Tolya Williams

• Counseled patients via telephone according to established guidelines and protocols, advising on provider-established plans of care.
• Relayed triage information and facilitated communication between provider and patient concerning patient disposition.
• Obtained case history and gathered triage information to determine appropriate avenue for care.
• Scheduled appointments for patients not requiring emergency services but needing examination from provider and consulting directly with provider.

• Communicated with insurance providers to resolve denied claims and resubmitted.
• Posted and adjusted payments from insurance companies.
• Communicated effectively and extensively with other departments to resolve claims issues.
• Assisted patients with understanding their medical bills and provided clarification on complex insurance issues, promoting a positive customer experience.

• Educated patients on pre-surgery requirements, such as fasting protocols or medication adjustments, resulting in fewer complications on the day of the procedure.
• Handled urgent requests effectively, prioritizing cases requiring immediate attention while also balancing routine surgery demands appropriately.
• Arranged pre-operative and post-operative appointments for surgical patients.
• Expertly managed planning, scheduling, and coordination of outpatient procedures.
• Billed insurance and patients for surgical implants
• Prepared patient charts

• Demonstrated strong attention to detail and organizational skills in managing a high volume of referrals while maintaining exceptional levels of patient care.
• Scheduled appointments with specialists on behalf of clients.
• Maintained a high level of accuracy in referral documentation, ensuring smooth transitions between healthcare providers.
• Processed referral requests from patients, doctors and other health care professionals.
• Obtained authorizations for surgery through the interpretation of patient medical records.

• Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
• Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
• Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
• Enrolled providers and Medicaid, Medicare, and private insurance plans.

Billed pharmacy claims for 65 short and long term healthcare facilities

Solved billing discrepancies maximizing revenue

Prepared monthly expense reports

Verified and corrected insurance ID's,Bin and PCN for denied claims for resubmission

Assisted with the credentialing of provider portals

Education:

Bachelor of Science from Bethune Cookman University

Certified med technician

CPR certified

Billing and Coding student