Summary
Overview
Work History
Education
Skills
Timeline
Generic
Tieshia Gibbs-Burks

Tieshia Gibbs-Burks

Zachary

Summary

Dynamic Outpatient Counselor at Millie & Mill LLC, adept in cognitive behavioral therapy and client advocacy. Proven track record in developing individualized treatment plans and enhancing patient outcomes through evidence-based interventions. Recognized for exceptional communication skills and a calm disposition, fostering a supportive environment for clients to thrive.

Skilled Outpatient Counselor with strong background helping clients overcome personal challenges and cope with triggering situations. Focused on facilitating exploration of issues, developing individualized plans and developing important skills. .

Compassionate member service advocate with extensive knowledge of counseling principles and practices. Adept at creating individualized treatment plans and leading group therapy sessions. Committed to creating safe, supportive environment for all participants.

Respectful counselor with proven track record of helping clients improve mental health and well-being through evidence-based therapeutic approaches. Skilled in selecting and utilizing appropriate treatment modalities and interventions to meet needs of individuals. Passionate about helping people manage mental health and improve quality of life.

Observant individual with excellent interpersonal and communication skills builds meaningful relationships with clients and families. Experienced in working with clients from diverse cultural and religious backgrounds. Offers crisis intervention to help individuals navigate through traumatic experiences.

Empathetic professional with hands-on experience providing quality psychological services to children and adults. Skilled in identifying, assessing and diagnosing mental health and emotional issues. Develops and implements treatment plans and provides counseling and therapy to obtain maximum results for patients.

Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives.

Dynamic individual and talent for navigating challenges. Brings strong problem-solving skills and proactive approach to new tasks. Known for adaptability, creativity, and results-oriented mindset. Committed to making meaningful contributions and advancing organizational goals.

Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.

Results-oriented achiever with proven ability to exceed targets and drive success in fast-paced environments. Combines strategic thinking with hands-on experience to deliver impactful solutions and enhance organizational performance.

Encouraging manager and analytical problem-solver with talents for team building, leading and motivating, as well as excellent customer relations aptitude and relationship-building skills. Proficient in using independent decision-making skills and sound judgment to positively impact company success. Dedicated to applying training, monitoring and morale-building abilities to enhance employee engagement and boost performance.

Collaborative leader partners with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings.

Tech-savvy innovator with hands-on experience in emerging technologies and passion for continuous improvement. Skilled in identifying opportunities for technological enhancements and implementing effective solutions. Adept at leveraging new tools and methods to solve problems and enhance productivity. Excels in adapting to fast-paced environments and driving technological advancements.

Overview

13
13
years of professional experience

Work History

Outpatient Counselor

Millie & Mill LLC (Klam Advisors)
04.2022 - 03.2025
  • Used cognitive behavior therapy to assist clients in recognizing and redirecting poor habits.
  • Developed individualized counseling plans for clients to incorporate short-term and long-term goals.
  • Implemented evidence-based therapeutic interventions to promote positive behavior change.
  • Conducted assessments to determine progress and performance and report findings to relevant authorities.
  • Guided clients in developing skills and strategies for dealing with problems.
  • Guided clients in effective therapeutic exercises integrated from Cognitive Behavior Therapy and Dialectical Behavior Therapy (DBT).
  • Worked collaboratively with other mental health professionals to provide consistent care and minimize diversion.
  • Prepared reports to summarize clients' mental health status and treatment progress.
  • Completed one-on-one counseling with broad range of clients suffering from various diseases and issues.
  • Observed and monitored client behavior and responses to treatment.
  • Provided comprehensive case management services, created treatment plans, and connected clients and families to appropriate resources.
  • Encouraged patients to discuss experiences in group and individual settings.
  • Provided referrals to connect clients with other community resources to support mental health and well-being.
  • Attended trainings to participate in regular supervision and continued education to maintain professional competence and ethical standards.
  • Supervised busy caseload, managing clients, balancing workload and prioritizing client needs.
  • Assessed mental health needs to determine nature and extent of clients' emotional, behavioral or mental health issues.
  • Conducted crisis interventions to respond to clients in crisis, assess immediate needs and provide support and resources.
  • Documented clients' progress to keep detailed notes on each client's treatment progress and changes in mental health status.
  • Displayed sensitivity to cultural and linguistic needs of clients and families served.
  • Adhered to ethical and legal standards for confidentiality, protecting clients' privacy.

