Tyona Veley
Rockford,IL
Summary
Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation, with outstanding knowledge of curriculum design and deep understanding of Commercial Claims. Proven success in involving all types of students in remote and in-classroom learning. Effective at getting new employees up to speed quickly and with a full understanding of company policies, procedures and standards. Excellent communication and planning abilities with a forward-thinking approach.
Overview
11
11
years of professional experience
Work History
Claims Supervisor
MedCost, LLC
11.2022 - Current
- Investigated, evaluated and adjusted multi-line claims in accordance with standards and laws.
- Developed strong relationships with external partners such as medical providers, attorneys, and investigators to facilitate effective information exchange during claim investigations.
- Maintained up-to-date knowledge on industry trends, best practices, and regulatory changes to ensure optimal decision-making in claims management process.
- Reduced claim processing time by implementing efficient workflow improvements and streamlining processes.
- Managed diverse caseload, prioritizing tasks effectively to meet strict deadlines and maintain quality standards.
- Increased accuracy in claim evaluations through comprehensive documentation and attention to detail.
- Coordinated resources efficiently during high-volume periods, ensuring seamless operations without compromising service levels.
- Monitored performance metrics regularly, identifying areas for improvement and implementing corrective measures accordingly.
- Reviewed historical records, current operational data and forecasting information to identify and capitalize on system enhancement opportunities.
- Collaborated with various departments to develop and implement strategies for improving overall claims handling process.
- Worked flexible hours across night, weekend, and holiday shifts.
- Worked well in team setting, providing support and guidance.
Training Instructor Supervisor
Argos Health
07.2021 - 08.2022
- Designing and administering training programs
- Evaluated employee skills and knowledge regularly, training and mentoring individuals with lagging skills
- Collaborating with upper management to enhance or change processes or procedures in order to proactively provide improved client support
- Demonstrates knowledge of, and consistently and fairly administers and supports company policies, procedures and guidelines
- Assisted in interviewing and hiring of new candidates
- Planned and implemented daily activities and responsibilities of 18 team members.
Claims Processor, Billing Analyst/Collector
Rosecrance Health Network
12.2019 - 07.2021
- Processed claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements
- Entered claims data into system
- Performed audit of randomly selected claims to ensure quality processing
- Researches claim overpayments and requests funds/Appeals
- Adjudicates UB and CMS1500 claims and adjustments (Medicare, Medicaid, and Commercial LOB)
- Provided timely customer service to members, providers, billing departments and other insurance companies on subject of claims
- Partnered with billing analyst department to investigate and remedy any gross margin trend issues
- Reviewed full history of past due accounts and contacted client or attorney regarding collection, implementation of payment plan or pursuit of legal remedies on unpaid accounts.
Insurance Billing Specialist
AccentCare Inc.
10.2017 - 08.2019
- Initiate billing on assigned claims in expeditious manner, whether through hard copy claims or electronic format
- Maintain control of claims billed and pending to ensure full accountability for all claims
- Submit all necessary level of appeals and maintain documentation of all collection activity
- Work with branch office designee on eligibility issues and necessary documentation to ensure timely collection of accounts
- Kept vendor files accurate and up-to-date to expedite payment processing
- Resolve credit balances on monthly basis and timely submission of refund request documentation to AR Manager
- Reconciled past due accounts achieving 95% reduction in outstanding invoices
- Trained and mentored new team members and managers on accounts payable systems and policies to build cohesive groups and promote operational performance
- Generated financial statements and reports detailing accounts receivable status.
Caregiver
In-Home Health
01.2015 - 06.2018
- Assisted clients with daily living needs to maintain self-esteem and general wellness
- Built strong relationships with clients to deliver emotional support and companionship
- Perform light housekeeping activities such as dusting, sweeping, changing linens and cleaning bathrooms
- Provided transportation to doctor's appointments, grocery stores, salons and barbershops
- Planned healthy meals, purchased ingredients and cooked meals to provide adequate nutrition for client wellbeing.
Medical Billing Specialist/Collector
Air Methods Corporation
08.2016 - 04.2017
- Experience in working aged accounts to reduce and maintenance bad debt
- Follow-up on claims INPT/OUTPT
- Maintains productivity standards and reports
- Responsible to obtain State collection guidelines if applicable
- Medicare, Medicaid, Commercial, and third-party payers (ERISA) for healthcare services collections
- Communication with insurance companies on benefits and balances due
- Responsible for identifying billing denials, claim denials, pricing errors, payments, etc
- Appeals/ Identifies contractual issues that are contrary or inconsistent with contract language
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Developed customized reports for management review, highlighting trends in key performance metrics such as claim denial rates and days outstanding for accounts receivable balances.
Claims Processor II
Inland Empire Health Plan
04.2015 - 04.2016
- Processed claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements
- Resolved problems resulting from claim settlement
- Performed audit of randomly selected claims to ensure quality processing
- Researches claim overpayments and requests funds
- Provided timely customer service to members, providers, billing departments and other insurance companies on subject of claims
- Adjudicates UB, CMS1500, adjustments (Medicare, Medi-Cal, and Commercial LOB)
- Provided timely customer service to members, providers, billing departments and other insurance companies on subject of claims.
Claims Examiner II
Blue Cross Blue Shield of Illinois
10.2012 - 01.2015
- Processed medical claims for Veteran Affairs, Coordinated Home Care, Skilled Nursing Facilities
- Ensured to process assigned claim forms and inspect apt allocation of co-pays, deductibles, reimbursements and co-insurance
- Complied with all judgmental policies and processes to assure appropriate claim payments
- Provided excellent customer service to all providers, members, insurance companies and billing department
- Collaborated with claims department and industry anti-fraud organizations to resolve claims
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Directed claims negotiations within allowable limit of $75k and supported successful litigations for advanced issues.
Education
Associate of Arts -
Rock Valley College
Rockford, IL05.2023
High School Diploma -
Ontario High School
Ontario, CA05.2011
Skills
- Project Management
- Customer Service
- Leadership skills
- Analytical thinking abilities
- Instructor mentoring
- Remote Training
- Training program development
- Proficient in Microsoft Office
- Project implementation
- Data organization
- Public speaking
- Staff Training
Websites
Timeline
Claims Supervisor
MedCost, LLC
11.2022 - Current
Training Instructor Supervisor
Argos Health
07.2021 - 08.2022
Claims Processor, Billing Analyst/Collector
Rosecrance Health Network
12.2019 - 07.2021
Insurance Billing Specialist
AccentCare Inc.
10.2017 - 08.2019
Medical Billing Specialist/Collector
Air Methods Corporation
08.2016 - 04.2017
Claims Processor II
Inland Empire Health Plan
04.2015 - 04.2016
Caregiver
In-Home Health
01.2015 - 06.2018
Claims Examiner II
Blue Cross Blue Shield of Illinois
10.2012 - 01.2015
Associate of Arts -
Rock Valley College
High School Diploma -
Ontario High School
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