TRISTA GRIFFIS
Chester
Summary
Knowledgeable Member Care Advocate with comprehensive background in facilitating authorization processes and ensuring compliance with industry regulations. Proven track record in collaborating with cross-functional teams to streamline workflows and enhance operational efficiency. Demonstrated ability in problem-solving and maintaining meticulous records.
Overview
16
16
years of professional experience
Work History
Authorization Coordinator
Aetna
01.2024 - Current
- Serve as a primary representative for the company's mission, fielding inbound calls from members and addressing healthcare inquiries with empathy and professionalism.
- Communicate effectively with patients and providers to resolve a variety of issues related to insurance claims, benefits information, and enrollment.
- Assist members in understanding their healthcare benefits, including the interpretation of EOBs and the distinctions between HSA, FSA, and HRA.
- Calculate out-of-pocket costs and explain deductible requirements to members, ensuring clarity and understanding.
- Provide resources for primary care and specialty providers within members’ coverage areas, supporting their healthcare journey.
- Document interactions meticulously to maintain compliance with HIPAA and regulatory standards.
Waiver Authorization Coordinator
Virginia Premier
12.2018 - 06.2023
- Managed comprehensive customer records and documentation, ensuring accuracy and adherence to healthcare policies.
- Conducted quality audits to maintain data integrity, enhancing the efficiency of patient data management.
- Developed and analyzed reports to streamline data collection processes, contributing to improved healthcare outcomes and member satisfaction.
Claims Data Entry
Ally Align Health
04.2018 - 12.2018
- Enhanced data entry processes for timely and accurate management of patient information, facilitating better service delivery.
- Collaborated on digital filing solutions, enhancing record management and supporting efficient data retrieval for healthcare claims.
- Worked effectively in fast-paced environments.
- Self-motivated, with a strong sense of personal responsibility.
Quality Assurance Technician
Perdue Farms
11.2015 - 04.2018
- Conducted product inspections and maintained compliance with safety and quality standards, ensuring accurate reporting and documentation.
- Maintained accurate documentation of all quality-related activities, facilitating easy access to records when needed.
- Conducted root cause analyses for identified defects, implementing preventive measures to minimize recurrence rates.
Information Technology Specialist (25B)
Uniter States Army
10.2009 - 10.2015
- Led cross-functional teams on complex projects, fostering collaboration among team members and driving project success.
- Collaborated on troubleshooting and resolving IT security issues, ensuring continuous protection of confidential data.
- Achieved significant cost savings through consolidation of hardware resources via virtualization technologies.
- Managed data security and compliance, maintaining government-level security clearance and ensuring the protection of sensitive information.
Education
Bachelor of Science - Health Information Management
Western Governors University
Salt Lake City, UT01-2022
Associate of Science - Health Information Management
ECPI University
Richmond12-2017
Skills
- Insurance verification processes
- Active listening abilities
- Business development
- Analytical problem solving
- Expertise in verifying insurance coverage
- Strong organizational skills
- Expertise in medical terminology
- Customer engagement
- Effective problem resolution
Timeline
Authorization Coordinator
Aetna
01.2024 - Current
Waiver Authorization Coordinator
Virginia Premier
12.2018 - 06.2023
Claims Data Entry
Ally Align Health
04.2018 - 12.2018
Quality Assurance Technician
Perdue Farms
11.2015 - 04.2018
Information Technology Specialist (25B)
Uniter States Army
10.2009 - 10.2015
Bachelor of Science - Health Information Management
Western Governors University
Associate of Science - Health Information Management
ECPI University
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