Virtual Total Loss Adjuster Trainee

Allstate
01.2022 - 04.2022
  • Calculated benefit payments.
  • Negotiated claim settlements when needed.
  • Investigated and analyzed extent of company liability concerning [Type] insurance loss or damages.
  • Corresponded with witnesses, claimants, specialists, and agents to compile incident information.
  • Approved payment of claims within certain monetary limit.
  • Examined photographs and surveillance and any other documents relating to claims.
  • Negotiated with claimants to settle claims.
  • Documented all findings in concise reports.
  • Issued payouts to claimants.
  • Carried and managed consistently heavy project workload through exemplary organizational, time management and collaboration talents.
  • Coordinated with local body shops to assign repair jobs and obtained rental vehicles for customers for duration of restoration process.
  • Identified suspicious claims, escalating issues to supervisor for further investigation and analysis.
  • Reviewed police reports, photographs and other documentation to gain complete understanding of accident.
  • Created detailed assessments of damages to property and vehicles.
  • Analyzed complex data and prepared accurate and comprehensive reports for clients.
  • Kept current on insurance regulations, laws, policies and procedures.
  • Successfully negotiated settlements with claimants and insurers.
  • Assessed complex claims and accurately determined value of damages.
  • Enhanced customer satisfaction by delivering honest advice to policyholders in regards to repair work and body shop processes.
  • Learned new materials, processes, and programs quickly.
  • Attended training courses to build understanding of processes, techniques, and industry.
  • Performed administrative functions, answering phones and filing paperwork in support of department.

Member Service Quality Improvement Specialist

Centene
03.2019 - 12.2021
  • Call Center Setting
  • Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards
  • • Review medical records and abstract data for HEDIS and other measure sets in compliance with standards • Track and report on issues and outcomes related to abstractions and over-reads
  • • Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required
  • • Perform other quality initiatives as necessary March 2019-December 2021 Collaborated with other departments to coordinate efforts in resolving complex
  • • claims issues.
  • • Requested additional information and documentation to support and validate claim.
  • • Analyzed coverage and communicated coverage positions to facilitate claims process.
  • • Resolved customer inquiries regarding claim status in an efficient manner. Maintained up-to-date knowledge of relevant laws, regulations, industry trends, best practices, and current technologies.
  • Worked effectively in fast-paced environments.
  • Identified issues, analyzed information and provided solutions to problems.
  • Goal-oriented professional with proven success in applying analytical skills to solve complex problems and overcome challenges. Dedicated to enhancing team performance and driving business success.
  • Proven ability to develop and implement creative solutions to complex problems.
  • Gained strong leadership skills by managing projects from start to finish.
  • Proved successful working within tight deadlines and a fast-paced environment.
  • Gained extensive knowledge in data entry, analysis and reporting.
  • Organized and detail-oriented with a strong work ethic.
  • Paid attention to detail while completing assignments.
  • Delivered services to customer locations within specific timeframes.
  • Adaptable individual with exceptional interpersonal skills and talent for building relationships. Known for delivering outstanding service and enhancing client satisfaction. Focused on fostering positive interactions and creating collaborative environment.
  • Identified and resolved discrepancies and errors in customer accounts.
  • Provided excellent customer care by responding to requests, assisting with product selection and handling ordering functions.
  • Cross-trained and backed up other customer service managers.
  • Enhanced productivity levels by anticipating needs and delivering outstanding support.
  • Followed-through on all critical inter-departmental escalations to increase customer retention rates.
  • Responded proactively and positively to rapid change.
  • Reduced process inconsistencies and effectively trained team members on best practices and protocols.

