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Click here or scroll down to respond to this candidate626 Piper CourtMyrtle Beach, SC Street Address
Cell PHONE NUMBER AVAILABLEE-mail EMAIL AVAILABLECandidate's Name
EmploymentJuly 1, 2004 to April 5, 2018Blue Cross/Blue Shield of SC, 8733 Highway17 Bypass, Surfside Beach SC 29575 PHONE NUMBER AVAILABLESenior QA Analyst Audit Tricare claims (CPT-4 and ICD-9 coding as well as Beneficiary claims).Written correspondence, WEB inquiries and telephone calls for customer service associates, checking for accuracy, timeliness and tone. . Coordinate timely review of audit findings and provides analysis and timely reporting to management. Complete in-depth research of errors detected, identified clerical, payment and systematic errors providing feedback to associates and managers. Assist Quality Control Analysts in cross training of new activities and research for data relative to customer service auditing or appeals. Maintain current operation desk procedures, TRICARE Policy Reimbursement, OPM and ADP, coordinating and implementing changes as needed.May 1, 1995 to July 1, 2004 Blue Cross Blue Shield of SC, Surfside Beach SCEducationLead Claims AssociateTeam Leader for customer services associates. Handled the most complex claims, correspondence, telephone calls and WEB inquiries (included Reprocessing, adjusting and claim data entry). Responsible for TRIWEST/TRICARE letters of direction Trained and Peer Coached all new associates to POD and other PODS when necessary. Determined Solutions (both long term and short term) for underlying causes of complaints or repeated inquiries and verify proper guidelines were followed. Personal Achievements: Completed Introductory DB2/QMF/Sql for non-programmers Team member for CRM: Smart Scripts (HNFS/PGBA Transition Planning)ICO 9001:2008 Certified (International Organization for Standardization)July 14,1979 thru August 1994 Department of Defense Naval Air Station San Diego CA, Naval Air Station Adak Alaska and Lemoore Naval Air Station, Lemoore CAPurchasing Agent/Contracting Officer Inventory Management Division for all stock classes including aircraft electronics, specialized machinery Researched all informal open market methods and competitive bid procedures. Assured rapid delivery of goods and services in direct support of operational requirements.1980 to 1981 North County College Escondido CAParalegal1982 to 1988 University of Alaska Adak AKPsychology1966 to 1967 Monroe Business Institute Bronx NYBusiness AdministrationVolunteer experienceElected member of the Board of Directors (offices held: President, Vice President and Secretary) for housing development in Myrtle Beach, SC,Vice President for Carolina Swamp Fox chapter of Blue Star Mothers of America, Inc.Personnel Officer for Civil Air Patrol #SC107Involved with Greyhound Rescue group (Greyhound Crossroads)Secretary and Treasurer for Alpha Beta Sigma SororityCivil service gradesGS07 |
