Customer Service Data Entry
Resume:
Tara R. Watkins
Email: *********@*****.*** ph.313-***-****
Summary of Qualifications
** **** ***** ** *** healthcare industry. 20 plus years in providing excellent customer service. My strengths are critical thinking, problems solving, time management and identifying inefficient operational processes. Excellent team player with effective leadership, organizational and communication skills.
Skills
●Medical Office
Administration
●Medical Terminology
●Medical software
●Eyefinity
●WEBDenis & Careweb
●CareAdvance
●Nasco
●Availity
●Content Manager
●Salesforces
●Microsoft Office
●ICD-10 Coding
CPT Coding
●Insurance billing
●Referral Authorization
●Insurance verification
●Precertification
●Prior Authorization
●Benefit Verification
●COB
●Data Entry
●Research/Analyst
●Training
●Leadership
●Team player
●Conflict Management
●Critical Thinking
●Excellent written and verbal communication skills
●Time Management
●10-key
●Payroll
●Onboarding
Professional Experience
Insurance Analyst II
June 2024 - February 2025 (SpectraForce Staffing) AbbVie Pharmaceutical Endocrinology-Remote
●Processed provider requests for authorization received via phone or electronically for Humira, Skyrizi and Rinvoq medications.
●Enter patient demographics and health insurance information into the hub information system and notify the physician of any incomplete or incorrect insurance information.
●Conducted benefit verification to ensure patient insurance covered medication and to advise patients of any additional assistance programs provided by insurance to assist with the cost of the medication.
●Provided subject matter expertise on medical and prescription insurance coverage/ verification, claim billing, medication prior authorization and appeal filing, and alternate financial assistance opportunities.
●Monitored the status of authorizations to ensure rapid turnaround resulting in procurement of drug products for the patient.
●Determined whether a reinvestigation of benefits was needed or to accept obtained benefit verification based on reasonableness and accuracy. Determine whether to escalate issues/concerns to management for review, guidance, and resolution. Participate in quality monitoring and in identifying and reporting quality issues.
●Collaborated with other areas to identify and share opportunities for process growth and productivity improvement.
●Troubleshoot and resolve any situations and take ownership if needed.
●Understand and comply with all required training, including adherence to federal, state, and local pharmacy laws, HIPAA policies and guidelines, and the policies and procedures of Pharmacy Solutions and clients.
●Identifies potential Adverse Event situations for reporting to Pharmacovigilance ensuring the client meets FDA regulations.
● Completes all required training and performs all functions in the position e.g., Soft Skills certification, product and disease overviews.
●Perform additional tasks, activities, and projects as deemed necessary by management.
Precertification Specialist
Jan 2017 - May 2024 - Blue Cross/Blue Shield - Michigan
●Prioritize, triage, and distribute precertification requests to staff to be processed.
●Process inpatient skilled nursing, rehabilitation,hospital stays and long term acute centers utilizing the Managed care systems.
●Answer precertification calls from providers inquiring about precertification requests.
●Benefits and Insurance verification.
●Make outbound calls necessary to expedite precertification requests in a timely manner.
●Serve as an Liaison between facilities,providers, and internal departments
●Analyze and research data to ensure claims are being paid properly.
●Collaborates with team leaders, coworkers and managers to resolve precertification issues.
●Train new employees on the process utilizing various managed care programs.
●Work as a gatekeeper on a rotating basis for the full department incoming fax inventory
●Took 10/15 calls outbound.
●Evaluated insurance coverage to determine the policy’s compatibility with programs.
●Contacted Medicare, Medicaid, and private insurance companies to obtain benefit and eligibility information.
●Verified insurance, answered phone calls, faxed, and made copies of medically related document .
●Verify insurance coverages and benefits via electronic access and telephone inquiries, assessing coordination of benefits and pre-authorization requirements.
●Coordinate closely with schedulers to ensure accurate and efficient communication regarding authorizations.
●Manage a multi-line phone system with professionalism, promptly transferring calls to the appropriate departments.
●Managed escalation of calls.
Hospice Aide
Oct 2012 – Jan 2017 - Arbor Hospice- Michigan
●Followed all company policies and provided hands-on nursing care under the supervision of a nurse.
●Assisted with daily activities such as personal hygiene, getting patients dressed and fed.
●Monitored vital signs including temperature; pulse, respiration and blood pressure.
●Kept the patient's room clean and sanitized to prevent infection and cross contamination.
●Reported any medical changes to the supervising nurse
●Assisted in the education of the 7 stages of grief after death.
Certified Nursing Assistant
Aug 2011 - Dec 2012 - Medilodge Nursing Facility - Michigan
●Provided assistance with personal care such as bathing,dressing and oral care on a daily basis.
●Monitored vital signs including temperature; pulse, respiration and blood pressure.
●Assessed patients for wounds, behavioral issues and medically significant symptoms.
●Set up meal trays and fed patients that needed assistance.
●Ensured the patient's room was kept clean and tidy.
●Reported any significant changes in patient to supervising nurse
Payroll Clerk
06/2008 – 11/2009 - The Populus Group - Michigan
●Processed payroll for 500 Navistar temporary employees.
●Assisted with the onboarding process for new hire employees.
●Provided customer service to employees regarding payroll issues, missing checks, address changes, missing hours, stop payment requests as well as other payroll related issues. Verified payroll checks and maintained personnel files.
●Submitted background checks using American Background website.
●Participated in I-9 audit to ensure employees were compliant with organization regulations.
●Proven track record of completing assigned tasks on time with accuracy and efficient work methods.
Referral and Insurance Authorization Coordinator
07/2007 – 06/2008 - U of M Hospital Radiology - Michigan
●Obtained referrals and insurance authorizations for testing three modalities Ultrasound,Breast Imaging and Bone Densitometry.
Education
Medilodge Nursing Facility, 2011 ● Certified Nursing Assistant Program
Davenport University, 2007 ● Associates degree in Business Administration - Concentration: Health Care Insurance Claims Management
Dorsey Schools, 2004 ● Diploma, Medical Billing
Contact this candidate