Prior Authorization Customer Service
Resume:
Tameka Anderson
San Antonio, TX *****
**************************@***********.***
Willing to relocate to: San Antonio, TX - Austin, TX Work Experience
Provider Services Representative
Pyramid consulting Inc for Centene Corporation - San Antonio, TX July 2023 to January 2024
Take provider calls for all billing and claims information. Policy clarification
Healthcare innovative
Prior authorization specialist
April 2023-July 2023
Medical billing
ICD 10 codes
Medical records
Claims adjustment
Behavioral Health Customer Service Representative Care United healthcare - San Antonio, TX
February 2022 to June 2022
• HIPPA compliance training.
• Comply with required workplace safety standards.
• Determine provider contracting status and appropriateness.
• Verify member eligibility and benefits.
• Determine provider contracting status and appropriateness.
• Determine diagnosis and treatment request.
• Assign billing codes (ICD-10 and/or CPT/HCPC codes).
• Perform action required per protocol using the appropriate Database.
• Researches claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error.
• Coordinated with VP/AVP/Director level leadership in enrollment, configuration area and defined process flows on various line of business.
• Performed claims system testing and/or analysis to ensure accuracy of the system's configuration and provider payments.
• Conducted research and root cause analysis on various claims issues to identify and resolve problem payment and configuration concerns.
Care Review Processor II/ Prior Authorization Coordinator Molina Healthcare Inc. - Long Beach, CA
December 2013 to November 2020
• Worked within the Care Access and Monitoring (CAM) team using provided information to ensure the delivery of high quality, cost-effective healthcare services according to State and Federal requirements to achieve optimal outcomes.
• HIPPA compliance training.
• Comply with required workplace safety standards.
• Determine provider contracting status and appropriateness.
• Verify member eligibility and benefits.
• Determine provider contracting status and appropriateness.
• Determine diagnosis and treatment request.
• Assign billing codes (ICD-10 and/or CPT/HCPC codes).
• Perform action required per protocol using the appropriate Database.
• Researches claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error.
• Coordinated with VP/AVP/Director level leadership in enrollment, configuration area and defined process flows on various line of business.
• Performed claims system testing and/or analysis to ensure accuracy of the system's configuration and provider payments.
• Conducted research and root cause analysis on various claims issues to identify and resolve problem payment and configuration concerns.
Provider Information Coordinator
SCAN Health Plan - Long Beach, CA
November 2013 to June 2014
• Assist with the coordination of projects; perform data entry functions related to provider information.
• Interact with other departments in regards to questions about provider configuration.
• Assist Provider Services team with urgent loading and/or modification of providers and facilities in MC400 and Ika
HIPPA compliance training.
• Perform other duties as assigned.
• Comply with required workplace safety standards. Provider Information Coordinator
Molina Healthcare Inc. - Long Beach, CA
June 2011 to July 2012
• Assist with the coordination of projects; perform data entry functions related to provider information.
• Interact with other departments in regards to questions about provider configuration.
• Assist claims, Provider Services, Member Service, and the Authorization teams with urgent loading and/ or modification of providers and facilities in QNXT.
• Claims adjudication.
• HIPPA compliance training.
• Perform other duties as assigned.
• Comply with required workplace safety standards. Texas Works Advisor II
Texas Health and Human Services Commission - San Antonio, TX November 2010 to May 2011
• Obtain, verify, and calculate income and resources to determine client financial eligibility for social service programs.
• Certify program eligibility, compute benefit levels, and determine the length of eligibility.
• Conduct reviews to determine or verify new and continued program eligibility.
• Calculate and process changes to client benefits such as overpayments, adjustments, or restoration of benefits.
• Document case records to maintain accurate and confidential client records.
• Knowledge of state and federal program eligibility guidelines, regulations, and policies; of social service eligibility requirements; and of community welfare resources.
• Skill in interviewing, in conducting individual needs assessments, and in operating computers and applicable computer software.
• Ability to maintain effective working relationships, to elicit and evaluate information, to conduct research and investigations, to perform basic arithmetic and data analysis, and to communicate effectively.
Application Services Technician
Maximus, Inc. - San Antonio, TX
November 2008 to November 2010
• Inputting client data.
• Maintaining client information.
• Processing applications for state funded programs. Provider Contract Coordinator
Molina Healthcare of Texas - San Antonio, TX
March 2008 to June 2008
• Ensuring timely flow of provider contracts and applications to prospective providers.
• Maintaining multiple provider network resources.
• Providing general support for Provider Services network projects as needed. Authorization Coordinator
United Health Group - San Antonio, TX
November 2005 to April 2007
• Ensuring timely flow of provider contracts and applications to prospective providers.
• Maintaining multiple provider network resources.
• Providing general support for Provider Services network. Education
High School Diploma
Sunset High School - San Antonio, TX
2000
Skills
• Excel
• Comprehensive
• 9000+ ks/hr alphanumeric
• Medicare
• Microsoft Word
• Medical knowledge
• Authorization
• Provider data management
• ICD-10 codes
• medical terminology and knowledge
• Outlook
• CPT codes
• Utilization management
• Network management
• Medical Claims Processing
• TYPE 55 WPM
• HIPPA compliance
• Medical Billing
• Medical Coding
• Analysis skills
• Insurance verification
• ICD-10
• CPT coding
• Medical terminology
• Medical records
• HIPAA
• ICD coding
• Typing
• Documentation review
• Order entry
• Customer service
• Outpatient
• Medicare
• Microsoft Excel
Contact this candidate