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, NY09.2015
Diploma - Medical Billing & Coding
Sanford-Brown Institute
White Plains, NY03.2008
Diploma - Medical Office Assistant
DRAKE BUSINESS SCHOOL
Bronx, NY06.1997
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
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