Tina Lowery
HBG,PA
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
22
22
years of professional experience
Work History
Sr Eligibility Consultant Operation Specialist
Aetna, CVS Health
Harrisburg, PA
05.2013 - Current
- Follow guidelines when reviewing applicant data to determine eligibility for enrollment into requested medical insurance plan
- Communicate with people from various cultures and backgrounds on application process
- Assist clients with completion of applications and paperwork when needed
- Demonstrate strong organizational and time management skills while managing multiple projects
- Excellent communication skills, both verbal and written
- Apply effective time management techniques to meet tight deadlines
- Proven ability to develop and implement creative solutions to complex problems
- Team lead in group projects, delegating tasks and providing feedback
- Organized and detail-oriented with strong work ethic
- Demonstrate respect, friendliness and willingness to help wherever needed
- Assists with Development and execution of performance management programs to increase employee engagement and productivity
- Develop new and improved training programs to fit business needs
- Facilitates virtual learning sessions
- Coordinate training schedules across departments with supervisors and managers to optimize training initiatives and work-flow management
- Develop lesson plans, instructional materials and written practice tests for current employees to go through refresher training courses to ensure everyone is up to date with any changes since their last training
- Trained and mentored over 200 new personnel hired to fulfill various roles
- Conducted regular reviews of operations and identified areas for improvement
- Collected, arranged, and input information into database system
- Educated staff on organizational mission and goals to help employees achieve success
- Optimized customer experience by delivering superior services and effectively troubleshooting issues
- Evaluated staff performance and provided coaching to address inefficiencies
- Identified clear connections between policies and business results to eliminate or reduce confusion and help employees achieve goals
- Devised and implemented processes and procedures to streamline operations
- Provided coaching and mentoring to employees
- Developed and updated tracking spreadsheets for process monitoring and reporting.
Claims Processing Specialist
Coventry Health Care
Harrisburg, PA
10.2007 - 04.2013
- Paid or denied medical claims based upon established claims processing criteria.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Managed large volume of medical claims on daily basis.
- Identified and resolved discrepancies between patient information and claims data.
- Researched and resolved complex medical claims issues to support timely processing.
- Followed up on denied claims to verify timely patient payment and resolution.
- Processed insurance payments and maintained accurate documentation of payments.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Verified patient insurance coverage and benefits for medical claims.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
Associate Customer Service Representative
Healthamerica
Harrisburg, PA
10.2002 - 09.2007
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Updated account information to maintain customer records.
- Provided primary customer support to internal and external customers.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Participated in team meetings and training sessions to stay informed about product updates and changes.
- Clarified customer issues and determined root cause of problems to resolve product or service complaints.
- Educated customers about billing, payment processing and support policies and procedures.
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
Education
Aetna/CVS Leaders In Training -
In-house Program
10.2022
GED -
William Penn Vo
04.1994
Skills
- Medicare Compliance
- CMS Guidelines
- Analysis and Assessments
- Enrollment Processing
- Researching Information
- Internal Department Communication
- Customer Interaction
- Documenting Communications
- Group and Individual Instruction
- Time Management
- Clear Verbal Communication
- Lesson Plan Development
- Employee Training
- Employee Coaching
- Materials Preparation
- Training Experience
Timeline
Sr Eligibility Consultant Operation Specialist
Aetna, CVS Health
05.2013 - Current
Claims Processing Specialist
Coventry Health Care
10.2007 - 04.2013
Associate Customer Service Representative
Healthamerica
10.2002 - 09.2007
Aetna/CVS Leaders In Training -
In-house Program
GED -
William Penn Vo
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