Adeline Tatum
Bradley
Summary
Dynamic Quality Review and Audit Analyst with a proven track record at Express Scripts, excelling in quality assurance and process improvement. Skilled in data analysis and coaching, I enhance team performance while ensuring compliance with medical guidelines. Bilingual in Spanish and English, I deliver exceptional customer service and support.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Quality Review and Audit Analyst
Express Scripts
Bradley
11.2020 - Current
- Perform extensive quality assessments and audits on approved Prior Authorizations to guarantee adherence to medical guidelines and precision of routing.
- Analyze data to identify trends and areas for improvement in the prior authorization process.
- Provide targeted coaching and feedback to Prior Authorization Technicians to enhance performance and accuracy.
- Enhanced Prior Authorization processing by pinpointing critical problem areas
Intake Prior Authorization Technician
Cigna Healthspring
Bourbonnais
11.2015 - 11.2020
- Oversaw high volume of inbound calls from Medicare members, delivering clear and accurate information regarding coverage determination processes.
- Executed Prior Authorization processing, ensuring accurate collection and validation of essential clinical data from members and healthcare providers.
- Proactively contacted healthcare providers to obtain necessary documentation, ensuring timely processing of requests.
Customer Service Representative
Accurate Communications
Omaha
10.2013 - 01.2014
- Handled inbound customer service calls while accurately entering customer information
- Coordinated appointment scheduling and ensured outstanding customer service.
Secretary/Dispatcher
Reliable Limo
Kankakee
10.2012 - 09.2013
- Handled phone inquiries and coordinated customer reservations.
- Coordinated driver dispatch, optimized schedules, and guaranteed timely service delivery.
- Processed invoices and posted payments to ensure accurate financial records.
Maintained organized office files to enhance retrieval efficiency.
Streamlined invoice processing procedures for improved accuracy and speed.
Elections Assistant
Supervisor of Elections Office
Orlando
06.2012 - 09.2012
- Handled phone communications and facilitated voter registration along with information revisions.
- Managed voter application processing within state database.
- Facilitated voter engagement during Early Voting phase.
Bank Teller
Farmers State Bank
Kankakee
08.2009 - 03.2012
- Facilitated customer transactions, involving deposits, withdrawals, and check cashing.
- Handled incoming calls and facilitated translation services when necessary.
Front Desk Agent
Lees Inn & Suites
Bradley
10.2002 - 04.2005
- Supervised guest check-in and check-out operations, guaranteeing exceptional experience
- Handled incoming calls, organized reservations, and ensured outstanding customer service.
Education
High School Diploma - Equivalent
Bradley-Bourbonnais Community High School
Bradley, IL05-2004
Skills
- Quality assurance and auditing
- Prior authorization processing
- Customer service and support
- Data entry and analysis
- Phone communication
- Appointment scheduling
- Record keeping
- Bilingual communication (Spanish/English)
- Database management
- Medical guidelines
- Coaching techniques
- Regulatory compliance
- Process improvement
- Effective communication
- Documentation management
- Internal auditing
Certification
Food Handler Certification
Timeline
Quality Review and Audit Analyst
Express Scripts
11.2020 - Current
Intake Prior Authorization Technician
Cigna Healthspring
11.2015 - 11.2020
Customer Service Representative
Accurate Communications
10.2013 - 01.2014
Secretary/Dispatcher
Reliable Limo
10.2012 - 09.2013
Elections Assistant
Supervisor of Elections Office
06.2012 - 09.2012
Bank Teller
Farmers State Bank
08.2009 - 03.2012
Front Desk Agent
Lees Inn & Suites
10.2002 - 04.2005
High School Diploma - Equivalent
Bradley-Bourbonnais Community High School