- Community Cleanup
- Offering time and support to shelters for the homeless, women, and animals
- Getting involved in local advocacy groups to promote positive change in the community
- Volunteer Work
- Animal Welfare Advocacy
Tammy D. Williams
Laplace,LA
Summary
Dedicated and self-motivated Risk Adjustment Representative with a strong track record in the healthcare industry. Expertise in building robust relationships and exceeding performance metrics while working independently. Skilled in engaging with clients, healthcare providers, and business partners through various communication methods. Committed to assisting individuals in navigating and accessing optimal healthcare benefits tailored to their unique needs.
Overview
19
19
years of professional experience
Work History
Risk Adjustment Representative
Humana
LaPlace, LA
10.2021 - 01.2026
- Conduct comprehensive research utilizing Ehub and Speedweb to ensure accuracy in Medicare Risk Adjustment (MRA) and compliance with HEDIS measures.
- Manage medical record requests, ensuring secure communication with healthcare providers for timely confirmation of receipt and processing.
- Collaborate with leadership to address complex account issues, ensuring resolutions align with regulatory standards.
- Perform data analysis and scrubbing for accuracy, linking and unlinking site IDs to maintain proper medical record associations.
- Maintain daily aging reports to track outstanding requests, ensuring timely resolutions within designated timeframes.
- Consistently met or exceeded monthly retrieval quotas, demonstrating strong organizational skills and a commitment to team success.
- Achieved 90% of monthly goals despite unexpected barriers, and developed a new tracking system to help ensure full goal achievement in upcoming months.
- Remote
- Analyzed risk adjustment data to identify trends and improve accuracy of coding processes.
Enrollment Billing Representative
Cigna
REMOTE
01.2021 - 10.2021
- Investigated unpaid balances from insurance companies, independently resolving discrepancies and submitting invoices according to payer-specific billing methods.
- Collaborated with internal teams and external payers to ensure accurate collection of invoiced amounts.
- Addressed client inquiries regarding payment options, billing details, and refund requests.
- Contract-temp
- Verified accuracy of accounts payable payments, resulting in 85% reduction in payment errors and check reissues.
- Processed billing inquiries and resolved discrepancies to enhance customer satisfaction.
- Collaborated with cross-functional teams to streamline billing procedures and improve accuracy.
- Analyzed billing data to identify trends, leading to proactive problem resolution strategies.
- Led initiatives to optimize workflows, reducing processing time and enhancing service delivery.
Benefit Representative / Clearance
MMC Group
11.2020 - 08.2021
- Verified benefits across various insurance plans, documenting coverage details for pharmacy and cost-sharing options.
- Processed medication claims, including Eliquis, ensuring timely and accurate submissions.
- Obtained prior authorizations to meet medication dispensing requirements and performed quality reviews for compliance and accuracy.
- Remote Contractor for Amerisource-temp
- Performed regular audits of benefits data, ensuring accurate records were maintained at all times.
Patient Service Representative
BGI Staffing
06.2020 - 07.2020
- Verified patient insurance coverage to facilitate billing processes and collected co-pays efficiently.
- Scheduled patient appointments, optimizing clinic workflow and enhancing patient access to care.
- Contract for Napoleon Pediatric Clinic
- Assisted patients with insurance verification and benefits inquiries to ensure accurate coverage.
- Facilitated effective communication between patients and medical staff to enhance service delivery.
- Resolved patient concerns promptly, improving satisfaction through active listening and problem-solving.
- Trained new team members on operational procedures to maintain high service standards.
- Participated in ongoing training programs related to HIPAA compliance, maintaining up-to-date knowledge on regulatory requirements.
- Verified insurance eligibility and coverage for patients.
- Handled sensitive patient concerns with professionalism and empathy, fostering an atmosphere of trust within the clinic.
Outbound Patient Service Representative
TriWest Healthcare Alliance
New Orleans, LA
10.2016 - 04.2020
- Provided information related to Veteran care through the Community Care Network, addressing inquiries regarding referrals, authorizations, and claims.
- Managed discrepancies in authorizations and claims through thorough account research and communication with Veterans and providers.
- Conducted outreach to gather essential appointment information and ensured compliance with operational standards.
- Inbound /Outbound 50-60 inbound calls per day
- Remote
Patient Access Representative II
East Jefferson Hospital
Metairie, LA
08.2012 - 12.2015
- Managed patient check-in/out processes, verified benefits, and scheduled appointments, ensuring a smooth patient experience.
- Cardiology
- Managed insurance verification processes to ensure accurate patient coverage.
- Facilitated patient registration and appointment scheduling for diverse healthcare services.
Certified Nursing Assistant
East Jefferson Hospital
Metairie, LA
08.2006 - 12.2015
- Provided patient care, administered EKGs, and monitored vital signs while ensuring compliance with HIPAA standards.
- Assisted with the transfer of residents, maintaining comfort and safety during procedures.
- Cardiology
- Supported needs of 10+ residents under long-term care.
Education
Professional Coder CPC_A - v23.1
MedCerts
Laplace, LA01.2025
Bachelor of Science - Healthcare Administration, Healthcare Management
University of Phoenix
Metairie, LA01.2013
Certificate - Medical Billing
Bryant and Stratton
Milwaukee, WI01.1998
Skills
- ICD-10 proficiency
- Medical record review
- HIPAA compliance
- Healthcare data management
Accomplishments
- Achieved VA veterans help reconition through effectively helping with homeless Veterans.
Interests
Timeline
Risk Adjustment Representative
Humana
10.2021 - 01.2026
Enrollment Billing Representative
Cigna
01.2021 - 10.2021
Benefit Representative / Clearance
MMC Group
11.2020 - 08.2021
Patient Service Representative
BGI Staffing
06.2020 - 07.2020
Outbound Patient Service Representative
TriWest Healthcare Alliance
10.2016 - 04.2020
Patient Access Representative II
East Jefferson Hospital
08.2012 - 12.2015
Certified Nursing Assistant
East Jefferson Hospital
08.2006 - 12.2015
Bachelor of Science - Healthcare Administration, Healthcare Management
University of Phoenix
Certificate - Medical Billing
Bryant and Stratton
Professional Coder CPC_A - v23.1
MedCerts