Tykeda Kellam
Rockmart,GA
Summary
Tech-savvy and smart professional equipped with experience in medical environments and top-notch administrative skills. Works great with colleagues and maintains strong patient relations. Excels at following procedures and independently handling common questions and concerns. Hardworking medical administrative professional offers great people skills, organized file management and deep understanding of patient protections. Enhances office operations by staying on top of patient and staff needs. Experience with electronic recordkeeping and insurance documentation. Skilled administrative team member with in-depth understanding of medical standards, compliance requirements and operational procedures. Practiced problem-solver with friendly and caring mentality and excellent communication skills. Expertise in inventory management, customer service and inner-office operations.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Care Review Processor
MOLINA
Remote
12.2021 - 06.2024
- Facilitates department workflow by supporting clinical team with various care coordination workflows
- Locates community services and other referral locations for enrollees, arranges access to care, supports communication with hospitals, and providers
- Provides non-clinical support to workflows involving utilization management, case management, disease management, and health promotion
- Troubleshoots when an appropriate provider, type of service, or appropriate level of care cannot be readily found
- Has current knowledge or researches availability of community resources and services and link members to appropriate services
- May assist in transitions in care for hospitalized patients and makes appropriate placements, if needed
- Assumes responsibility for self-development and career progression
- Proactively seeks and participates in ongoing training (formal and informal) in all aspects of the Care Worker role
- Assists in the mentoring and training of new Care Workers
- Remains responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers
- Coordinates and manages distribution of correspondence and materials to enrollees and providers
- Participates in operational activities, including data collection, tracking, and analysis
Care Worker
MAGELLAN/MOLINA
Remote
08.2021 - 12.2021
- Facilitates department workflow by supporting clinical team with various care coordination workflows
- Locates community services and other referral locations for enrollees, arranges access to care, supports communication with hospitals, and providers
- Provides non-clinical support to workflows involving utilization management, case management, disease management, and health promotion
- Troubleshoots when an appropriate provider, type of service, or appropriate level of care cannot be readily found
- Has current knowledge or researches availability of community resources and services and link members to appropriate services
- May assist in transitions in care for hospitalized patients and makes appropriate placements, if needed
- Assumes responsibility for self-development and career progression
- Proactively seeks and participates in ongoing training (formal and informal) in all aspects of the Care Worker role
- Assists in the mentoring and training of new Care Workers
- Remains responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers
- Coordinates and manages distribution of correspondence and materials to enrollees and providers
- Participates in operational activities, including data collection, tracking, and analysis
Prescription Drug Plan Customer Service Rep
ANTHEM INC
Remote
04.2021 - 08.2021
- Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims
- Assisting customers with open enrollment
- Analyzes problems and provides information/solutions
- Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database
- Thoroughly documents inquiry outcomes for accurate tracking and analysis
- Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner
- Researches and analyzes data to address operational challenges and customer service issues
- Provides external and internal customers with requested information
- Under immediate supervision, receives and places follow-up telephone calls
- Uses computerized systems for tracking, information gathering and troubleshooting
- Seeks, understands and responds to the needs and expectations of internal and external customers
- Required to meet department goals
- Answered customer inquiries and provided accurate information regarding products and services.
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Performed administrative tasks such as filing paperwork, updating databases and generating reports.
- Resolved complex problems by working with other departments to provide solutions that meet customer needs.
- Developed strong relationships with customers by providing personalized assistance and support.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
Prescription Drug Plan Customer Service Rep
APPLEONE
Glendale, CA
11.2020 - 04.2021
- Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims
- Assisting customers with open enrollment
- Analyzes problems and provides information/solutions
- Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database
- Thoroughly documents inquiry outcomes for accurate tracking and analysis
- Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner
- Researches and analyzes data to address operational challenges and customer service issues
- Provides external and internal customers with requested information
- Under immediate supervision, receives and places follow-up telephone calls
- Uses computerized systems for tracking, information gathering and troubleshooting
- Seeks, understands, and responds to the needs and expectations of internal and external customers.
