Summary
Overview
Work History
Education
Skills
Personal Information
Timeline
Generic

Tonya Roper

Las Vegas,NV

Summary

Dynamic and results-oriented professional with extensive experience in dispute resolution and claims processing. Proven track record of enhancing customer satisfaction and streamlining operations, achieving a 30% improvement in dispute resolution efficiency. Expertise in Health Information Systems, medical terminology, and exceptional negotiation skills drive collaborative problem-solving and operational excellence. Aiming to leverage these skills to further enhance service delivery in a challenging environment.

Overview

23
23
years of professional experience

Work History

Claim Operations Resolution Expert

UnitedHealth Group/Optum
Las Vegas, US
10.2018 - 11.2024
  • Identified required information for resolving claims processing issues.
  • Provided dispute resolution services to clients in a professional and timely manner.
  • Developed, implemented and monitored dispute resolution strategies for the organization.
  • Investigated customer complaints and initiated appropriate corrective actions.
  • Researched, analyzed and resolved complex customer disputes.
  • Coordinated with internal staff to ensure successful resolution of customer issues.
  • Established effective communication channels between customers and company personnel to resolve disputes quickly.
  • Conducted mediation sessions between parties involved in disputes to facilitate understanding of each other's perspectives.
  • Prepared reports on dispute resolutions for management review.
  • Collaborated with legal team to develop litigation strategies when necessary.
  • Assisted customers in filing claims or submitting documents related to their disputes.
  • Reviewed past cases to identify areas needing improvement in dispute resolution processes.
  • Gathered evidence from both sides of the dispute before making recommendations for resolution.
  • Identified potential risks associated with different methods of resolving disputes.
  • Analyzed customer feedback regarding dispute resolution processes.
  • Drafted communications outlining details of settlement agreements between parties.
  • Negotiated settlements between conflicting parties while protecting the interests of both sides.
  • Facilitated meetings between disputing parties to discuss possible solutions.
  • Advised customers on best practices for avoiding future conflicts or disputes.
  • Maintained records of all mediated conversations and proceedings.
  • Participated in seminars, workshops and training programs related to conflict resolution techniques.
  • Monitored compliance with established policies governing dispute resolution procedures.
  • Reported on proposed changes relevant to employee performance enhancement and efficiency boosting.

Physician Billing Specialist-Patient Accounts

Piedmont-Rockdale Hospital CBO
Conyers, US
11.2015 - 05.2018
  • Compiled and imported patient self-pay aging report every month.
  • Examined weekly reports to assess outstanding patient balances.
  • Assisted with inbound patient call inquiries concerning outstanding balances.
  • Conducted out-bound calls to patients to collect outstanding balances.
  • Arranged payment schedules for overdue patient balances in alignment with department policy.
  • Verified and amended patient insurance records for accuracy.
  • Contacted insurance companies to address claim denials.
  • Prepared and sent appeals to insurance company with necessary documentation.
  • Balanced patient account receivables with existing credits.
  • Documented patient accounts in EHR for issuing refund checks.
  • Processed payments from patient credit cards.
  • Resolved billing disputes in coordination with medical practitioners and office personnel.

Senior A/R Clerk

Department of Ob-GYN, Montefiore Medical Center
Bronx, US
05.2013 - 09.2015
  • Reviewed incorrectly processed claims to ensure accuracy and proper handling.
  • Appealed denied claims by submitting supporting documentation.
  • Handled electronic claim resubmissions using various methods including web portals, mail, and fax.
  • Monitored and managed outstanding patient self-pay accounts.
  • Collaborated with third-party collection agency to manage delinquent self-pay accounts.
  • Conducted insurance verifications efficiently via multiple platforms.
  • Handled patient transactions through third-party payment systems.

Client Services Representative

H&R Block
Mount Vernon, US
01.2002 - 04.2013
  • Checked in clients for tax preparation appointments.
  • Coordinated scheduling for optimal client-tax professional alignment.
  • Directed incoming calls to appropriate parties efficiently.
  • Responded to client inquiries about fundamental tax details.
  • Handled financial transactions through POS system.
  • Reconciled end-of-day financial records.
  • Aided in onboarding Client Service Professionals.
  • Executed various administrative duties as delegated.

Education

Some College - Heath Services Management

The College of Westchester
White Plains, NY
09.2015

Diploma - Medical Billing & Coding

Sanford-Brown Institute
White Plains, NY
03.2008

Diploma - Medical Office Assistant

DRAKE BUSINESS SCHOOL
Bronx, NY
06.1997

Skills

  • Proficient in Facets
  • Experienced with Macess Platform
  • Experienced with E-Clinical Works
  • Experienced with EPIC Systems
  • Experienced with IDX Integration
  • Proficient with Health Information Systems
  • Skilled in ICD-10 Classification
  • Experienced in CPT Coding Practices
  • Proficient in Medical Terminology
  • Experienced with Microsoft Word
  • Intermediate Excel Expertise
  • Competent in Outlook Functionality

Personal Information

Work Permit: Authorized to work in the US for any employer

Timeline

Claim Operations Resolution Expert

UnitedHealth Group/Optum
10.2018 - 11.2024

Physician Billing Specialist-Patient Accounts

Piedmont-Rockdale Hospital CBO
11.2015 - 05.2018

Senior A/R Clerk

Department of Ob-GYN, Montefiore Medical Center
05.2013 - 09.2015

Client Services Representative

H&R Block
01.2002 - 04.2013

Some College - Heath Services Management

The College of Westchester

Diploma - Medical Billing & Coding

Sanford-Brown Institute

Diploma - Medical Office Assistant

DRAKE BUSINESS SCHOOL
Tonya Roper