Taliah Thomas

I am 26 years old and currently enrolled in post university college to obtain my degree in the human service field

Centers Plan For Healthy Living August 2017 - February 2020

Member Service Representative

• Monitor Phones
• Educated on Benefits/ Services 
• Listen & Answer Members/ Provider questions and concerns
• Transfer calls when needed 
• Provide Eligibility and Benefits 
• Document Inbound & Outbound Calls
• Resend Authorizations
• Book transportation/Verify Transportation vendors
• Trained to Provide benefits and services for MLTC, FIDA and Medicare Advantage 

•  Examine and performs an initial review of claims including CMS 1500, CMS 1450 by paper or electronic
• Prepare claims until validation process for providers and members on clinical or adjusted claims
• Examine and validate electronic, paper claims including adjustments, C.O.B and MSP claims in a timely and accurate manner
• Review each claim flagged and completing and at time in accordance with established criteria and payment guidelines
• Complete and review route all reviews in accordance with time parameters establish by the health plan/ stated and federal regulation guidelines
• research , resolve and respond to claim appeals and inquires to include the organization, sorting and entry of details. As well as research and document results of claims either for condition or special consideration
• Preparation of required payment initiation and related correspondence
• Build and maintain proactive and positive working relationships with clients and brokers
• Engagement in projects and process improvement initiative as requested
• Report any problems that may affect the claims and process 
• Must meet and exceed production and quality standard by following policies and procedures

Youth Worker

• Responsible for ensuring client safety, providing direct care services
• Monitor, screen and oversee all clients entering the TILLs and maintain building safety. 
• Monitor self-administration of medications, engaging clients on a one to one basis as needed.
• Monitors house rules adherence by all clients
• Respond to mental health and medical needs. Responds to all emergencies as needed
• Assist with intake process for clients 

Direct Support Professional 

• Provides direct care to those with intellectual and developmental disabilities.
• Performs personal care tasks, including assistance with basic personal hygiene and grooming, feeding, and ambulation, medical monitoring, and health care related tasks.
• Fosters positive relationships between caretakers and individuals served.
• Ensures client safety and maintaining a safe environment.
• Reminds and assists clients with self-administration of medications 
• Documents services provided.
• Performs home management functions such as light housekeeping, laundry, bed making, and cleaning.
• Plans meals, shopping for groceries, preparing and serving food/meals, feeding and clean-up.
• Accompanies clients to scheduled appointments and transports clients , running errands for clients or scheduled outdoor activities
• Assists with toileting 

Zion Foundation Inc March 2022

Behavioral Aide

• 1:1 behavior intervention including daily data collection
• Emergency placement 
• Providing support in clinical and behavior services
• Accompanies clients to scheduled appointments and transports clients , running errands for clients or scheduled outdoor activities
• Addressing behavior management, safety needs 
• Supporting emotional and social needs
• ensure health and hygiene protocols are adhered to.
• Assist youth in strengthening/developing their skills in interpersonal communication, social interactions, behavioral conduct, and coping and adapting.

Sept. 2010 - June Susan E. Wagner High School, Staten Island, NY

Sept. 2015 - Present Kingsborough Community College, Brooklyn, NY

Major : Biology

Sept. 2022 Post Univeristy 

Waterbury, CT

Major: Human services