Tech Support Advisor
IBEX GLOBAL SOLUTIONS
Hampton, VA
08.2020 - 10.2020
- Carefully listen to and understand customer issues
- Probe and isolate issue causes
- Utilize available resources to identify appropriate solutions for issues with smartphones, smart watches, air pods (all versions), and iPads
- Explain product features and benefits, answering questions and setting proper expectations for customer inquiries
- Ensure customer satisfaction through effective call resolution
- Identify and escalate emerging product or customer dissatisfaction issues.
Transaction Processor ll
CONDUENT
Chesapeake, VA
02.2018 - 08.2020
- Handling and processing highly confidential documentation in inbound and outbound mail
- Demonstrating special attention to details
- Scanning documents using a high capacity scanner
- Having the ability to communicate appropriate options for resolution in a timely manner
- Strong use of computer skills in Microsoft Office, Windows, Pass, and Internet Explorer
- Checks processing systems
- Identifying documents and their purpose to crate a database of information
- Processing documents by following internal processes and identifying any gaps in required information.
Benefits Admin Sr. Associate
CONDUENT
Chesapeake, VA
09.2017 - 02.2018
- Taking inbound calls making benefit elections for clients
- Health and welfare employee benefit plans including but not limited to: Medical, dental, prescription plan, life insurance, AD&D, and LTD enrollments and changes; COBRA process, as well as the cost of associated premiums
- Transferring calls
- Navigating different programs to assist participants with self-service portal navigation
- Respond to telephone inquiries and complaints using standard scripts and procedures while gathering information, researching/resolving inquiries, and logging customer calls
- Handling payroll calls when needed.
Cashier
HOME DEPOT
Virginia Beach, VA
02.2016 - 10.2017
- Checking out customers in a retail warehouse
- Providing the most convenient customer service
- Cash handling
- Opening credit accounts
- Making payments on accounts
- Brief stocking
- Making coffee
- Cleaning when needed.
MetLife Disability Claims Processor
SUTHERLAND GLOBAL
Chesapeake, VA
07.2017 - 09.2017
- Effectively and independently manages an assigned caseload of the most complex claims which consists of pending, ongoing/active, and appeal reviews
- Provided timely, balanced, and accurate claims reviews, documentation, and recommended decisions in a time-sensitive and fast-paced environment and in accordance with state and department of insurance regulations
- Provided frequent, proactive correspondence with our claimants and/or their representatives demonstrating empathy and active listening while providing clear updates, direction, and explanations regarding the claim process, benefits, and other pertinent plan provisions correspondence used to gather essential details regarding medical conditions and treatment, occupational demands, financial information, and any other information that may be pertinent to the evaluation of the claim.
- Reviewed and verified insurance policy information to assess coverage and determine appropriate claims processing procedures.
- Analyzed and evaluated claim forms, medical reports, bills, and other documents to ensure accuracy of data.
- Processed a high volume of incoming claims in accordance with established policies and procedures.
- Applied knowledge of coding systems such as CPT-4 and HCPCS codes for proper reimbursement.
- Documented decisions on each claim based on research findings and applicable benefit plans.
- Corresponded with providers regarding any missing or incomplete documentation needed for successful adjudication of claims.
- Assisted customers via telephone inquiries related to their specific claim status or general questions about the company's services.
- Reconciled payment discrepancies between provider statements and remittance advice from payers.
- Performed quality assurance reviews on completed work to ensure compliance with standards.
- Managed escalated customer complaints pertaining to denied or delayed payments in a timely manner.
- Updated job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
- Verified claim data correctness in preparation for processing.
- Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
- Researched medical claims for validity to resolve discrepancies.
- Built rapport and trust with injured insureds through effective customer service techniques which involved fair and prompt processing of claims.
Assistant Manager
CHECK INTO CASH
Virginia Beach, VA
08.2016 - 02.2017
- Answering phone calls
- Making courtesy and collection calls
- Opening LOCs
- Opening title loans
- Putting liens on vehicles
- Cashing checks
- Selling money orders
- Creating folders
- Cash handling
- Filing
- Night deposits
- Draw balancing
- Accepting payments
- Western Unions
- Light cleaning of office space.
