Tyra Woods
Mebane,NC
Summary
Personable and dedicated Customer Service Representative with extensive experience in healthcare industry. Solid team player with upbeat, positive attitude and proven skills in establishing rapport with patients,clients, medical professionals. Motivated to maintain customer satisfaction and contribute to company success. Results-oriented with demonstrated passion for helping others, building relationships.
Overview
16
16
years of professional experience
Work History
Sr. Reimbursement Specialist
Insight Global
Orlando, FL
05.2023 - 05.2024
- Prevented delays and claim denials by correcting information prior to submission.
- Guided office staff on how to effectively complete prior authorization forms and appeals documentation to achieve positive results.
- Followed up on denied and unpaid claims to resolve problems and obtain payments.
- Monitored and documented accounts receivable trends and account-specific profitability.
- Delivered timely information to insurance representatives to resolve common and complex issues.
- Created documents in accordance with payer guidelines and submitted to appropriate parties.
- Helped minimize escalations by reaching out to clients in advance of expected problems.
- Built proactive, client-specific edits into system to prevent future denials.
- Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
- Verified client information by analyzing existing evidence on file.
- Maintained confidentiality of patient finances, records, and health statuses.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Coordinated with contracting department to resolve payer issues.
- Checked documentation for accuracy and validity on updated systems.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Notified insurance agents and accounting departments of policy cancellations and changes.
HR Assistant I
Spectraforce Technologies Inc.
Burlington, NC
10.2022 - 02.2023
- Fielded employee inquiries related to insurance, pension plan, vacation, sick leave and employee assistance.
- Advocated for staff members, helping to identify and resolve conflicts.
- Administered employee benefits programs and assisted with open enrollment.
- Improved organizational filing systems for confidential employee records, resulting in improved accessibility and efficiency.
- Completed human resource operational requirements by scheduling and assigning employees.
- Collected and analyzed information to monitor compliance outcomes and identify and address trends of non-compliant behavior.
- Improved office efficiency by effectively managing internal communications and correspondence.
- Collaborated with managers to identify and address employee relations issues.
- Developed and implemented onboarding and orientation programs for new employees.
- Maintained personnel records and statistical data to establish accuracy and compliance with applicable regulations.
HR Assistant I
Talent Burst, Inc.
Natick, MA
03.2022 - 07.2022
- Documented human resources records and maintained confidentiality of sensitive personal information.
- Responded to inquiries by answering telephone calls, in-person questions and emails.
- Updated Human Resources Information System (HRIS) database, maintained data accuracy and assisted with system changes.
- Supported coordination of benefits open enrollment activities and process.
- Filed paperwork, sorted, and delivered mail and maintained office organization.
- Processed employee termination paperwork at direction of supervisory staff.
- Answered and redirected incoming phone calls for office.
- Developed and maintained HR policies and procedures.
- Compiled employee records from individual departments to maintain central files.
- Tracked various statistics and kept detailed records to support human resources department.
- Responded to employee inquiries regarding benefits and other HR topics.
- Helped employees register for benefits programs using online portals.
Site Activation Coordinator
Radiant Systems
South Plainfield, NJ
09.2021 - 01.2022
- Worked with principal investigator and sponsors to facilitate daily trial activities and comply with research protocols.
- Maintained compliance with protocols covering patient care and clinical trial operations.
- Collected, evaluated, and modeled collected data.
- Screened patient records, databases, and physician referrals to identify prospective candidates for research studies.
- Complied with research protocols by providing ongoing quality control audits.
- Followed informed consent processes and maintained records.
- Paid attention to detail while completing assignments.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Developed strong organizational and communication skills through coursework and volunteer activities.
Customer Service Agent
eTeam Inc.
Somerset, NJ
02.2021 - 09.2021
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Demonstrated high attention to detail, organization and management of multiple tasks and projects simultaneously.
- Addressed customer account discrepancies and concerns.
- Investigated and resolved accounting, service and delivery concerns.
- Investigated and resolved customer inquiries and complaints quickly.
