Open to opportunities

Tamarlan Pridgett

@tamarlanpridgett

Patient Navigator and Medicare/claims-focused customer service professional delivering empathetic resolutions and care coordination.

United States

Message

What I'm looking for

I’m looking for a patient-centered role where I can coordinate care, handle claims/appeals and escalations, and use my HIPAA-compliant documentation skills to resolve issues quickly with a supportive, diverse team.

I’m an optimistic patient navigator with a strength in customer service escalation resolution and a passion for fostering a positive, diverse, nurturing culture. I bring 10+ years of clinical experience as a registered medical assistant and 12+ years’ experience across medical practices, insurance organizations, Hubs, and hospital systems.

In remote roles with Cardinal Health, United Healthcare, and in prior leadership, I’ve handled inbound and outbound member/patient needs through benefit verification, referrals, coordination of care, and detailed documentation. I’m experienced with Medicare (A/B/C/D), Medicaid, Tricare, and commercial payers, including submitting and researching claims, appeals, prior authorizations, Medicare medical necessity reviews, and releases of information while maintaining HIPPA compliance.

Experience

Work history, roles, and key accomplishments

Current

Patient Navigator

Current

Cardinal Health

Oct 2023 - Present (2 years 8 months)

Reviewed enrollment applications and screened patients for appropriate assistance programs, resolving escalated provider and patient inquiries with empathy and clear communication. Conducted medical necessity reviews and managed prior authorization and appeal follow-up, including coordinating records requests and pharmacy/infusion orders.

Prior Authorizations Medical Necessity Review Medication Orders HIPAA compliance

Member Service Advocate

UnitedHealthcare

Oct 2020 - Oct 2023 (3 years)

Resolved inbound Medicare member questions across benefits, claims, appeals, grievances, enrollment, prior authorizations, referrals, and premiums while following strict call center compliance processes. Managed escalations with outbound follow-ups and maintained strong operational performance, including less than 3% monthly abandonment and revenue-impacting appeal support.

Deductible And OOP Validation ICUE Follow Up

Patient Account Rep & Team Lead

Memorial Hermann Medical Group

Feb 2015 - Oct 2020 (5 years 8 months)

Led a team of 17 with minimal supervision by improving daily workflows, monitoring productivity, and reducing potential claim errors through proactive report reviews. Managed front-office operations and coordinated patient care by handling registrations, benefits verification, referrals, prior authorization requests, and claims adjustments across Medicare Advantage, Commercial, and Medicaid.

Medicare Advantage And Medicaid Claims Support Prior Authorizations Care Coordination Benefit Verification

Medical Assistant

The Foot and Ankle Clinic of West Monroe

Aug 2012 - Feb 2015 (2 years 6 months)

Provided patient intake and clinical support by triaging vitals, assisting with wound care, and supporting provider workflow with accurate documentation and scribing. Managed administrative and revenue-cycle tasks including surgery scheduling, prior authorization and appeals submissions, claims processing/research, and patient billing issue resolution.

Athena Health Scheduling Surgery Scheduling Prior Authorizations Wound Care Medical Scribing HIPAA compliance