Tyeisha Jefferson
Summary
To contribute to your organization’s success through the use of exceptional customer service, healthcare, and people skills. I am passionate about helping patients, assisting in managing health-related conditions. Knowledgeable about patient care. Well-organized and compassionate with good relationship-building skills.
Overview
18
18
years of professional experience
Work History
Contact Tracer
Christian Community Health Center
Chicago, IL
11.2023 - Current
- Provided comprehensive training to new employees as Contact Tracers, Patient Service Representatives, and Patient Access Representatives
- Tracked monitored, and scheduled follow up appointments for patients recently discharged from hospital.
- Supported patients throughout their transition to care while effectively managing and coordinating patient health information across the organization.
- Reviewed medical records to identify and gather necessary data for HEDIS measures.
- Conducted outbound calls to providers in order to obtain additional information needed for accurate reporting of HEDIS measure results.
- Analyzed data from multiple sources such as EMRs, claims systems, and other external databases to ensure accuracy of reported metrics.
- Processed incoming medical records requests and payments
- Processed requests for copies of patient medical files within designated timeframes.
Patient Service Representative
Chicago Family Health Center
Chicago, IL
01.2020 - 05.2022
- Registers patients; obtains demographic and insurance information; verifies insurance coverage, collects co-pays, deductibles, and previous balances; posts payments and updates demographic and insurance information
- Greets patients and visitors and responds to routine requests for information
- Serves as a liaison between patients and medical support staff
- Schedules patient appointments and coordinates cancellations, reschedules, and additions to schedules
- Updates insurance, financial responsibility and other data when changes or additions occur and communicates to patient as appropriate.
Workers’ Compensation Claims Specialist I
Zurich American Insurance
Schaumburg, IL
10.2015 - 05.2019
- Handle 500 + Workers Compensation claims of moderate to high exposure and complexity within specific limits and authority
- Verifies applicable coverage and liability and medical professionals
- Contacts insured, attorneys, medical facilities and claimants by phone
- Gathers information germane to exposure and Best Practices and acts upon information received
- Provides updates to interested parties based on information contained in the file
- Sets appropriate reserves within authority level
- Answer 50+ inbound calls/faxes/emails approving medical procedures, diagnostic tests such as (MRI, CT scans, PET)
- Documents claim files pursuant to Best Practices
- Recognizes Subrogation and Fraud
- Must meet state license requirements within prescribed timeframe
- Anticipates, recognizes, and responds to customer needs; supports implementation of customer initiatives
- Compares alternatives for solving problems or improving procedures or products and provides recommendations
- Handles designated accounts and multi-party claims.
Medical Intake Coordinator
Zurich American Insurance
Schaumburg, IL
07.2013 - 10.2015
- Interacts with medical professionals and displays excellent organizational skills
- Handling a variety of different states
- Handles Medical Terminology and Electronic Medical records on daily basics
- Deliver exceptional customer service to customers inquiring about various Worker's Compensation cases
- Provide medical providers with vital information to obtain payment of outstanding medical bills
- Assist customers and clients with various claim handling information
- Call out to providers regarding Certification and Denial processes and to obtain additional clinical information
- Refers medical professionals to the appropriate Vendor facilities
- Knowledgeable with in the Utilization Review process
- Input legal and medical information pertaining to Worker's Compensation claims into the systems
- Process closures and incoming e-faxes from several mailbox folders for the pre-certification process of workers comp injuries
- Act as the customer service liaison between the attorney, adjuster, medical provider, nurse case manager, the injured worker and any other party affiliated for the handling and disposition of the claim.
Physician Advisor Coordinator
Zurich American Insurance
Schaumburg, IL
03.2006 - 11.2012
- Coordinate caseloads for Physician Advisors (PA) review Workers Compensation cases
- Document rationale of PA referral and review notes into Mainframe
- Provide physicians and clients with detailed information on the approval or denial of claims
- Implemented tracking controls on medical files removed for review
- Invoice clients for all physician billable hours
- Manage calendars and workflow for 24 staff physicians and nurses where required
- Assist in training new hires on low exposure claims and terminology
- Set-up and input incoming Worker's Compensation claims by daily deadline
- Process confidential claimant information in an appropriate manner
- Administer payment of medical and expense invoices in a timely fashion
- Interact with all levels of management regarding high visible claims.
Education
Medical Assisting Degree -
Olympia College
Basic Life Support (BLS) Certification
Skills
- Athena
- Revenue
- Medicaid System
- Microsoft Word
- Outlook
- Excel
- Lotus Notes
- EZ Access
- Claims Connect
Timeline
Contact Tracer
Christian Community Health Center
11.2023 - Current
Patient Service Representative
Chicago Family Health Center
01.2020 - 05.2022
Workers’ Compensation Claims Specialist I
Zurich American Insurance
10.2015 - 05.2019
Medical Intake Coordinator
Zurich American Insurance
07.2013 - 10.2015
Physician Advisor Coordinator
Zurich American Insurance
03.2006 - 11.2012
Medical Assisting Degree -
Olympia College
Basic Life Support (BLS) Certification
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