Tonya Winter
Deary,ID
Summary
Dynamic and detail-oriented professional with extensive experience at Cambia Health Solutions, excelling in problem-solving and customer service. Proven ability to enhance team collaboration and maintain HIPAA compliance while managing databases. Recognized for effectively resolving issues and promoting high customer satisfaction through excellent communication and organizational skills.
Overview
25
25
years of professional experience
1
1
Certification
Work History
CSP III
Cambia Health Solutions
Lewiston, ID
08.2021 - Current
- Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Assisted with customer requests and answered questions to improve satisfaction.
- Updated and maintained databases with current information.
- Completed day-to-day duties accurately and efficiently.
- Identified needs of customers promptly and efficiently.
Certified Medical Assistant
Gritman Medical Center
Moscow, ID
01.2019 - 08.2021
- Assisted in minor surgical procedures such as suturing lacerations or removing stitches under the direction of a physician.
- Educated patients on preventive care topics such as diet and exercise habits or medication compliance.
- Obtained insurance authorizations for prescribed medications or treatments for patients in need of financial assistance programs.
- Assisted physicians and nurses with patient exams, including taking vital signs, preparing exam rooms, and updating medical records.
- Ensured that all equipment was functioning correctly prior to use during patient examinations or treatments.
- Collected urine samples from patients for drug screens or pregnancy tests when necessary.
- Maintained patient confidentiality in accordance with HIPAA regulations.
- Prepared specimens for laboratory testing and performed routine laboratory tests.
- Managed inventory of medical supplies ensuring adequate stock levels were maintained at all times.
- Administered injections under the direction of a physician or nurse practitioner.
- Ordered medical supplies from approved vendors based on predetermined budget parameters.
- Conducted diagnostic tests such as EKGs or hearing screenings in accordance with established protocols.
- Maintained cleanliness in examination rooms by stocking supplies and disposing of used materials properly.
- Performed clerical tasks such as transcribing dictation from physicians or coding patient information into electronic databases.
- Assisted with scheduling patient appointments and follow-up visits.
- Monitored lab results for accuracy and alerted physicians immediately if any abnormalities were detected.
- Provided support to patients by helping them fill out forms and answering their questions about health care services.
Certified Medical Assistant
Pullman Medical Center
Pullman, WA
09.2017 - 01.2019
- Assisted in minor surgical procedures such as suturing lacerations or removing stitches under the direction of a physician.
- Educated patients on preventive care topics such as diet and exercise habits or medication compliance.
- Obtained insurance authorizations for prescribed medications or treatments for patients in need of financial assistance programs.
- Assisted physicians and nurses with patient exams, including taking vital signs, preparing exam rooms, and updating medical records.
- Ensured that all equipment was functioning correctly prior to use during patient examinations or treatments.
- Provided support to physicians during consultations by recording patient histories accurately and documenting treatment plans accordingly.
- Collected urine samples from patients for drug screens or pregnancy tests when necessary.
- Maintained patient confidentiality in accordance with HIPAA regulations.
- Prepared specimens for laboratory testing and performed routine laboratory tests.
- Managed inventory of medical supplies ensuring adequate stock levels were maintained at all times.
- Administered injections under the direction of a physician or nurse practitioner.
- Conducted diagnostic tests such as EKGs or hearing screenings in accordance with established protocols.
Medical Assistant
Lewiston Orthopedics
Lewiston, ID
10.2016 - 09.2017
- Educated patients on healthcare topics such as nutrition and disease prevention methods.
- Provided assistance to medical staff in performing minor surgical procedures.
- Answered phones, scheduled appointments and managed patient flow while greeting visitors in a professional manner.
- Ordered medical supplies, maintained inventory logs and restocked exam rooms when needed.
- Kept examination rooms clean, stocked with necessary supplies and prepared for incoming patients.
- Assisted physicians with patient care by taking vital signs, patient histories and preparing patients for examinations.
- Assisted with pre-operative preparation of patients including providing instruction about post-operative care plans.
- Maintained accurate medical records through filing, charting, transcription and data entry into electronic health record system.
- Adhered to HIPAA regulations regarding safeguarding confidential patient information at all times.
- Documented notes during patient visits.
- Cleaned and maintained medical equipment following procedures and standards.
- Interviewed and engaged patients to obtain medical history, chief complaints and vital signs.
Prior Authorization Specialist
St. Mary's Hospital for Children
Cottonwood, ID
05.2012 - 10.2016
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Educated healthcare professionals on how to properly submit a request for pre-authorization.
- Collaborated with internal staff members to resolve discrepancies or issues related to prior authorizations.
- Assisted with developing policies and procedures related to prior authorizations.