Inpatient Behavioral Health Referral Specialist

Health Care Support Group (temp for Centene)
07.2018 - 03.2019
  • Call Center Setting
  • Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
  • Coordinated with medical staff and patients to find cost-effective options for services.
  • Called insurance companies to get precertification and other benefits information on behalf of patients.
  • Linked families to relevant community support to meet non-medical needs.
  • Answered telephone calls to offer office information, answer questions, and direct calls to staff.
  • Scheduled appointments with specialists on behalf of clients.
  • received behavioral health prior authorizations including prtf auths from providers and transferred them into Tru Care database and sent them off to the utilization managers for review
  • *took inbound calls from providers and members to initiate authorizations over the phone as well as provided status of authorizations to providers
  • *handled all grievence and appeals as well as retro auth request July 2018-March 2019
  • • Responded promptly to inquiries from patients or families regarding referral status
  • • Maintained accurate records of all referrals and follow-up activities.
  • • Adhered to relevant regulations while processing patient referrals.

Prior Authorization Pharmacy Technician

Hinduja Global Solutions (Aetna)
12.2011 - 07.2018
  • Call Center Setting
  • Approved 90% of prior authorizations
  • • Used master formulary to determine tier and classification of a drug retrieved
  • • Reviewed every page of a patient medical record • Received up to 500 faxes a day processed over 40 prior authorizations a day
  • • Scanned and faxed patient medical records to senior pharmacist for further review
  • • Used Citrix to processed prior authorization claims • Processed Medicare Part A, B and D claims • Determined patient medical diagnoses using ICD-9 and ICD-10 codes
  • • Communicated directly with doctor offices, pharmacies, insurance companies and members
  • • Received and verified requests for prior authorizations and ensured that they are administered properly
  • • Consulted with presiding doctors or nurse managers to obtain clearance for the necessity of treatment
  • • Looked through insurance plans in a detailed manner and process required referrals
  • • Sorted medical records and submitted them to the carrier in a bid to expedite the authorization process
  • • Kept medical staff in the loop about any delays or problems in obtaining authorizations
  • • Applied billing and coding principles in sync with government policies and standards
  • • Ascertained that insurance carriers' documentation requirements are completed and that all copies are placed in patients' medical records files
  • • Verified patients' benefits and ensure that proper prior authorization and re-authorization is obtained for additional treatment
  • • Communicated with members regarding coverage, benefits, eligibility and renewals
  • Answered incoming phone calls and addressed questions from customers and healthcare providers.
  • Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
  • Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
  • Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.

Education

Bachelor of Science - Health Information Management

Western Governors University
Salt Lake City, UT

High School Diploma -

Tara High School
Baton Rouge, LA
04-2011

Skills

  • Cognitive behavioral therapy
  • Substance abuse treatment
  • Group therapy
  • Client advocacy
  • Clinical documentation
  • Family therapy
  • Behavioral assessment
  • Individual counseling
  • Counseling
  • Call logging
  • Training experience
  • Quality assurance controls
  • Customer support
  • Call control skills
  • CallSelect
  • Providing customer support
  • Documentation and reporting
  • Calm disposition
  • Customer communications
  • Quality assurance
  • Call center customer service
  • Property adjusting
  • Accident scene investigations
  • Casualty and property loss
  • Exposure analysis
  • Policy investigations
  • Automobile appraisals
  • Automobile claims specialist
  • Medical terminology
  • Drug utilization review
  • HIPAA regulations compliance
  • Conflict resolution techniques
  • Training and mentoring
  • Workflow optimization
  • Pharmaceutical calculations
  • Stress management techniques
  • Process improvement strategies
  • Innovation and creativity

Timeline

Outpatient Counselor

Millie & Mill LLC (Klam Advisors)
04.2022 - 03.2025

Virtual Total Loss Adjuster Trainee

Allstate
01.2022 - 04.2022

Member Service Quality Improvement Specialist

Centene
03.2019 - 12.2021

Inpatient Behavioral Health Referral Specialist

Health Care Support Group (temp for Centene)
07.2018 - 03.2019

Prior Authorization Pharmacy Technician

Hinduja Global Solutions (Aetna)
12.2011 - 07.2018

Bachelor of Science - Health Information Management

Western Governors University

High School Diploma -

Tara High School
Tieshia Gibbs-Burks