Verification Specialist Prior Authorization

Tabitha Gamble

Dallas Ft. Worth, TX Area

972-***-**** • ******@*****.*** • linkedin.com/in/tabitha-gamble-689a3039 Clinical Administration Professional ǀ Call Center Operations Patient benefits verification specialist with experience working with hundreds of commercial and government insurance companies helping commercialize and maximize benefits of specialty and branded medications/healthcare services. Qualified to efficiently coordinate care of patient benefits to assure access to pharmacy products and services before appointment. Focused on accelerating speed-to- therapy to help improve outcomes for manufacturers, healthcare providers and patients. SKILLS & QUALIFICATIONS

Virtual Team Management Patient Affordability Programs Diplomatic Problem Resolution Supervisory Aptitude Audit Support & Quality Initiatives Critical Thinking Process Improvements Medical Management Review Case Management WORK HISTORY

Prior Authorization Manager, Health Services Clinical Coverage Review 2/2010 to Present United Healthcare ǀ Plano, TX

Manage non-clinical supervisors and serve as a resource and coach for non-clinical staff.

Answering non-clinical questions from staff and resolving client issues.

Providing ongoing training and education on non-clinical knowledge.

Providing updates and conducting monthly meetings with staff.

Maintaining staff levels, interviewing and hiring employees and enforcing disciplinary actions.

Case auditing of staff and implementing performance improvement plans.

Oversee process improvement projects for various teams. Prior Authorization Supervisor, Health Services CCR 10/2005 to 2/2010 United Healthcare ǀ Plano, TX

Direction of all operational activity for their assigned staff within the site.

Measure site performance against business unit goals, achieving targeted metrics.

Identifies opportunities to evaluate work and coaches/mentors staff accordingly.

Partnered with Medical Directors to facilitate Medical Director and staff interaction.

Maintained consistent service levels through managing staffing levels monitoring metrics, process improvement, and human resource alignment.

Communicated and collaborated with other members of care management organization to improve health care quality and efficiency, develop best practices, and identify provider and network issues.

Verified coding is accurate for the prior authorization reviews. Clinical Administrative Services Coordinator 11/2004 to 10/2005 United Health Care, Specialized Services ǀ Plano, TX

Performed triage and screening of incoming requests received by e-mail, fax and telephone.

Prepared cases for nurses based on demographic information for patients, facilities and providers.

Obtained clinical and benefit materials or eligibility. Screened cases for clinical review. Case Manager 8/1997 to 6/2004

Cigna Group Insurance ǀ Dallas, TX

Case Management of Short Term and Long Term Disability claims.

Coordinated and oversaw rehabilitated efforts.

Established benefit eligibility and verified employer information.

Contacted Medical providers to collect medical records for and in-depth investigation.

Developed a comprehensive return to work strategy. Tabitha Gamble ǀ Page 2

Worked with medical providers and in house consultants to identify physical and mental ability.

Coordinated distribution of disability benefits with government agencies.

Assisted claimant in applying for additional or supplemental benefits.

Administered and distributed statutory benefits.

Communicated with client representatives’ daily regard employee benefit.

Compiled and maintained periodic reports for Policy Holders.

Worked closely with Workers Compensation Board in New York and New Jersey. ADDITIONAL CAREER EXPERIENCE

Team Lead Claims Specialist ǀ North American Insurance Company Sales Underwriter ǀ GEICO Insurance

EDUCATION

Cedar Valley Community College, Dallas, Texas ǀ Business Management (In Progress) North Lake College, Irving TX ǀ Workers Compensation, License University of Arkansas in Pine Bluff, Pine Bluff, AR ǀ General Studies AWARDS

Circle of Excellence for Outstanding Service and Teamwork 2001 Excellent Performance Award 2003

Workers Compensation, TX

Service Awards 2012

Nominated for Service Hero Award 2016

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