K e y o n i a W i l l i a m s

Phone: 214-***-**** Email: ad3q8e@r.postjobfree.com

EDUCATION

EVEREST COLLEGE

**/****-**/****

CERTIFIED BILLING AND CODING

HEALTHY HAIR ACADEMY

**/****

EXPERIENCE

WPS Health Solutions

CLAIMS- TPCU Analyst Provider Certification Analyst October 2024 -Current Job Title: Maintain the records for providers that submit claims to Tricare and research the provider’s certification and eligibility for accuracy

Responsibility: All providers must be approved and certified by TPCU so that we can pay claims correctly to meet our contract standards set by the government. All records are added and updated through the unit to pay claims

• Process claims using Mainframe

• Verify Doctors licenses and credentials using OnBase system

• Access Olli to verify claim edits and work instructions

• Resolve claim edits to process claims

• Certify and build providers records

• Process claims on 1500/837 forms

• Locate policies and instructions for Certification requirements

• Work from claim Queue

• Maintain quality and productivity

• Tax Reporting

• Sent denial letters, letters requesting for more information to process claims etc.

• Maintain an audit trail for Provider Certification

• Use Provider file for claim processing

• Meet TPCU Department Standards which includes 2 hours of idle time, 95% quality, 95% productivity Systems I used

• Mainframe

• Onbase imaging

• Trifecta 837 claim Data

• Eloquence

• Olli

Provider Customer Service Representative, Administrative Support August 2016- September 2023

United Health Group

• Processing and handling g claims, submit claims flag reconsiderations submit information on pended claims and find confirmations access letters, remittances advices and reimbursement policies submitting appeals,making sure all written requests are submitted for the appeal and all documents are in order. Input appeals in system daily. Answer incoming phone calls from health care providers (i.e. physician offices, clinics) and identify the type of assistance the provider needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs)

• Focus on resolving issues on the first call, navigate through the appropriate computer system(s) to identify the current status of the issue and provide appropriate response to caller

• Deliver all information and questions in a positive, conversational and compassionate manner to facilitate developing a relationship with the provider, while providing the best customer service experience possible

• Complete the documentation necessary to track provider issues and facilitate the reporting of overall trends

• Meet the performance goals established for the position in the areas of: efficiency, call quality, provider satisfaction, first call resolution and attendance

• Intern supervisor from June 2020 – Oct.2020 responsibilities were to overview calls and monitoring calls to make sure employees are helping providers and staying on top of 1st call resolution. Making sure team meets quota, and handling day to day duties

• Team leader providing help with appeals, training new and on coming employees for the company to complete day to day duties. Assisting with any issues and handling problems if any

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Customer Service Representative June 2012- August 2016 City of Dallas 311/ Animal Shelter

• Proficient with SRMS Systems, data entry,requirements and protocols

• Efficient in performing administrative and clerical functions

• Ability to communicate in a friendly and professional manner in non-emergency situations

• Communicate with emergency personnel if and when needed

• Assisted with pet adoption process.

• Help with the transport of animals to and from veterinary appointments Customer Service Representative June 2008-June 2012 American Health Benefits

• Registered patients, processed and routed outbound and inbound calls to appropriate locations

• Educated members on alternative insurance methods (when needed)

• Verified clinical information to make sure requirements were suitable for patients and providers needs

• Processed payment transactions

References upon Request

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