Tyana Jones
Surprise
Summary
People-oriented and result driven supervisor with6 years of management experience in minimizing downtime, process optimization, and increasing production. Demonstrated the ability to identify and resolve issues quickly and effectively. Using strong collaboration and communication skills to help team members find their potential and meet expectations. I am a flexible and compassionate leader who is resourceful.
Overview
18
18
years of professional experience
Work History
Telecommute Supervisor Provider Data
UnitedHealth Group
05.2019 - Current
- Giving feedback
- Creating team schedules
- Onboarding and training
- Interviewing
- Posting requisitions
- Motivating and train employees
- Evaluate performance
- Workflow management
- Provide daily metrics and department communications via daily huddle
- Create and adjust basket VPH in Omega for accuracy in production numbers
- Complete monthly1:1 to review metrics, barriers, and audit errors
- Record monthly metrics on scorecards
- Complete Annual reviews
- Manage inventory
- Update auditing process to help identify training needs
- Implementing coaching plans to improve quality
- Run daily reports
- Complete tasks as assigned
- Assist in creating/ updating SOP
- Creating process documents
- Reopen/ Assign work as needed
- Delegation
- Manage special projects
- Create survey action plans
- Complete comp planner
- Utilize NDB to load provider’s and Groups
- Manage HHS claims inventory
Telecommute Provider Data Analyst
UnitedHealth Group
05.2018 - 05.2019
- Process claims in Pega
- Investigate provider information suspicious activity
- Process IA CDAC claims
- Wrote PEGA case stories/ PEGA testing
- Reopen/ Assign work as needed
- Update SOPs/Create user guides
- Do IRS verifications
- Load providers into NDB
- Run Reports for inventory and TAT
- Process mail received
- Complete monthly team quality audits in Pega and NDB
- Provide training for PEGA and NDB
- Complete projects as assigned
Telecommute Sr. Provider Data Specialist
UnitedHealth Group
01.2017 - 05.2018
- Assist with reporting when needed
- Process claims in the NDM Work queue
- Completed Oxford claims
- Added BSARs for Providers and Grp in CPS Facets and CSP Macess
- Assisted in Phone call log
- Updated/ Added providers in NDB
- Updated/ Added UHC IDs in NDB
- Do IRS Tin verifications
Telecommute Provider Data Specialist
UnitedHealth Group
05.2017 - 01.2017
- Load providers, Groups, and Facilities in River Valley Facets database
- Add/ Updated Facilities, Groups, and providers in NDB per Lotus Notes requests
- Release Provider, Group, and Facility Claims in River Valley and CSP Facets
- Utilize NDM Work queue to complete CSP Claims
- Add Div directly in Cosmos
- Utilize Macess to view claims
- Utilize NDB to load providers, groups, and Facilities in River Valley Facets
- Update Excel Spreadsheet that is assigned every day for list of claims to complete
- Processed NY NDM claims
Provider Data Maintenance Specialist
United Behavioral/Optum Health
10.2009 - 05.2012
- Enter provider data updates into UBH and PBH Facets database
- Managed NDB errors using Microsoft Access database
- Process incoming ePUF requests within10-day TAT
- Maintained and updated provider/group data in NDB database
- Performed verification of provider and group NPI numbers via NPI website
- Assisted with Electronic Managed Care Change Form (EMCCF) queue
- Performed entry of Divs into Cosmos database
- Trained/Assisted team members as deemed appropriate
- Performed other duties or urgent projects assigned by manager
- Utilize share point for workflows and Department communication
- Process PDSQ (Provider Database Specialist Que)
- Look up JDH (John Deere) Alt IDs up in River Valley Facets
- Add all Veterans Administration Medical Center Addresses in UBH Facets and NDB via emailed spreadsheet
- Manage John Deere/ TennCare Mailbox
- Add Information on Xcel spreadsheet for newly Credentialed TennCare providers and send out email
Credentialing Coordinator
United Behavioral Health
09.2006 - 10.2009
- Reviewed and audited incoming applications from providers applying to UBH Provider Network
- Performed primary source verification activities on provider files to maintain compliance with UBH, NCQA and The Joint Commission standards within specific timeframes
- Maintained consistent knowledge of State, NCQA and UBH Standards and Regulations
- Contacted providers, health plans, licensing boards and other related parties to verify provider data
- Performed weekly review of reports to ensure provider applications remained in compliance with UBH Standards
- Processed all Tenncare provider applications within30-day TAT in compliance with customer contract
- Performed data entry of provider information into Facets database
- Prepped provider exception files and miscellaneous documentation for Credentialing Committee review
- Sent welcome packets to newly approved providers
- Contacted network managers to obtain missing documents needed for credentialing application process
- Rostered Clinicians into CAQH (Online Provider Application)
- Performed indexing of scanned provider documentation into online medical record database
- Prepped and batched application documentation to be scanned
- Performed initial credentialing shelling of provider application
- Utilized Lotus Notes for email
Education
Vocational Human Biology course, Vocational Human Biology Lab course
Minneapolis Community and Tech College
Minneapolis, MN01.2011
Vocational Medical Terminology course, Vocational Anatomy and Physiology course
Minneapolis School of Business
Brooklyn Center, MN01.2005
Certified Nursing Assistant training course - undefined
Minneapolis Community and Tech College
Minneapolis, MN01.2003
High School Diploma - undefined
North Community High School
Minneapolis, MN01.2002
Skills
- Training and mentoring
- Goal oriented
- Staff management
- Customer service
- Staff development
- Team building
- Process improvement
- Conflict resolution
- Coaching and mentoring
- Teamwork and collaboration
- Problem-solving
- Inventory management
- Organizational skills
- Multitasking
Timeline
Telecommute Supervisor Provider Data
UnitedHealth Group
05.2019 - Current
Telecommute Provider Data Analyst
UnitedHealth Group
05.2018 - 05.2019
Telecommute Provider Data Specialist
UnitedHealth Group
05.2017 - 01.2017
Telecommute Sr. Provider Data Specialist
UnitedHealth Group
01.2017 - 05.2018
Provider Data Maintenance Specialist
United Behavioral/Optum Health
10.2009 - 05.2012
Credentialing Coordinator
United Behavioral Health
09.2006 - 10.2009
Vocational Medical Terminology course, Vocational Anatomy and Physiology course
Minneapolis School of Business
Certified Nursing Assistant training course - undefined
Minneapolis Community and Tech College
High School Diploma - undefined
North Community High School
Vocational Human Biology course, Vocational Human Biology Lab course
Minneapolis Community and Tech College
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