- Met customer call guidelines for service levels, handle time and productivity.
- Maintained up-to-date knowledge of product and service changes.
Customer Service Representative
Med-EL
Durham, NC
2019.07 - 2020.01
- Served as the primary contact for customers including patients/family members,medical providers (hospital,implant centers,research centers and surgeons, audiologists, educators regarding product needs.
- Worked with patients and clinics by answering product and service questions.
- Processed orders,prepared correspondences and fulfill customer needs to ensure excellent service standards and maintain high customer satisfaction.
- Accepted special projects and assignments as business requires.
- Assisted others Med-EL team members in achieving company goals.
- Strategize with customers by listening,interpreting their needs,and advising on solutions.
- Communicated with customers thru email within one business day.
- Collaborated with all internal staff members including Reimbursement,Accounting,Product Control,Order fulfillment and sales team on a regular basis to help maintain account relationships.
- Informed customers about billing procedures, processed payments.
- Escalated customer concerns, store issues and inventory requirements to supervisors.
- Tracked emails,phone call interactions per day for auditing, reporting and training purposes.
Reimbursement Specialist
Aerotek
Cary, NC
07.2018 - 03.2019
- Worked with the Janssen CarePath Program verifing patient health insurance eligibility for speciality medications such as Remicade, Simponi, Tremfya, Stelara.
- Responsible for obtaining and creating prior authorizations and triage cases for patient's to receive medications through commercial medical and pharmacy plans .
- Determine program eligibility by conducting Verification of Benefits for providers.
- Gained accurate documentation of payor information and patient status.
- Identified potential adverse events and transferred to clinical program member.
- Acted as single point of contact for assigned group of prescribers.
- Worked with traditional Medicare Part A/B ,Medicare Advantage , MAPD an supplement policies to verify benefits for eligibility.
- Maintained community-based customer relationship management (CRM) database by entering data for referrals and appointments.
- Performed a wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
- Observed strict confidentiality and safeguarded all patient-related information.
- Drafted documents based on payer guidelines and submitted to the necessary parties.
- Applied health insurance expertise and exemplary customer service skills to attain correct verification of benefits.
Reimbursement Specialist
Mckesson Corporation Specialty
Cary, NC
11.2017 - 01.2018
MAPD on-line systems.
Verify patient benefits for all assigned patients within program required timeframes.
Notified appropriate stakeholders of verified and corrected information.
Complete accurate entry of bilpayorsnformation to ensure timely payment and avoid delay in patient therapy.
Daily communicated with payers and physician offices regarding program status and financial responsibility.
Perform duties necessary to facilitate payment from third party payers.
Processed a designated amount of new patients daily by accurately inputting information in the system.
Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.
Referral Specialist
Piedmont Health Services
Carrboro, NC
06.2015 - 05.2017
- Maintain ongoing tracking and appropriate documentation on referrals by using an IT database, to promote team awareness and ensure patient safety.
- Ensure complete and accurate registration, including patient demographic and current insurance information.
- Assemble information concerning patient's clinical background and referral needs, provided appropriate clinical information to specialist.
- Contact review organizations and insurance companies to ensure prior approval requirements are met.
- Review details and expectations about the referral with patients, ensuring referrals were addressed in a timely manner.
- Assist patients in problem solving potential issues related to the health care system, financial or social barriers.
- Identify and utilize cultural and community resources. Establish and maintain relationships with identified service providers.
- Ensure patient’s primary care chart was up to date with information on specialist consults, hospitalizations, ER visits.
- Point of contact for outside EMR database with Duke, UNC, ARMC hospital.
- Created and setup accounts for the physicians and clinical support staff.
- Trained new employees on processing and tracking referrals.
Claim Processor
Beacon Health Options
Morrisville, NC
03.2013 - 06.2015
- Process and paid Mental Health claims for policy holders of BCBS of Horizon.
- Authorized high dollar claims, monitored claims for fraudulent behavior by a provider or facility.
- Investigated and verified health benefits and eligibility of patients.
