Tre’Verius Hughes
Buckeye,AZ
Summary
Administrative Services professional with an extensive experience in medical record retrieval, data validation, and customer support across healthcare environments. Proven ability to resolve complex issues, maintain data accuracy, and provide exceptional service to diverse clients. Familiar with HEDIS measures and adept at utilizing various systems for efficient operations. Committed to upholding high productivity standards while ensuring compliance with organizational protocols.
Overview
10
10
years of professional experience
Work History
Administrative Services Intermediate
Wollberg Michelson
Buckeye, AZ
11.2023 - Current
- Investigate and resolve data accuracy issues in member medical record retrieval by linking care claims to the correct providers using systems such as Facets, Manifest, Lanes, and SDHC.
- Ensure precise retrieval and validation of medical records, maintaining thorough documentation of interactions.
- Manage medical record requests through JotForm, conducting provider outreach to verify contact information.
- Prepare, send, and follow up on fax packets, adhering to secure communication and productivity standards.
- Conduct initial research for contact verification and flag locations as needed in QMRM chases.
Customer Care Claims Specialist
TriWest Healthcare Alliance
Phoenix, Arizona
01.2024 - 08.2024
- Delivered customer service supporting Veteran care within the Community Care Network, addressing inquiries on medical and behavioral health authorizations.
- Resolved eligibility and account discrepancies through detailed account research and reviews.
Customer Care Specialist
Reed Group
Westminster, Colorado
12.2020 - 06.2022
- Managed leave of absence claims, overseeing timely initiation and follow-up while assisting individuals via multiple communication channels.
- Processed Short-Term Disability claims, enhancing expertise in disability and leave management.
Senior Collections Specialist
Target financial.
Tempe, Arizona
11.2019 - 12.2020
- Handled account inquiries and negotiated payment plans with delinquent account holders, using problem-solving skills to resolve credit discrepancies.
- Verified billing accuracy, maintaining a customer-focused approach to improve call experience.
Customer Care Specialist
Shamrock Foods
Phoenix, Arizona
12.2018 - 11.2019
Quality Assurance Analyst
Community Bridges Inc.
Mesa, Arizona
04.2015 - 01.2017
- Collected and entered demographic and medical data into electronic systems, ensuring thorough documentation for patient records.
- Organized patient medical records and prepared clinical documentation for healthcare professionals.
Education
Some College (No Degree) -
Ashford University
San Diego, CASkills
- Medical Record Retrieval & Data Validation
- HEDIS Measures Knowledge
- Customer Service Excellence
- Problem-Solving & Conflict Resolution
- Data Entry & Documentation
- Effective Communication
- Research & Verification
- System Proficiency: Facets, Manifest, Lanes, SDHC, JotForm
Timeline
Customer Care Claims Specialist
TriWest Healthcare Alliance
01.2024 - 08.2024
Administrative Services Intermediate
Wollberg Michelson
11.2023 - Current
Customer Care Specialist
Reed Group
12.2020 - 06.2022
Senior Collections Specialist
Target financial.
11.2019 - 12.2020
Customer Care Specialist
Shamrock Foods
12.2018 - 11.2019
Quality Assurance Analyst
Community Bridges Inc.
04.2015 - 01.2017
Some College (No Degree) -
Ashford University