Twinquitta Gallons
Ocala,FL
Summary
Energetic and analytical professional with a keen eye for detail and a passion for uncovering insights. Possesses a solid foundation in data analysis and statistical methods, along with proficiency in Excel and SQL. Committed to driving data-driven decisions and delivering actionable recommendations.
Overview
11
11
years of professional experience
Work History
Provider Payment Recon Analyst I
Elevance Health
12.2022 - Current
- Company Overview: Anthem Inc
- Review EOB and medical records, making informed decisions on claim approvals or denials
- Resolve claim payment issues for all claim functions, achieving measurable improvements in processing efficiency
- Drive efficient claim resolution through thorough investigations, implementing targeted actions that lead to measurable improvements in processing
- Anthem Inc
- Managed multiple projects simultaneously while adhering to strict deadlines and quality standards.
- Reduced errors in data entry, instituting rigorous quality control checks.
Front Desk Scheduler
Advent Health
06.2022 - 11.2023
- Streamlined communication processes, managing high-volume calls and correspondence to enhance operational efficiency for medical staff
- Coordinated with insurance companies to secure prior authorizations, facilitating seamless patient care and reducing treatment delays
- Maintained meticulous medical records and technical library, ensuring accurate and up-to-date information accessibility for healthcare providers
- Organized essential documents to maintain an efficient filing system for easy access to records when required.
Medical/ Dental Claims Representative III (Promotion)
Anthem Inc.
12.2021 - 12.2022
- Transmitted correspondence and medical claim copies via right fax, ensuring timely delivery
- Processed medical, short term, home health, and dental claims in a high-volume environment, maintaining accuracy and efficiency
- Reviewed high dollar claims and coordinated with third-party reviewers to ensure proper payment issuance
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
Medical/ Dental Claims Representative II (Promotion)
Anthem Inc.
12.2020 - 12.2021
- Processed inpatient claims with precision, balancing workload across departments
- Manually priced claims per agreements, coordinating benefits effectively
- Consistently exceeded quality metrics and performance targets, earning recognition for outstanding achievements in claims processing efficiency
- Meticulously reviewed complex medical and dental claims, ensuring accuracy in pricing and benefit coordination to minimize errors and disputes
- Collaborated with cross-functional teams to expedite complex claims investigations and resolutions.
Medical/ Dental Claims Representative I
Anthem Inc.
12.2019 - 12.2020
- Evaluate and process medical/dental claims, ensuring adherence to company guidelines and maintaining high-quality standards in remote work environment
- Meticulously review claims for authorization and coordination of benefits requirements, contributing to accurate and efficient claim processing
- Consistently achieve 100% quality rating through diligent application of daily quality checks and performance metrics
- Conducted detailed assessments of claims documents, ensuring accuracy and completeness before submission for approval.
Physician Support Specialists
Tampa General Medical Group
06.2016 - 12.2019
- Streamlined communication processes, managing high-volume calls and correspondence to enhance operational efficiency for medical staff
- Coordinated with insurance companies to secure prior authorizations, facilitating seamless patient care and reducing treatment delays
- Maintained meticulous medical records and technical library, ensuring accurate and up-to-date information accessibility for healthcare providers
- Improved patient outcomes by developing comprehensive treatment plans tailored to individual needs.
DME/ Medical Intake Operations Coordinator
WellCare
07.2015 - 03.2016
- Used online tools to ascertain authorization requirements based on service type, location, and provider details
- Analyzed authorization requests, determining appropriate handling for inpatient and outpatient cases while ensuring compliance with eligibility and network policies
- Simplified authorization process, balancing customer service with operational efficiency, leading to improved provider satisfaction and reduced processing times
- Contributed to the development of departmental policies and procedures ensuring consistency across the organization.
Customer Service Representative - Call Center
Anthem Inc.
02.2014 - 07.2015
- Established contact with internal and external customers, ensuring clear communication
- Resolved routine product or service issues via inbound and outbound calls, enhancing customer satisfaction
- Clarified customer requirements, ensuring accurate and complete updates to customer files
- Verified new member enrollments through carrier calls, ensuring data accuracy
- Exceeded performance metrics consistently, earning recognition as a top performer within the team.
Education
Bachelors of Health Science - Health Administration
University of Phoenix
Online01.2025
Associate of Health Sciences Degree - Health and Human Services
Ultimate Medical Academy
Online01.2019
Diploma - Medical Administrative Assistant
Ultimate Medical Academy
Online01.2013
HS Diploma - Allied Health
D. W. Waters Career Center
Tampa, FL01.2009
Skills
- Microsoft office
- MS Excel
- Time management
- Attention to detail
- Documentation and reporting
- Critical thinking
- Data research and validation
- Decision-making
- Data processing
- Process improvements
- Compliance analysis
- Strategic planning
- Multiple priorities management
Timeline
Provider Payment Recon Analyst I
Elevance Health
12.2022 - Current
Front Desk Scheduler
Advent Health
06.2022 - 11.2023
Medical/ Dental Claims Representative III (Promotion)
Anthem Inc.
12.2021 - 12.2022
Medical/ Dental Claims Representative II (Promotion)
Anthem Inc.
12.2020 - 12.2021
Medical/ Dental Claims Representative I
Anthem Inc.
12.2019 - 12.2020
Physician Support Specialists
Tampa General Medical Group
06.2016 - 12.2019
DME/ Medical Intake Operations Coordinator
WellCare
07.2015 - 03.2016
Customer Service Representative - Call Center
Anthem Inc.
02.2014 - 07.2015
Bachelors of Health Science - Health Administration
University of Phoenix
Associate of Health Sciences Degree - Health and Human Services
Ultimate Medical Academy
Diploma - Medical Administrative Assistant
Ultimate Medical Academy
HS Diploma - Allied Health
D. W. Waters Career Center
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