - Business Management

Strayer University

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Tia N. Cole