Tyeisha Jones
Norcross,GA
Summary
To obtain a position related to my skills and experience in a progressive organization that offers growth and opportunity. Highly-motivated and efficient healthcare professional with passion in working with and providing assistance in diverse populations. Organized Team Leader builds positive rapport, inspire trust and guide teams toward achievement of organizational goals. Strong facilitator adept at working cross-departmentally with co-management and top-level leadership. Excellent trainer and mentor. Experience in scheduling, registration, prior authorization management with intermediate knowledge of CPT and ICD-10 codes. Ability to work independently and under stressful conditions with excel organizational, communication and interpersonal skills. Possess great ability to communicate with insurance companies and patients to assist with or resolve any billing questions and issues. Excellent multi-tasker and flexible team player with an enthusiastic and positive attitude.
Overview
10
10
years of professional experience
7
7
years of post-secondary education
Work History
UM Team Lead
OODA Health/ Cedar
02.2021 - Current
- Supports team manager and performs management duties when manager is absent or out of office
- Provides encouragement to team members, including communicating team goals and identifying areas for new training or skill checks
- Assists management with hiring processes and new team member training
- Interviews potential candidate for job openings within the department
- Ensures adequate coverage by managing Paid Time Off requests
- Manages, edits, and approve the team’s timesheets
- Answers team member questions, helps with team member problems, and oversees team member work for quality and guideline compliance
- Communicates deadlines and sales goals to team members
- Develops strategies to promote team member adherence to company regulations and performance goals
- Conducts team meetings to update members on best practices and continuing expectations
- Generates and shares comprehensive and detailed reports about team performance, mission-related objectives, and deadlines
- Minimizes resource and time losses by addressing employee or production issue directly and implementing timely solutions.
- Evaluates employee skills and knowledge regularly, training and mentoring individuals with lagging skills.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Cross-trains existing employees to maximize team agility and performance.
- Reviewing employee and workflow error trends during client meetings
- Participating in whiteboard session to improve the workflow process
Prior Authorization Specialist
OODA Health/ Cedar
Norcross, GA
10.2020 - 02.2021
- Processed prior authorization rules based on documented guidelines
- Determined whether a prior authorization is complete with appropriate billing/coding requirements and supporting documents
- Transferred medical data from paper formats into computer files or database systems
- Typed in data provided directly from customers
- Verified data by comparing it to source documents
- Retrieve data from the database or electronic files as requested
- Verified eligibility and compliance with authorization requirements for service providers.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
Reimbursement Specialist II
Change Healthcare
08.2019 - 10.2020
- Handled patient and insurance inquiries associated with specific patient accounts, including identification and resolution of billing discrepancies when reviewing the account
- Effectively communicated with inbound and outbound guarantors/patients or insurance companies as to the status of the account and answers questions or inquiries efficiently
- Adheres to HIPAA, PCI, and Change Healthcare Policies; Answers or makes inbound/outbound calls in a fast-paced environment; handles difficult situations while maintaining quality customer service and expected
- Responsible for working self-pay or insurance receivables and related payments for the client
- Effectively work accounts receivable to optimize cash flow and to meet organizational financial goals and objectives
- Established budget plans or payment arrangements with established guidelines and policies
- Accurately documented all follow-up activities pertaining to each specific account in the CHC Workflow tool(s) concisely, completely and/or takes action in the client system as directed.
