Tyesha Holland
Charlotte
Summary
Healthcare service professional with proven track record in patient communication and problem resolution. Adept at managing patient inquiries, coordinating with medical teams, and ensuring smooth service delivery. Strong focus on teamwork and adaptability, consistently achieving results even in high-pressure environments. Known for empathy, active listening, and effective conflict resolution skills.
Overview
10
10
years of professional experience
Work History
Paraprofessional
Adaptative Intervention Group
03.2024 - Current
- Assisted in implementing individualized education plans for diverse learning needs.
- Supported classroom activities and maintained a structured environment for students.
- Documented student behaviors and progress reports for ongoing assessment and support adjustments.
- Fostered a positive learning environment by establishing strong rapport with students, parents, and faculty members.
- Tailored lesson plans for students with emotional and cognitive disabilities.
- Took part in professional development workshops to boost skills.
- Promoted positive behavior changes by consistently reinforcing appropriate actions using praise and rewards.
- Maintained accurate documentation of resident health records in compliance with regulatory standards.
- Conducted thorough patient interviews to obtain detailed medical histories, allowing for more effective treatments and interventions.
- Obtained client medical history, medication information, symptoms, and allergies.
Healthcare Customer Service Representative
Alorica
02.2021 - 03.2024
- Resolved customer inquiries regarding healthcare services and benefits.
- Provided accurate information to patients about insurance eligibility and coverage options.
- Assisted in processing claims and following up on outstanding issues with insurance providers.
- Maintained detailed records of customer interactions in CRM systems for quality assurance.
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Facilitated smooth communication between patients, insurance companies, and medical staff for seamless coordination of care.
- Monitored turnaround times for authorization requests, implementing strategies to expedite processing when necessary.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
- Meet service level goals (Average speed of answer and call handle time)
- Applying knowledge of ICD-9, ICD-10, Cpt, and Hcpc coding when reviewing claim discrepancies
- Verification of benefits
- Handled medical record request per payor policy.
- Medical terminology.
Benefits Verification Specialist
Monte Nido & Affiliates
01.2019 - 02.2021
- Verified patient benefits through thorough analysis of insurance policies and eligibility criteria.
- Collaborated with healthcare providers to obtain accurate authorization for treatment services.
- Ensured compliance with all regulatory requirements related to benefit verification processes.
- Trained and mentored new staff on best practices for benefits verification and documentation standards.
- Streamlined workflows to enhance efficiency in processing benefit verifications and appeals.
- Optimized the use of electronic claims submission systems to expedite claim processing times.
- Utilized advanced research skills to investigate specific policy provisions and resolve any ambiguities or conflicts.
- Collaborated with healthcare providers to ensure accurate billing and benefit coverage information.
- Safeguarded confidential client information by adhering to strict privacy guidelines and protocols.
- Skilled at working independently and collaboratively in a team environment.
- Uphold HIPAA standards and support team collaboration.
- Contact Payors via telephone,fax,email, or portal to ensure accurate benefits.
- Collaborated with insurance companies to clarify coverage details and expedite review of complex cases.
- Maintained up-to-date knowledge of changing healthcare regulations and insurance policies to ensure accurate processing of requests.
Team Lead
Spectrum
03.2016 - 01.2018
- Resolved customer inquiries efficiently through active listening and problem-solving techniques.
- Implemented process improvements that streamlined call handling, reducing average response times.
- Utilized CRM software to document interactions and track customer issues accurately.
- Handled escalated customer complaints effectively, leading to satisfactory resolutions for both the client and the company.
- Adapted quickly to new technologies introduced into the call center environment, utilizing tools effectively during customer interactions.
- Retained customers considering cancellation by addressing their concerns, offering alternative solutions, and showcasing the value of our products and services.
- Coordinated cross-functional collaboration to optimize project delivery timelines and quality outcomes.
- Empowered team members by delegating responsibilities according to individual strengths and areas of expertise.
- Mentored junior staff, fostering skill development and promoting a culture of continuous improvement.
- Coordinated training sessions, improving team performance through targeted skill enhancement initiatives.
- Increased customer satisfaction by ensuring timely completion of projects and adherence to high-quality standards.
Education
No Degree - Clinical Medical Assisting
National Health Career Association
Charlotte, NC11-2025
No Degree - Phlebotomy
Ohio School of Phlebotomy
Charlotte, NC11-2025
High School Diploma -
Ashbrook Highschool
Gastonia, NC06-2014
Skills
- Behavior management
- Effective communication
- Helping students with special needs
- Small group and individual assistance
- Kipu
- Salesforce
- EKG administration
- HIPAA
- Medical Terminology
- Injections/Wound Care
- Urinalysis
- Collaborate MD
- Facets
- ICD-9 &10
- Diagnosis code knowledge
- Microsoft outlook,Excel, and Teams
Timeline
Paraprofessional
Adaptative Intervention Group
03.2024 - Current
Healthcare Customer Service Representative
Alorica
02.2021 - 03.2024
Benefits Verification Specialist
Monte Nido & Affiliates
01.2019 - 02.2021
Team Lead
Spectrum
03.2016 - 01.2018
No Degree - Clinical Medical Assisting
National Health Career Association
No Degree - Phlebotomy
Ohio School of Phlebotomy
High School Diploma -
Ashbrook Highschool