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