- Facilitated communication between providers, payers and health plans regarding prior authorization processes.
- Conducted quality assurance audits of prior authorization processes according to established standards.
- Advised provider offices on proper coding practices that are necessary for successful claim submission.
- Ensured compliance with state and federal regulations pertaining to prior authorizations.
- Researched clinical criteria and determined eligibility for requested services based on plan provisions.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Developed relationships with external vendors providing pre-authorization services.
- Identified areas where improvements can be made within the department by analyzing trends in denials and approvals.
Office Coordinator
Syringa Therapy Services
Grangeville, ID
09.2007 - 05.2012
- Supported other teams with various administrative tasks when required.
- Provided administrative support for all departments in the organization as necessary.
- Processed invoices and coded documents according to company procedure standards.
- Coordinated office operations and procedures to ensure organizational effectiveness and efficiency.
- Maintained office supplies inventory by checking stock to determine inventory level; anticipating needed supplies; evaluating new office products; placing and expediting orders for supplies.
- Greeted visitors and directed them to the appropriate area or person.
- Compiled data, tracked changes, and created reports in Excel spreadsheets.
- Supported internal team members with technical knowledge, operational support and exemplary customer service.
- Organized workloads to streamline tasks and efficiently oversee day-to-day operations under tight deadlines.
- Maintained up-to-date knowledge of healthcare reimbursement policies, regulations, and industry trends.
- Determined medical necessity of requested services by reviewing patient records and corresponding with providers as needed.
- Facilitated resolution between providers, payers, patients, and internal staff on matters related to prior authorizations.
- Collaborated with providers to obtain missing information required for authorization submissions.
- Reviewed and processed prior authorization requests according to insurance guidelines.
- Researched payer coverage policies, procedures, and requirements.
- Scheduled patient appointments, diagnostic specialty appointments, tests and procedures.
Medical Assistant
Mountain States Medicine
Grangeville, ID
10.2000 - 09.2007
- Organized patient charts before each day's clinic sessions began.
- Educated patients on healthcare topics such as nutrition and disease prevention methods.
- Conducted EKGs, spirometry testing, audiograms and other diagnostic tests as requested by the physician.
- Assisted with pre-operative preparation of patients including providing instruction about post-operative care plans.
- Kept examination rooms clean, stocked with necessary supplies and prepared for incoming patients.
- Adhered to HIPAA regulations regarding safeguarding confidential patient information at all times.
- Answered phones, scheduled appointments and managed patient flow while greeting visitors in a professional manner.
- Prepared laboratory specimens for analysis and organized lab results for review by the physician.
- Ordered medical supplies, maintained inventory logs and restocked exam rooms when needed.
- Assisted physicians with patient care by taking vital signs, patient histories and preparing patients for examinations.
Education
Some College (No Degree) - Health Informational Technology Professional
North Idaho College
Couer D Alene, IDSkills
- Database management
- HIPAA compliance
- Customer service
- Team collaboration
- Problem solving
- Attention to detail
- Effective communication
- Time management
- Analytical and critical thinking
- Excellent communication
- Organizational skills
- Dependable and responsible
Certification
- ASCP Phlebotomy Technician
- HITPRO Certification
- Certified Medical Assistant (currently expired but can renew)
Timeline
CSP III
Cambia Health Solutions
08.2021 - Current
Certified Medical Assistant
Gritman Medical Center
01.2019 - 08.2021
Certified Medical Assistant
Pullman Medical Center
09.2017 - 01.2019
Medical Assistant
Lewiston Orthopedics
10.2016 - 09.2017
Prior Authorization Specialist
St. Mary's Hospital for Children
05.2012 - 10.2016
Office Coordinator
Syringa Therapy Services
09.2007 - 05.2012
Medical Assistant
Mountain States Medicine
10.2000 - 09.2007
Some College (No Degree) - Health Informational Technology Professional
North Idaho College
Similar Profiles
Tara ClineTara Cline
Claims Production Specialist-Contract at Cambia Health SolutionsClaims Production Specialist-Contract at Cambia Health Solutions
Michael BrownMichael Brown
Documentation Specialist II at Cambia Health SolutionsDocumentation Specialist II at Cambia Health Solutions
Mary AndersonMary Anderson
Customer and Provider Service Ambassador at Cambia Health SolutionsCustomer and Provider Service Ambassador at Cambia Health Solutions
Gracey CoulterGracey Coulter
Manager & Bartender at My Office Bar & GrillManager & Bartender at My Office Bar & Grill
David PeckhamDavid Peckham
Delivery Driver at Swift TransportationDelivery Driver at Swift Transportation