Tamika Barnes

Columbus, OH

Authorized to work in the US for any employer

Work Experience

Provider Claims Service Representative

AmeriHealth Caritas - Columbus, OH

November 2021 to March 2023

Answer Provider inquiries regarding benefits eligibility and other Provider issues.Respond to Providers and health plan claims inquiries. Reviewed and adjudicated claims based on Provider and Health plan contractual agreement and Claims processing guidelines. Forward Claims requiring external department intervention. Suspend claims requiring additional information. Monitor outstanding inquiries. Document files as appropriate to support payment decision.

Care Review Processor

Molina Healthcare - Columbus, OH

October 2021 to April 2022

Send and received faxes to process prior authorization for Hospital and Nursing Home admission.

Billing Review Specialist

Good Night Medical - Westerville, OH November 2016 to March 2021

Complete insurance verifications for pending orders. Obtain prior authorization for pending orders.Ensure insurance coverage meets necessary requirements to receive documentation,and submit request for documentation as needed. Make Patients calls to obtain any information needed to complete insurance verifications

Customer Service Representative II

Buckeye Community Health Plan Ambetter Federal Market Place - Columbus, OH

October 2015 to October 2016

Responsibilities

Respond to telephone or written correspondence inquiries from members and/or providers within established timeframes utilizing current reference materials and available resources

Provide assistance to members and/or providers regarding website registration and navigation

Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application

Process written customer correspondence and provide the appropriate level of timely follow up

May coordinate member transportation and make referrals to other departments as appropriate Maintain performance and quality standards based on established call center metrics including turnaround times

Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment

Identify any trends related to incoming or outgoing calls that may provide policy or process improvements to support excellent customer service, quality improvement and call reduction

Customer Care Representative

Health Scope Benefits - Columbus, OH

December 2014 to October 2015

Responsibilities

Handling customer service calls from members, provider and client representative • Analyzing problems brought forth during phone inquiry and applying appropriate resolutions • Work and Analysts and other departments to research problems • Establishing and maintaining professional rapport with clients and providers • Maintaining and assuring of documentation • Continuous knowledge of numerous benefits interpretation • Ability to learn claims processing as well as adjustments

Customer Service Representative

Hock's Pharmacy - Vandalia, OH

August 2007 to February 2012

Vandalia, Ohio

Handle incoming orders received via email, telephone and fax; Inputting new orders into company database; Assist Customer Service Department with product and order issues, order status and related product matters; Ensure order fulfillment, accuracy and quality control.

Pharmacist Assistant

Beeber Pharmacy - Dayton, OH

August 2006 to December 2006

Entered prescription details in patient profile; select correct medication and labeled for pharmacist review; checked and restocked supplies, packaged and label orders for nursing home patients.

Mortgage Document Processor

Radian Express - Dayton, OH

August 2001 to December 2006

Created printed materials for the company on a high volume basis; responsible for shipping out Mortgage Documents ; filed and copied Mortgage Documents ; answered customers calls; entered and verified a variety of data in appropriate formats; tracked and verified quality of data entry from all sources and performed other basic clerical duties associated with home loan Closing.

Education

High school or equivalent

Dunbar High School 1993

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