Summary
Overview
Work History
Education
Skills
Timeline
Generic

Tonya Prekaj

Madison Heights,MI

Summary

To use my experience as a customer service advocate in a positive work environment with opportunity to grow.

Overview

19
19
years of professional experience

Work History

Customer Service Advocate II

Centene
Farmington , MO
05.2022 - Current
  • Provide assistance to member and providers regarding website registration and navigation
  • Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustments
  • Use of dual monitors and multiple applications
  • Structured Environment
  • Maintain performance and qualify standards based on established metrics including turn around times
  • Trucare cloud Champion
  • Reference current materials and programs to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits, and authorization status
  • Provide first call resolution working with appropriate internal and external resources

Infant Lead Teacher

Little Leaders Academy
Clinton Twp, MI
08.2021 - 04.2022
  • Develop and maintain professional relationships with parents, teachers and directors
  • Observe children for signs of illness, injury, learning disorders, speech or emotional problems
  • Observe that children are meeting milestones.

Medical Records Coordinator

Michigan Orthopaedic Surgeons
Southfield, MI
01.2019 - 01.2019
  • Receive and process medical records request for release of patient information
  • Receive short term disability, and FMLA paperwork
  • Process short term disability return to work certifications, FMLA
  • Send paperwork to physician’s for review and signature
  • Retrieve voicemails and assist patient with their needs
  • Answer phone calls and assist disability company, attorneys, patients
  • Enter messages to nursing staff, MA’s for work notes
  • Assist patients with releases, fax, mail, website, or drop off.

Patient Transportation

Beaumont Health
Royal Oak, MI
01.2017 - 01.2019
  • Helps patients by transporting them into, around, and out of the health care organization
  • Transport patients by assisting patients on and off beds, stretchers, wheelchairs and moving them to treatment areas, operating areas, and patient rooms, and discharge doors
  • Comforts patients and their families by offering support and encouragement, demonstrating caring and cultural sensitivity
  • Transports deceased patients by following protocols and delivering them to the mortuary
  • Maintain safe, secure and healthy work environment by following standards and procedures.

Call Center, Front Desk

Michigan Orthopaedic Institute
Southfield, MI
01.2016 - 01.2017
  • Verified insurance and coverage for appointment
  • Check patient’s in for appointment and collected balances due/co-pays
  • Checked patient out and scheduled follow-up visit
  • Picked up phone called and scheduled New and return patients with the appropriate physician according to protocol
  • Transfer calls to the appropriate department/staff
  • Enter messages for follow-up calls for MA’s, physician’s and nursing staff.

Senior Medical Records Coordinator and Scheduling Specialist

Center for Advanced Obstetrical Care and Research (Perinatology Research Branch, Wayne State University)
Detroit, MI
01.2009 - 01.2016
  • Assist physicians, nursing staff and patients in coordinating appointments for medical care and procedures
  • Worked as a liaison between patients and medical staff
  • Update medical records with proper documentation including, but not limited to: insurance information, diagnostic codes and services rendered.

Patient Care Coordinator

Metropolitan Orthopedics
Harper Woods, MI
01.2005 - 01.2009
  • Worked closely with patients and physicians to schedule surgeries, independent medical evaluation and follow-up visits
  • Verified insurance and coverage and obtained preauthorizations utilizing medical coding for appropriate diagnoses
  • Updated medical records with patients and medical staff
  • Collaborated with physicians and nursing staff to ensure that patients received multidisciplinary care post-operatively including, but not limited to: setting up home health care, physical therapy and DME
  • Communicated patient needs to private insurance companies and Medicare
  • Reviewed, organized and submitted appropriate documentation from medical records to insurance companies, home health agencies and medical equipment providers
  • Assisted the billing department with front-end billing edits, audits and submissions.

Education

Associates in General Education -

Oakland Community College
01.2013

Pursuing B.S. Health Administration with emphasis on Health Management -

Oakland University

Skills

  • Able to handle multiple assignments under high pressure and excel in meeting deadlines
  • Superior time management and organization skills
  • Excellent written and oral interpersonal communication skills
  • Detail oriented
  • Exceed standards in customer service
  • Highly motivated and able to work independently as well as part of a team
  • Dedicated with a positive attitude

Timeline

Customer Service Advocate II

Centene
05.2022 - Current

Infant Lead Teacher

Little Leaders Academy
08.2021 - 04.2022

Medical Records Coordinator

Michigan Orthopaedic Surgeons
01.2019 - 01.2019

Patient Transportation

Beaumont Health
01.2017 - 01.2019

Call Center, Front Desk

Michigan Orthopaedic Institute
01.2016 - 01.2017

Senior Medical Records Coordinator and Scheduling Specialist

Center for Advanced Obstetrical Care and Research (Perinatology Research Branch, Wayne State University)
01.2009 - 01.2016

Patient Care Coordinator

Metropolitan Orthopedics
01.2005 - 01.2009

Associates in General Education -

Oakland Community College

Pursuing B.S. Health Administration with emphasis on Health Management -

Oakland University

Similar Profiles

CREATE PROFILE
Tonya Prekaj