Client Service Representative
Aerotek
06.2019 - 08.2019
- Answered telephone call inquiries and promote appropriate products and services to customers
- Researched and resolved complaints to ensure customer retention and satisfaction
- Provided excellent customer service by being attentive, respectful and professional at all times; insures understanding of customer request and follows-through as promised
- Verified customer’s account and invoices while staying in compliance with HIPAA and HITECH laws
- Maintained departmental standard of answering and resolving inbound customer service daily
- Assessed method of payment for invoices, initiate processing, may refer to specialist for financial options
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
Authorization Coordinator
Fidelis Care
New York, NY
06.2018 - 05.2019
- Met company’s qualitative and quantitative targets; used a metrics system of 85% productivity, 95% quality, and daily call standard of 70 to 85 calls
- Completed clerical duties related to the processing of Authorization Requests
- Received/Answered up to 80 incoming calls daily, in a call center environment with a 90% productivity and 96% quality
- Verified member plan eligibility and coverage, with subsequent notification to designated staff of eligibility issues;
- Performed extensive phone contact with providers and requesting additional information for review based on Prior
- Authorization requirement protocols where necessary
- Adhered to the established criteria and timeframes for processing urgent authorization or referral requests
- Performed concurrent and retrospective reviews in collaboration with Concurrent Review Nurses and Case
- Managers regarding member authorizations within the scope of their role and responsibilities
- Identified, maintained, and protected sensitive HIPAA information (PHI) and following procedures to ensure the security of such information
Sr. Patient Access Associate
Community Health Center of Buffalo
05.2017 - 06.2018
- Obtained, inputted, and retrieved accurate information into and from the Electronic Medical Record (EMR) system
- Scheduled appointments, completes Pre-Registration tasks, verifies demographic and insurance information, and completes
- Other tasks as needed to ensure claims can be billed accurately in all departments including Pediatrics, Primary
- Care,& Dental
- Coordinated patient and information flow, while maintaining patient confidentiality in compliance with Federal HIPAA laws
- Completed Prior Authorizations and Referrals via fax, mail and portals for several payers
- Explained estimated cost for medical treatments and answered patient questions to promote good understanding of proposed services.
- Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Collaborated with clinical staff to address specific needs and resolves issues associated with efficient service delivery
- Mentored and trained new staff in the admissions department, monitoring the data collected in the admission process for accuracy
- Ensured that all staff members in their department are complying with departmental institutional, and national policies and regulations
- Assessed method of payment for services, initiate processing, may refer to specialist for financial options
- Accurately, professionally, and promptly answered incoming calls, transferred calls, makes outgoing calls, returns missed incoming calls and responds to inquiries as is appropriate
- Effectively communicated with coworkers, managers, clients with the use of memos and secured emails.
Office Assistant
Daemen College
Amherst, NY
10.2012 - 05.2017
- Trained new staff on office procedures
- Efficiently utilized the printer, copier, fax machine and Microsoft Programs
- Answered phone at desks; Communicated effectively with faculty, students, and staff
- Ensured that all program area schedules are completed satisfactorily in a timely manner
- Ensured the maintenance of accurate program and administrative records
Education
MBA - Human Resource Management
Capella University
06.2020 - 09.2022
Bachelor of Science - Health Care Studies
Daemen College
09.2012 - 05.2017
Skills
Microsoft Office (Word, Excel, Access, PowerPoint
Microsoft Outlook
EClinicalWorksEaglesoftSalesforceFacetsEpacesLawsonLockboxMeditechKnowledgeable in [Artiva]
Knowledgeable in [Healthenet]
Knowledgeable in [GUIDING CARE]
Knowledgeable in [Vital]
ICD-10Medical RecordsCPT CodingMedical BillingProduction monitoring
Employee Evaluation
Client Service
Knowledgeable in [Faxcom]
Staff education and training
Performance improvement
Human resources team leadership
Timeline
UM Team Lead
OODA Health/ Cedar
02.2021 - Current
Prior Authorization Specialist
OODA Health/ Cedar
10.2020 - 02.2021
MBA - Human Resource Management
Capella University
06.2020 - 09.2022
Reimbursement Specialist II
Change Healthcare
08.2019 - 10.2020
Client Service Representative
Aerotek
06.2019 - 08.2019
Authorization Coordinator
Fidelis Care
06.2018 - 05.2019
Sr. Patient Access Associate
Community Health Center of Buffalo
05.2017 - 06.2018
Office Assistant
Daemen College
10.2012 - 05.2017
Bachelor of Science - Health Care Studies
Daemen College
09.2012 - 05.2017