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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Chaterelle Way PHONE NUMBER AVAILABLEColumbia, SC Street Address EMAIL AVAILABLEPROFESSIONAL PROFILEDedicated and goal oriented professional with valuable experience on various levels. Experience includes key business functions in Management, Operations, Client Relations, Billing, Auditing and Customer Service.SUMMARY OF QUALIFICATIONSEffective communication, public speaking and organizational skillsProblem solving, analytical skills, negotiation and persuasion skillsEffective Leadership skillsEffective Employee Coaching and TrainingExperience working remotePROFESSIONAL EXPERIENCEMembership Analyst June 2021 -PresentBlueCross BlueShield Columbia SCProduce medical benefit contracts and bookletsExtract medical, dental and vision benefits from the benefit systemCommunicate with Account Representatives regarding validity of benefits as neededSubmit booklet print request to print shop if requestedEnsure that member and group level benefits materials are produced with accuracy and timelinessDemonstrate oral and written communication skillsAnalytical thinking skillsAccounting Technician II Oct 2018 June 2021BlueCross BlueShield Columbia SCPerform billing for assigned groupsProcess/Generate adjustments to billingProcess group reconciliationsProcess refundsResearch payments that are placed on cash suspense to identify where they should be appliedGenerate daily, weekly and monthly financial reportsIdentify errors on reports, research and resolveProcess/Apply paymentsQuality Assurance Coordinator Oct 2015 Oct 2018BlueCross Blue Shield Columbia SCServed as subject matter expert and work leader for Membership processorsTrained staffAssumed managerial tasks in the absence of Supervisor and ManagerAssigned, monitored and audit work of team via Departmental DatabaseEnsured audit performance and reporting deadlines were metProvide customer satisfaction through continuous quality improvementsSr. Quality Assurance Analyst Nov 2013 Oct 2015BlueCross BlueShield Columbia SCConduct quality audits to evaluate accuracy and effectiveness of departmental functionsConduct quality assurance audits of technical documentation; customer service/call center; membership; processing support systems; procedures and claimsIdentified problems, analyze cause and effect and suggest recommendations for improvementsMet with Subject Matter Experts (SME) to document work instructions and proceduresUpdate and maintained DatabasesUpdate and maintained Table of Content for access via Divisional Web SiteEnsured documentation format followed corporate policies and standardsCoordinate, Scheduled and Facilitated Meetings and TrainingProvider Enrollment Analyst Aug 2010 Nov 2013BlueCross BlueShield Columbia SCReviewed, researched, and processed provider and supplier enrollment CMS 855S applicationsEducated DME providers and suppliers on DME applications requirementsVerified documentation to confirm authenticity and validityProcessed applications per Government regulationsKeyed data in Secure Government databaseProvide quality customer service to internal and external customers via phone and emailIssued Medicare number to providers upon application completionAccounting Clerk Jan 2009 Aug 2010BlueCross BlueShield Columbia SCProcessed monthly invoices and mail according to departmental guidelinesAudited Florida Combined Life Dental billing for validity and submit reports of findingsProcessed re-bills to correct rate adjustments, member changes and billing periodsConducted Accounts Receivable Audits upon requestResearched funds erroneously applied and assigned to the correct appropriation for postingCancelled groups, sent final invoices, and issued refunds when applicableProcessed daily depositsProcessed data in various systems - CES, PIRS and FIPSEDUCATIONMaster of Arts: Management and LeadershipWebster UniversityBachelor of Science: Business ManagementUniversity of Maryland University CollegeBlue Streak - Toastmasters Member Competent Communicator |
