Crystal Thomas
Memphis
Summary
Talented performer with a demonstrated ability to provide information in a fair, accurate, and respectful manner. Seeking a position that leverages my hands-on experience while also offering opportunities for continued professional growth. Considered a team player with exemplary multitasking skills. Authorized to work in the US for any employer.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Short Term Disability Claims Examiner
Reliance Matrix
10.2024 - Current
- Investigate claim issues, providing resolution within departmental and regulatory guidelines
- Interpret and administer contract provisions: eligibility and duration
- Accurately code all system fields with correct financial, diagnosis, and duration information
- Coordinate with other departments to ensure appropriate claims transition or facilitate timely return to work
- Adhere to compliance, departmental procedures, and Unfair Claims Practice regulations
- Actively contribute to customer service, quality, and performance objectives
- Engage in departmental training to stay current with all claim management practices
- Manage Performance Guarantee clients and meet targeted metrics
- Maintain confidentiality and protect personal health information in accordance with HIPPA rules and regulations
Account Manager II
Quest Diagnostics
06.2018 - 10.2024
- Identify and pursue new business opportunities, generating revenue
- Monitor client accounts, manage billing, and prepare and present reports on account performance
- Develop and maintain relationships with clients, ensuring their satisfaction and needs are met
- Respond to customer inquiries and complaints, developing customer service policies and procedures
- Assist clients with locked accounts, username/password login reset, and troubleshoot results when needed
Eligibility Case Manager
Express Scripts
10.2015 - 06.2018
- Verify insurance/recipient eligibility, billing, and follow-up on claims to Medicare, Medicaid, and Private Insurer Payers
- Research and respond to Medicare, Medicaid, and other Payer inquiries regarding billing issues and insurance updates
- Review unpaid and/or denied claims, appeals, and follow-up on accounts to zero status
- Organize and distribute comprehensive appeal packages to the insurance provider
- Review and interpret explanation of benefits to determine contractual allowance
Pharmacy Technician
APS Pharmacy
01.2015 - 12.2017
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Enhanced pharmacy workflow by assisting pharmacists with medication dispensing, labeling, and packaging.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
Patient Care Technician
The Little Clinic
08.2014 - 04.2017
- Perform administrative tasks such as patient intake, insurance verification, process prior authorizations, collect payments, and answer multiple phone lines
- Assist patients in preparation for examinations by assessing and recording vital signs, triage, collect urinalysis, and assist with inventory and marketing
Store Manager
Rainbow Shops
06.2001 - 09.2014
- Recruit, hire, and onboard staff members, training them on company guidelines and employee handbook
- Plan, monitor, and evaluate job performance to ensure store staff meet objectives
- Provide coaching, counseling, and disciplinary actions when necessary
- Oversee the annual store budget and collaborate with corporate and financial departments on reporting and process payroll via ADP
Education
Associate of Applied Science (AAS) - Business Human Resource Management
Southwest Tennessee Community College
Memphis, TN12.2022
Skills
- Adaptability and flexibility
- Workload prioritization
- Analytical thinking
- Case management
Certification
TN Pharmacy Tech License Registered by TN Board of Pharmacy 08/2016
Timeline
Short Term Disability Claims Examiner
Reliance Matrix
10.2024 - Current
Account Manager II
Quest Diagnostics
06.2018 - 10.2024
Eligibility Case Manager
Express Scripts
10.2015 - 06.2018
Pharmacy Technician
APS Pharmacy
01.2015 - 12.2017
Patient Care Technician
The Little Clinic
08.2014 - 04.2017
Store Manager
Rainbow Shops
06.2001 - 09.2014
Associate of Applied Science (AAS) - Business Human Resource Management
Southwest Tennessee Community College
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