Tyrome Williams

• Pre-processing of PI inventory to include Information received through Right
• Information received through Provider Portal
• Information received through
• Research, identify and obtain data/information needed to help process PI claims or resolve claims issues (e.g., verify information received, review claim history, and confirm received dates are compliant)
• Perform initial screening of PI claims to determine if further review by Certified Coder is necessary
• Review medical records and other documentation submitted with reconsiderations; process to completion or escalate for further review as appropriate
• Resolve or address new or unusual claims errors/issues as they arise, applying appropriate knowledge or prior experience
• Collaborate with internal business partners to resolve claims errors/issues (e.g., CPCs, Benefit Analysts, Clinical Reviewers, Analytics)
• Monitor TAT of claims awaiting medical records, finalize claims in Salesforce for lack of information when appropriate
• Review PI Customer Service tickets and determine additional action needed; send uphold letters or escalate for further review as appropriate
• Document IKA claim comments and send letters in IKA as necessary
• Document and follow-up on all assigned inventory, utilizing on-line systems and procedures, according to established guidelines
• Utilize experience and judgement to plan, accomplish goals and effectively resolve each assigned task
• Document and communicate status of claims/investigations to stakeholders as needed, adhering to reporting requirements (e.g., status letters/reports)
• Use appropriate systems/platforms/applications to process PI claims
• Navigate systems tools and screens efficiently and effectively (e.g., keyboard skills, macros, shortcuts)
• Use appropriate documentation, reference materials and/or websites to ensure that claims are processed accurately and efficiently (e.g.,
• Policy/procedure manuals, knowledge libraries, bulletins, training materials, databases, SharePoint sites, data warehouses)
• Achieve applicable performance metrics (e.g., productivity, quality, TAT)
• Performs all other related duties as assigned

• Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
• Verified patient insurance coverage and benefits for medical claims.
• Managed large volume of medical claims on daily basis.
• Researched and resolved complex medical claims issues to support timely processing.
• Paid or denied medical claims based upon established claims processing criteria.
• Utilized electronic medical record systems to store, retrieve and process patient data.
• Monitored and updated claims status in claims processing system.
• Identified and resolved discrepancies between patient information and claims data.
• Used administrative guidelines as resource or to answer questions when processing medical claims.
• Responded to correspondence from insurance companies.
• Researched and resolved medical record discrepancies.
• Transcribed and entered patient medical information into electronic medical records systems.

• Prepared loan packages and closing instructions for bank employees.
• Completed post-closing quality control evaluations of originated mortgage loans.
• Affirmed loan document accuracy to protect lenders from potential fraud.
• Calculated debt-to-income ratios to determine maximum loan amounts and avoid overextending applicants.
• Verified credit histories, personal references and employment backgrounds for each applicant.
• Tracked loan status and updated applicant information to inform lenders of changes to applicants' financial situation.
• Analyzed credit reports to assess risk and determine applicants' ability to repay loans.
• Set up, stored and updated customer files, department records and regulatory paperwork.
• Prepared loan documents and explained terms to clarify loan conditions and requirements with applicants.

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• Developed and maintained relationships with customers, lenders and other third parties.
• Evaluated loan requests and documents to verify accuracy and completeness.
• Processed loan applications and monitored progress from start to finish.
• Monitored pipelines to track and log status of loans.
• Analyzed potential risks and evaluated loan products to identify suitable options for customers.
• Approved loan applications based on customer creditworthiness and provided detailed financial advice.
• Obtained copies of applicants' credit histories and reviewed paperwork to determine feasibility of granting loans.
• Assessed loan portfolios for compliance with underwriting policies.
• Negotiated loan terms and conditions with customers to secure best deal.
• Assisted customers with completing loan applications and other paperwork.
• Explained very technical financial information to applicants in easy to understand language.
• Proactively identified solutions for customers experiencing credit issues.
• Created strategies to develop and expand existing customer sales, resulting in increase in annual sales.
• Assisted clients with improving financial health by counseling on issues such as excessive spending and borrowing.
• Established plans and payoffs for customers' loans, prioritizing control of overall costs.

• Utilized specialized software to process incoming claims, enter data and generate reports.
• Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
• Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
• Managed workload and priorities to meet claims processing meet deadlines.
• Maintained confidentiality of patient finances, records, and health statuses.
• Maintained strong knowledge of basic medical terminology to better understand services and procedures.
• Collaborated with claims department and industry anti-fraud organizations to resolve claims.
• Monitored claims processing trends to identify potential areas of improvement.
• Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
• Evaluated accuracy and quality of data entered into agency management system.
• Identified and reported potential fraud or abuse related to claims to protect system's integrity.
• Tracked and reported on claims processing metrics to aid senior management in making informed decisions.