Tia Barker
Chesterfield
Summary
Dynamic Medical Management Specialist with extensive experience at Anthem, excelling in quality assurance and data analysis. Proven track record in training and mentoring teams, enhancing service quality, and ensuring HIPAA compliance. Adept at problem-solving and effective communication, driving improvements in care coordination and client satisfaction.
Overview
10
10
years of professional experience
Work History
MEDICAL MANAGEMENT SPECIALIST II
Anthem
04.2021 - Current
- Enters authorizations for Medicaid Personal and Respite Care
- Checks quality of all Denial Letters sent to members and providers.
- Provides insight during team huddles pertaining to the VA Ambassador Program.
- Train additional team members to appropriately complete tasks.
- Coordinates with other professionals involved in providing care services to ensure continuity of care for the client.
- Actively listen to clients' concerns and worked collaboratively with them to identify solutions.
PERFORMANCE QUALITY ANALYST I
Anthem
11.2018 - 04.2021
- Drove service quality by evaluating phone calls, and correspondence handled within organization.
- Analyzed and interpret data and make recommendations for change based on judgement and experience.
- Provided feedback where necessary to frontline staff and identify opportunities for improvement.
- Worked closely with higher level auditor to identify opportunities within organization.
- Participated in pre and post implementation audits of member inquiries and corrective action process.
- Documented audit results, document findings, and suggest appropriate action.
- Demonstrated ability to audit multiples lines of business, multiple functions, and multiple systems.
- Functioned as expert for discrepancy review, questions from teammates, and business partner and interpretation of guidelines and audit process.
- Mentored Legato auditors for National WGS Provider Services.
MEDICAL MANAGEMENT SPECIALIST I
Anthem
10.2017 - 11.2018
- Gathered clinical information regarding cases and determines appropriate area to refer or assign case.
- Received incoming calls from Medicaid members regarding their case management case.
- Assisted Commonwealth Coordinated Care Plus members with setting up appointments with their Care Coordinator.
- Acted as liaison between Medical Management and other internal departments.
- Updated tracking databases.
- Prepared Medicaid reports and documents all actions.
- Assigned Medicaid members to appropriate Case Manager for their medical needs.
- Completed DMAS Health Assessment within 6-month timeframe.
- Verified all member information to report properly to DMAS.
- Followed up with members regarding missed transportation trips with Southeastrans.
OPERATIONS EXPERT
Anthem
05.2017 - 10.2017
- Handled all supervisor calls, while serving as front-line resource for customer care associates.
- Handled complex case research and resolution.
- Provided feedback for member surveys via Convergys.
- Researched benefit and claim escalations, and if need be, creating Rational Team Concert to reconcile issue.
- Performed side by side coaching sessions with associates that need additional help.
- Pulled daily inquiries by using Simon Report and send out to team.
- Monitored inventory to ensure workflow remains uninterrupted.
- Collaborated with additional departments to ensure procedures and policies are accurate and complete.
- Keyed, processed, and adjusted claims as need be.
- Lead team huddles weekly to discuss any upcoming changes, communications, as well go over team stats.
- Conducted interviews for new hires.
- Designed and executed on-boarding plans for customer representatives and new Operation Experts.
- Manually keep track of call opportunities by using Microsoft Excel.
- Created team building exercises to engage associates, and to heighten morale.
- Communicated with Workforce Management to make sure associates comply with adherence.
CUSTOMER CARE ASSOCIATE I/II/III
Anthem
Richmond
09.2015 - 05.2017
- Responded to customer inquiries via telephone and email regarding provider contracts, insurance benefits, eligibility, and claims.
- Assisted in group chat by responding to questions and providing accurate answers.
- Lead team huddles in absent of manager to discuss any upcoming changes, communications, as well as go over team stats.
- Kept track of team scoreboard, and updated information weekly.
- Followed up with members in timely manner.
- Became Open Enrollment Ambassador to provide information about Anthem Health Plans.
Education
Bachelor of Science - Psychology
Liberty University
Lynchburg, VA05.2021
High School Diploma -
Hermitage High School
Richmond, VA06.2005
Skills
- Quality assurance
- Data analysis
- Team collaboration
- Effective communication
- Problem solving
- Training and mentoring
- Attention to detail
- Microsoft Office
- Conflict resolution
- Insurance verification
- HIPAA compliance
- Decision making
- Active listening
- Medical terminology
- Report preparation
- Fraud investigation
- Leadership
- Collaboration
- Dependable and responsible
- Time management
- Self-motivated
- First Aid/CPR
Timeline
MEDICAL MANAGEMENT SPECIALIST II
Anthem
04.2021 - Current
PERFORMANCE QUALITY ANALYST I
Anthem
11.2018 - 04.2021
MEDICAL MANAGEMENT SPECIALIST I
Anthem
10.2017 - 11.2018
OPERATIONS EXPERT
Anthem
05.2017 - 10.2017
CUSTOMER CARE ASSOCIATE I/II/III
Anthem
09.2015 - 05.2017
Bachelor of Science - Psychology
Liberty University
High School Diploma -
Hermitage High School