TYRHONDA HUNT

• Medical terminology, Current Procedural Terminology (CPT)/Healthcare Common Procedure (HCPCS)/International Classification of Diseases (ICD)-9 coding knowledge.
• Coordinated provider inquiries for Blue Shield of California network, ensuring accurate benefits information.
• Reviewed provider contracts, fee schedules, and credentialing files to ensure compliance with regulatory standards.
• Applied knowledge of medical terminology and anatomy to facilitate effective communication and decision-making.
• Ability to exercise discretion and make independent judgments, seeking review when decisions represent a significant departure from established guidelines.
• Knowledge of Microsoft Office programs including Excel, Word or similar programs.
• Ability to maintain composure during challenging interpersonal interactions.
• Active listening skills; including interpersonal skills and telephone communication.
• Organizational skills with attention to detail and follow-up.

Apply defined procedures and policies to accurately maintain provider file maintenance in the provider manager application, groups, hospitals, and specialty healthcare providers, Completed provider inquiries and updates related to Blue Shield of California and Blue Shield of California Promise Health Plan networks. Coordinate with other departments to ensure timely and appropriate responses are completed, responsibilities, policies, and procedures, Conducted research and applied critical thinking to meet or exceed daily goals while maintaining high-quality work standards, contributing to overall team performance. May receive expedited, research, and resolve complex issues.

• Supported Blue Shield of California provider network operations
• Reviewed provider applications and credentialing documentation
• Resolved provider eligibility and benefits inquiries

• Communicated telephonically with members to conduct general outreach health assessments.
• Coordinated clinical service requests across Blue Shield of California care teams and providers.
• Reviewed member records for prior authorization and referral processing requirements.
• Scheduled appointments with network providers and clinical staff.

• Researched and resolved member/subscriber appeals while interpreting and explaining health plan benefits, policies, and procedures to respondents. researches, reviews and resolves appeals while clarifying issues and educating customers in the process. interprets and explains health plan benefits. Policies procedures and functions to members and providers. Drafted complex written correspondence addressing member appeals to ensure clarity and compliance. Established cohesive relationships with IPA partners and vendors through telephone, field work, and written communication.
• Reviewed member appeals and grievances using Blue Shield of California case records.
• Logged appeal details in Blue Shield of California tracking systems.
• Coordinated medical records, claims data, and supporting documents for review.

• Processed health plan data and information using automated systems, ensuring adherence to production and quality standards. Process group level changes such as renewals, new group installations, billing unit updates, group names and address changes, benefits and rate information updates, Identified and resolved issues with enrollment information and member eligibility. Frequently contacted other internal staff and external customers to verify information as needed to computer processing work; made recommendations to management for improvement in work processes, Maintained reports and performed database input and maintenance.
• Processed Blue Shield of California claims using member and provider records
• Reviewed eligibility, benefits, and coverage details for Blue Shield of California members
• Updated case files in Blue Shield of California processing systems

• Answers incoming calls, scheduled appointments, direct referrals and transfers calls, task and delivers message as needed, determine patients eligibility and verifying insurance, confirm patient appointments, Provide general administrative support to providers, Sending message to providers regarding medication, test results, provided information on referral, interact with other providers, Obtain and enter accurate demographic information into the EHR such as address, Managed automatic call routing to direct calls to appropriate agents or departments.
• Managed patient registration and check-in for WellSpace Health clinic visits.
• Scheduled appointments using practice management and electronic health record systems.
• Verified insurance coverage and updated demographic information for patient files.

• Shipping files, Updated data sheets to reflect the latest information., calling customer regarding denial or approved claims, performed additional duties, Approved workers' compensation payments based on claim evaluations.. Identify required data fields from each claim, and enter that information into the database for the client, Reviewed insurance claims for completeness and accuracy..
• Coordinated claims data entry within Gallagher Bassett case management systems.
• Reviewed source documents for accuracy before updating claims records.
• Entered policy details, incident notes, and claimant information into databases.

• Conducted outbound calls to veterans and providers to confirm appointments. to veterans and providers to ensure appointments are scheduled for service in a timely manner, add or update member alerts in the medical management systemss, Makes outbound calls to obtain medical documentation, available as inbound for questions regarding choice program, Work with multiple system to ensure accurate data entry and information is given for appointing veterans, making sure proper paperwork and eligibility are up to date for providers.
• Answered customer inquiries for Maximus call center programs and services
• Verified eligibility details and updated case records in service systems
• Resolved account questions using scripted guidelines and policy information

• Processing medical claims, data Entry, 10-key, override claims deny and approve claims, process payments, had to meet production of 150 claims an hour, review and adjust accounts Assist with other billing responsibilities entered patients and provider information into database, executed various billing tasks, scanning documents, made sure claims are accurate, verification of patients' insurance, read and interpret E.O.B.s, medical terminology, open and sort mail. Preparing and submitting insurance claims. Assist Medi-Cal providers with Appeals/Denied claims, Verified Tars, handled 80 to 100 inbound calls, check forms CMS 1500 and UB-04, answered questions about claims benefits, Knowledge of CPT codes and ICD-9.
• Processed customer invoices using Xerox billing systems and account records.
• Resolved billing discrepancies through account review and client communication.
• Reconciled payments, credits, and adjustments across billing accounts.