- Provided guidance and support to junior staff members on daily tasks, projects, and objectives.
- Assisted in the development of operational strategies to ensure efficient and productive operations.
- Managed customer service inquiries and complaints in a timely manner.
- Maintained up-to-date knowledge of company products and services.
- Supervised daily operations including scheduling shifts, assigning duties.
- Delegated daily tasks to team members to optimize group productivity.
- Collaborated with store manager to develop strategies for achieving sales and profit goals.
- Assisted supervisor in evaluating employee performance and cultivating improvement initiatives.
- Completed thorough opening, closing and shift change functions to maintain operational standards each day.
- Resolved customer inquiries and complaints requiring management-level escalation.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
Substitute Teacher
NORTHAMPTON PUBLIC SCHOOLS
Machipongo, VA
09.2011 - 02.2016
- Following lessons plans
- Assuming responsibility for the entire class while the teacher is absent.
Education
AAS - Early Childhood Education
Eastern Shore Community College
Melfa, Virginia12.2013
Advanced Studies Diploma -
Northampton High School
Eastville, Virginia12.2005
Skills
- Basic Office Skills
- Strong computer literacy
- Microsoft Office
- Typing
- Strong customer service skills
- Good organizational skills
- Hands on experience with the care of elderly adults and those of a vulnerable population
- Empathetic
- Sympathetic
- Healthcare Savvy
- HIPAA
- Medical Terminology
- Enrollment
- Eligibility
- Member Services
- Provider Relations
- Patient Advocacy
- Medical Claims
- Disability Claims
- Explanation of Benefits
- Insurance Verification
- Utilization Management
- Pre-Authorization
- Patient Account and Billing
- Documentation Review
- Payment Processing
- Problem Solving
- Strong Analytical and Critical Thinking
- Account Management
- Strong Math/Accounting Skills
- Leadership Skills
- Fast Learner
- Attention to Detail
- Active Listening
- Calm Under Pressure
- Communication Skills
- Interpersonal Skills
- Troubleshooting and Tech Savvy
- Multi-Tasking
- Professionalism
- Phone Etiquette
- Diverse
- CRM Systems
- Soft Phone Skills
- Navigational Skills
- Health Care Plans
- Care Management
- Case Management
- COBRA
- Reviewing and Processing Invoices
- Credentialing Skills
- Electronic Medical Records
- Appeals and Denials
- Benefits Calculations
- Data Entry
- Medical Coding
- Documentation and Recordkeeping
- Electronic Recordkeeping
- Current Procedural Terminology (CPT)
- Calendar and Appointment Management
- Certified Medical Administrative Specialist
- Detail-Oriented
- Verbal and Written Communication
- Bookkeeping
- Administrative Support
- Relationship Building
- Data Management
- Database Administration
- HIPAA Compliance
- Problem-Solving
- Office Management
- Organization and Time Management
- Data Entry Software
- Computer Proficiency
- Patient Billing
Certification
Associate in Applied Science, 05/2013
Timeline
Care Review Processor
MOLINA
12.2021 - 06.2024
Care Worker
MAGELLAN/MOLINA
08.2021 - 12.2021
Prescription Drug Plan Customer Service Rep
ANTHEM INC
04.2021 - 08.2021
Prescription Drug Plan Customer Service Rep
APPLEONE
11.2020 - 04.2021
Tech Support Advisor
IBEX GLOBAL SOLUTIONS
08.2020 - 10.2020
Transaction Processor ll
CONDUENT
02.2018 - 08.2020
Benefits Admin Sr. Associate
CONDUENT
09.2017 - 02.2018
MetLife Disability Claims Processor
SUTHERLAND GLOBAL
07.2017 - 09.2017
Assistant Manager
CHECK INTO CASH
08.2016 - 02.2017
Cashier
HOME DEPOT
02.2016 - 10.2017
Substitute Teacher
NORTHAMPTON PUBLIC SCHOOLS
09.2011 - 02.2016
Associate in Applied Science, 05/2013
AAS - Early Childhood Education
Eastern Shore Community College
Advanced Studies Diploma -
Northampton High School
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