- Practice good communication skills, maintained a good understanding of health coding and medical terminology.
- Keep meticulous records of claims and follow up on lapsed cases.
- Provided customer service for providers and facilities inquiring about denied claims. Analyzed and process insurance claim, checking it for validity.
Patient Account Associate
Duke PRMO
Durham, NC
10.2012 - 03.2013
- Recorded and generated variety of information pertaining to the patient revenue process.
- Resolved issues in order to receive accurate reimbursement and optimize internal and external customer satisfaction.
- Refunded posting balances and check process for all system entities.
- Collected revenue from insurance payers to effectively manage accounts. Assisted in hospital billing and collection managements.
- Generated letters entered and sorted data, performed clerical duties, such as word processing, data entry.
- Answers inquiries by phone regarding past-due accounts and insurance guidelines; researches incorrect addresses for past-due accounts.
- Contacted responsible party to resolve delinquent accounts; prepared payment plans and monitors adherence to plans by responsible party.
Commerical Intake Specialist
Blue Cross and Blue Shield of North Carolina
Durham, NC
05.2008 - 01.2012
- Processed admission notifications and requests from subscribers and providers based on established guidelines.
- Established utilization and medical necessity guidelines, approved admissions and lengths of stay and communications determinations to the provider or subscriber.
- Instructed providers regarding authorization procedures eliminating denied claims and inquiries from providers and subscribers.
- Determined whether authorized services are acceptable per certificate and policy provisions.
- Obtain pertinent information for questionable services, document reason for review, and refer cases to ECM or Medical Review Analyst.
- Worked with an multidisciplinary Health Care coordination team to identify and task appropriate health care service delivery for selected patients, and providers.
- Review and process prior approval to make a positive determination for drugs needing authorizations per company guidelines.
- Trained internal staff members on administrative processes, work instructions and procedures to facilitate consistent and seamless company operations.
Education
High School Diploma -
Southern Alamance High School
Skills
- Excellent verbal and communication skills
- Strong commitment to provide exceptional customer service
- Ability to analyze data and perform multiple tasks and work independently
- Effective interpersonal skills
- Able to interact effectively with diverse populations
- Proficient in following through with delegated tasks
- Developed and maintain professional relationships with patients, physicians, clients
- Strong clinical judgment
- Personal and professional integrity
Affiliations
- Certification in Administrative Training.
- Notary Public
- Attended a three day training course for PFSU Life Insurance certificate.
- Proficiency in Microsoft Office, Outlook. Excel, PowerPoint
- Knowledge of Computer Database: Webfocus, Medco, IDX,
- Rightfax, AS400, Teams Elite, Misys, SAP, Medco, Navision, CRM, EPIC
- MaxMC, Hyland Onbase, Legacy, Groupwise, McAuto Coder MMCIS, Sharepoints, NC Tracks, Maestro Care, Ability, ARMC Healthlink, UCSW, Security Connect, Centricity, Salesforce, UNC Carelink, Cover My Meds
Timeline
Sr. Reimbursement Specialist
Insight Global
05.2023 - 05.2024
HR Assistant I
Spectraforce Technologies Inc.
10.2022 - 02.2023
HR Assistant I
Talent Burst, Inc.
03.2022 - 07.2022
Site Activation Coordinator
Radiant Systems
09.2021 - 01.2022
Customer Service Agent
eTeam Inc.
02.2021 - 09.2021
Customer Service Representative
Med-EL
2019.07 - 2020.01
Reimbursement Specialist
Aerotek
07.2018 - 03.2019
Reimbursement Specialist
Mckesson Corporation Specialty
11.2017 - 01.2018
Referral Specialist
Piedmont Health Services
06.2015 - 05.2017
Claim Processor
Beacon Health Options
03.2013 - 06.2015
Patient Account Associate
Duke PRMO
10.2012 - 03.2013
Commerical Intake Specialist
Blue Cross and Blue Shield of North Carolina
05.2008 - 01.2012
High School Diploma -
Southern Alamance High School
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