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Click here or scroll down to respond to this candidateCandidate's Name
EMAIL AVAILABLE PHONE NUMBER AVAILABLE Buda, TXSummaryResults-focused healthcare services professional with over 10 years of experience in executing provider services for large and medium enterprises. Successful at overseeing team performance and allocating resources to meet workflow and demand. Excellent conflict resolution skills with proven ability to defuse high-stress situations.SkillsProvider managementTrainingCommunicationLeadershipBenefits enrollmentNetwork & ContractsCustomer relationship buildingCredentialingTroubleshooting and configurationCRM and office management softwareData entryCritical thinkingMicrosoft OfficeProject planningTeam buildingFile and data retrieval systemsExperienceCollabera/ Abbott Laboratories Austin, TX Rebates & Fees Analyst (Temp)02/2023 CurrentReview incoming agreements and upload terms and conditions to the Rebates and Admin Fee systemPrepare rebate verification form templates for customers to ensure timely data submissionsEfficiently complete Microsoft Excel spreadsheets, v-lookups, conditional formatting.Manage the shared email box, responding to internal and external customer inquiries and appropriately assigning email tasks to rebate analystsComplete check submissions and accompanying reports, ensuring the log is complete and up to dateOperate independently within a varied and changing scope of responsibilities under some supervisionProvide support for internal audits through the collection and submission of requested documentsConduct audits of provider information and escalate issues for resolution as appropriate.Operate independently within a varied and changing scope of responsibilities under some supervisionCompliance with internal policiesTegria Healthcare Consulting & Technology Services Seattle, WAProvider Maintenance Analyst (Temp)08/2022 - 11/2022Provide support for baseline provider data transactions that cannot be administered automatically via provider database due to system limitations and/or data integrity issues.Perform baseline demographic transaction updates utilizing provider system applications in support of claim adjudication and provider directory.Resolve on-going department support using research and analysis essential to resolving concerns/issues raised by providers and internal/external customers.Conduct audits of provider information and escalate issues for resolution as appropriate.Modify and update existing policies and claims to reflect change in beneficiary, amount of coverage, or type of insurance.Catalyst Solutions Phoenix, AZProvider Data Configuration (Temp)09/2021 - 03/2022Maintain provider enrollments in Medicare and Medicaid across various states.Support members through navigation of enrollment process to facilitate optimal decisions.Analyze information from interviews, educational and medical records, consultation with other professionals, and diagnostic evaluations to assess clients' abilities, needs, and eligibility for services.Process benefits applications with an 100% accuracy rate.Explain eligibility details and affordability options to patients with kindness and respect.Follow up with insurance carriers to address and rectify denied claims.Accenture Austin, TXProvider Enrollment Specialist (Temp)10/2020 - 09/2021Assisted with configuration issues and loading of provider information as needed.Maintained accurate and timely maintenance of critical provider information on all claims and provider databases.Validated data housed on provider databases and ensure adherence to business and system requirements of customers respective to contracting, network management, and credentialing.Trained team members and users in newly implemented and emerging technology to enhance business productivity.Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.La Care Health Plan Los Angeles, CAProvider Claims Specialist10/2017 - 01/2020Oversaw regulatory and strategic initiatives to ensure accuracy of medical claims.Responded to written claim inquiries professionally.Increased member satisfaction rate by 48% via providing claim updates and corrections.Acted as intermediary between insurance companies and customers, including researching and assessing information to determine validity of claims.Modified, updated, and processed existing policies and claims to reflect changes in beneficiary, amount of coverage, and type of insurance.Improved profit margins by 62% with streamlining operations and workflow.SCAN Health Plan Long Beach, CACustomer Service Advocate03/2016 - 10/2017Handled escalated calls for front-line associates to address complex issues and restore customer satisfaction.Cultivated impactful relationships with customers and drove business development by delivering product knowledge.Informed customers about billing procedures, processed payments, and provided payment option setup assistance.Trained new employees on procedures and policies to maximize team performance.Performed troubleshooting, mediation, and resolution to complex member issues.Maintained legal protection and transparency via documenting transactions with comprehensive member forms and summarized actions taken for improved internal communication.Maxim Staffing Mountlake Terrace, WASenior Customer Service Representative06/2014 - 06/2015Assisted customers by answering questions, addressing concerns, and providing current account information.Educated customers about products, pricing, and policies to address and resolve issues.Met and exceeded performance goals to support long-term company growth and market dominance.Handled approximately 100 calls each day, including new sign-ups, service cancellations, and cross-selling opportunities.Oversaw and guided team of 10 associates to handle customer call escalations, training, and mentoring new employees on customer service and order processing.Education and TrainingAshford University San Diego, CABachelor of Arts in Behavioral Health05/2017Cerritos College Norwalk, CAAssociate of Arts in General Studies06/2015 |
