Tonjuanay Clark
St. Louis,MO
Summary
Earnest and driven Health Advisor familiar with insurance claims, premiums and copays. Good data entry abilities, documentation skills and follow-through on routine and complex tasks. Offering 8 years of related experience.
Overview
16
16
years of professional experience
Work History
Health Advocate
Humana
08.2021 - Current
- Managed daily activities that impacted targeted service levels and tracked adherence to schedules and average handle times.
- Demonstrated professional and polished demeanor with positive, upbeat and friendly personality and supported calling work during times of peak contact volume.
- Proficient utilizing electronic medical record and documentation programs.
- Proficient and/or experience with medical terminology and/or ICD-10 codes.
- Utilization Review and/or Prior Authorization, preferably within a managed care organization.
- Provided information such as copay and premium details, pre-approval procedures and available products.
- Handled more than 50 daily inbound calls from health plan customers.
Care Coordinator Remote
United Health Care
08.2017 - 08.2021
- Handle resolution/inquiries from members and/or providers parallon
- Facilitated on-going assessment of patient and family needs and oversaw implementation of interdisciplinary team plan of care
- Investigated and reported issues relating to patient care and conditions which might hinder patient well-being
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology, and other procedures
- Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements
- Efficiently and effectively processed a large volume of medical claims on a daily basis
- Implemented services to assist company in maintaining exceptional client service ratings on external audits
- Cooperated with Medicare, Medicaid and private insurance providers to establish relationships and resolve billing issues
- Follow all required FDCPA regulations and system procedures
- Used company software and databases to maintain records of services performed and patient conditions.
Medical Collections Specialist
Parallon Business Solutions
02.2016 - 08.2017
- Oversaw daily collections and accounts receivable activities, developing robust strategies to maximize collections and reduce aged accounts
- Analyzed loss reports and reviewed with senior management to measure overall portfolio performance
- Minimized loss by negotiating payment terms directly with clients, consistently achieving 100% recovery rate
- Motivated and encouraged team members to communicate more openly and constructively with each other
- Juggled multiple projects and tasks to ensure high quality and timely delivery
Inbound Sales Representative
Charter Communications
11.2013 - 08.2015
- Memorized scripts to achieve easy conversational flow in interactions with potential customers.
- Exceeded productivity targets and sales goals by 95%.
- Utilized automated systems to log and retrieve information.
- Worked with multiple means of communication within fast-paced environment.
- Kept detailed records of changing inventories for technology products using crm.
- Communicated with customers regarding marketing campaigns and promotions, answering questions and addressing concerns.
Crew Member Team Leader
Taco Bell
12.2008 - 11.2013
- Supervised team members and oversaw effective and efficient completion of job duties.
- Inspected tools and equipment to maintain safety and efficiency.
- Created identical dishes numerous times daily with consistent care, attention to detail, and quality.
- Unloaded food supplies from distributor trucks to efficiently organize inventory.
- Communicated closely with servers to fully understand special orders for customers.
- Maintained well-stocked stations with supplies and spices for maximum productivity.
Education
Bachelor of Science -
Harris Stowe State University
High School Diploma -
MCCLURE NORTH HIGHSCHOOL
01.2010
Skills
- Business development
- Ability to type 55 WPM
- Collecting information
- Error verification
- Work ethic
- Team building
- Relationship building
- Microsoft Office expertise
- Quality assurance controls
- Office equipment proficiency
- Active listening
- Call center experience
- Inbound and outbound calling
- Accounting
- Accounts receivable
- Benefits
- Billing
- Data entry
- Delivery
- Senior management
- Insurance
- Listening
- Machinery
- Medical terminology
- Excel
- Negotiating
- Organizational skills
- Progress
- Quality
- Quality assurance
- Safety
- Scripts
- HIPAA compliance
- Crm
- CGX
Additional Information
McClure North homecoming group - vice president, Greater Rising Star feed the homeless ministry - member, Foster care coalition - member, Sullivan University steppers - member
Timeline
Health Advocate
Humana
08.2021 - Current
Care Coordinator Remote
United Health Care
08.2017 - 08.2021
Medical Collections Specialist
Parallon Business Solutions
02.2016 - 08.2017
Inbound Sales Representative
Charter Communications
11.2013 - 08.2015
Crew Member Team Leader
Taco Bell
12.2008 - 11.2013
Bachelor of Science -
Harris Stowe State University
High School Diploma -
MCCLURE NORTH HIGHSCHOOL
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