Tuesday Bean-Calus
Warren,MI
Summary
Detail-oriented Claim Audit Quality Specialist with over 10 years of healthcare and claims experience. Expertise in auditing, documentation accuracy, and eligibility verification, along with comprehensive knowledge in pharmacy billing and workers' compensation. Effectively reviews pre- and post-payment claims, interprets plan documents, and implements corrective actions to ensure compliance.
Overview
2
2
years of post-secondary education
11
11
years of professional experience
Work History
Realtor
Real Estate One
Metro Detroit
03.2024 - Current
- Communicate effectively with clients, lenders, and title companies to ensure smooth transaction flow and regulatory adherence.
- Review and audit real estate contracts, financial disclosures, and compliance documentation for accuracy and completeness.
- Demonstrated attention to detail and organizational accuracy in processing multi-step transactions, meeting strict deadlines.
- Utilized Microsoft Excel and CRM systems for tracking transactions, reconciling finances, and managing client databases.
- Maintained confidential records, ensuring documentation compliance with state, federal, and company standards.
CNA/Hospice Aid
Connected Hands
Metro Detroit
07.2021 - 05.2023
- Accurately documented patient records, treatments, and care plans in compliance with HIPAA and facility standards.
- Recorded patient vitals, services rendered, and insurance verification data with meticulous attention to detail, supporting accurate patient assessments and care planning.
- Reviewed medical records for accuracy to confirm patient eligibility, service authorization, and plan coverage alignment, ensuring compliance with healthcare regulations.
- Identified discrepancies in charting and collaborated on corrective actions to uphold billing accuracy and quality compliance, enhancing service delivery.
- Excelled in production-driven settings, managing multiple cases while maintaining documentation accuracy and time management.
Claims Adjuster
Progressive Insurance
Remote
07.2021 - 03.2022
- Reviewed pre- and post-payment claims for accuracy and ensured compliance with policy coverage terms, enhancing claims processing integrity.
- Reviewed pre- and post-payment claims for accuracy and compliance with policy coverage terms.
- Verified and analyzed data used in settling claims to validate claims and settlements according to company practices and procedures.
- Communicated with claimants via phone calls, emails, or letters to provide status updates and request additional documentation, fostering transparency and trust.
- Produced audit reports and maintained thorough documentation of findings in Excel-based tracking systems.
- Communicated regularly with claimants via phone calls, emails or letters regarding status updates or additional documentation requests.
- Handled difficult conversations professionally while maintaining composure during high-stress situations.
- Utilized various computer software programs and databases to complete claims analysis.
Lead Pharmacy Technician
Health Choice Pharmacy
Eastpointe, MI
04.2019 - 03.2021
- Coordinated with prescribers, payers, and patients to resolve claim rejections and prior authorization issues, ensuring timely access to medications.
- Verified patient benefits and processed overrides by interpreting healthcare plan documents and formularies, facilitating appropriate medication access.
- Verified that all documents related to prescriptions were completed correctly before submitting them to the pharmacist for review.
- Conducted training sessions for new technicians on departmental procedures and safety protocols. on departmental procedures, policies, processes and safety protocols.
- Supported inventory management by placing orders with vendors to maintain stock levels. management by placing orders with vendors and confirming receipt.
- Prepared bulk medicines by organizing and labeling prescribed medications for pharmacy use. with prescribed medications and affixed labels.
Nursing Assistant
LaJoy Health
Metro Detroit
10.2018 - 03.2020
- Delivered compassionate care to patients across diverse medical settings, fostering a supportive environment for recovery.
- Monitored vital signs, glucose levels, and other indicators of health status regularly.
- Documented patient information in computer systems according to established protocols to ensure accurate and timely care.
- Provided assistance with daily living activities like eating or bathing.
Lead Pharmacy Technician
Meds Direct Pharmacy
Clinton Township, MI
11.2015 - 12.2018
- Processed and audited prescription claims for accuracy and compliance with health plan requirements, ensuring optimal coverage eligibility.
- Processed and audited prescription claims for accuracy, coverage eligibility, and compliance with health plan requirements.
- Trained and mentored new pharmacy technicians in insurance billing procedures and claims adjudication, enhancing team competency in data entry accuracy.
- Utilized Microsoft Excel and pharmacy management systems to track claim adjustments, reconcile payments, and report audit findings.
- Identified errors and collaborated on corrective action plans, driving improvements in claims accuracy and timeliness.
- Communicated effectively with members, providers, and internal departments to resolve discrepancies.
Education
B.S. - Psychology
Central Michigan University
Mount Pleasant, MI 08.2024 - 10.2026
Certificate - Behavioral Studies
Macomb Community College
Warren, MIA.A.S. - Psychology
Macomb Community College
Warren, MISkills
- Real Estate Compliance
- Transaction Management
- Contract Review
- Market Analysis
- Property Eligibility
- Transaction Processing
- Real Estate Software
- CRM Platforms
- Risk Assessment
- Microsoft Office Suite
- EMR/EHR Systems
- Document Verification
- Time Management
- Team Leadership
- Problem-solving
- Attention to Detail
Timeline
B.S. - Psychology
Central Michigan University
08.2024 - 10.2026
Realtor
Real Estate One
03.2024 - Current
CNA/Hospice Aid
Connected Hands
07.2021 - 05.2023
Claims Adjuster
Progressive Insurance
07.2021 - 03.2022
Lead Pharmacy Technician
Health Choice Pharmacy
04.2019 - 03.2021
Nursing Assistant
LaJoy Health
10.2018 - 03.2020
Lead Pharmacy Technician
Meds Direct Pharmacy
11.2015 - 12.2018
Certificate - Behavioral Studies
Macomb Community College
A.A.S. - Psychology
Macomb Community College