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Click here or scroll down to respond to this candidateCandidate's Name
Jacksonville,Florida Street Address
Phone PHONE NUMBER AVAILABLEEMAIL AVAILABLESummary: Extensive years of experience as a Provider and Member Contact Center Professional within the Healthcare Industry. Proficient in ICD 9/10 codes, Claim entry, Claim adjustment, and Medical Coding and Terminology. Experience in providing information regarding patient accounts to authorized callers while complying with HIPAA guidelines and regulations. Hands-on experience in Diamond and Quest Claims processing; responsible for researching, coordinating and resolving written/ telephone inquiries and claim exceptions including claims process for: HMO, Blue Options, PPO products, Blue Care, Blue Choice, and Medicare Advantage. Responsible for sharing knowledge with team members on Diamond system workflow to ensure consistency in claims processing guidelines along identifying, documenting, and monitoring improvements to the Provider Service Organization processes internally and externally. Educate business partners on Availity capabilities (Eligibility and Benefits, Claims Reconciliation Tool and CareCalc). Developed manipulation in Microsoft Office Applications to include Word, Excel, PowerPoint, Outlook 2010, as well as SharePoint. Outstanding ability to perform in high stress situations and adapt to change with no supervision and communicate with corporations, insurance and Pharmaceutical companies via telephone or correspondence.Skills: Customer Service & communication skills Knowledge of Medical Coding and Terminology. Ability to collect and summarize data, identify trends and propose logical solutions. Manual Claim entry. Manual Claim adjustment. Knowledge of Eligibility and Benefits, Claims Reconciliation Tool and CareCalc. Spreadsheet & Database Creation ICD 9/10 codes Data entry Developed manipulation in Microsoft Office Applications to include Word, Excel, PowerPoint, Outlook 2010, as well as SharePoint. Siebel7, Power Point, Excel, Microsoft Word, ICS, IMS, MHS, EIP, CIP, PVDR, RBMS, Legacy, SAP,Fore help, Imaginator, Convergence, Seibel Super User, Client Letter, Quest, CMCA, Diamond, PIP, COB, NIA, PAIS, RADMD, PPFI2800, APT, CRT, AVAILITY,HICS, BEIC-Archer, Service Link Peoplesoft and Blue Squared. Group, individual, and specialty products Blue Options, Blue Care, Blue Choice, GoBlue, BlueMedicare HMO, BlueMedicare Rx, BlueMedicare PPO, Blue Medicare Private-Fee-For-service(PFFS), Medigap Plans, MyBlue. Lines of Business BlueChoice (PPO, POS), Blue Options, Blue Care (HMO), and Traditional. Scion, PA State System, Wand, Davis Vision, IAD, Citrix, EXP, Member Portal, NPI Cross work, Verint. Possess excellent oral and written communication skills to effectively respond to inquiries and all levels of management. Utilize excellent analytical skills with the ability to apply analytical thinking in order to facilitate problem solving, decision-making, and process improvements. Outstanding ability to perform in high stress situations and adapt to change with no supervision. Excellent organizational skills, with high attention to detail, which allow for managing multiple priorities with optimal performance and perseverance to completion. Education: High School Diploma (GED), Florida State community College, Jacksonville, FL May13 Professional Achievements: Shining Star Award Rising Star Award BCBSFL Six Sigma Introduction Six Sigma Yellow Belt Certification Experience:Bank of America/ ICONMA Oct. 22 Jan. 23Wealth management Client Service Effectively educate, promote and guide clients through our online and mobile self-service capabilities at every opportunity. Provide clients with clear, complete and accurate responses to their questions and inquiries at point of call Manage risk by accurately authenticating clients, fully adhering to policy / procedures and proactively identifying and escalating potential risks Error-free and timely processing of client requests (i.e. cred card payments, transfers within accounts, setting up online banking access, credit or debit card activation, etc.) Navigate through multiple applications and tools to understand policy / procedures, gain clarity on various products / services and research and resolve issues with client accounts Display passion, commitment and deliver an experience that improves our customers financial lives WestRock/ MWIDM Oct. 21 May 22Accounts Payable Processor II Processing of accounts payable invoices in paper and electronic form. Adhere to requirements as defined within a service level agreement (relating to processing time frames, discounts captured, response times to vendor/mill inquiries, etc.). Maintain an accounts payable process which is invisible to the vendors and mill locations, achieved through diligent and efficient processing. Be part of a shared services A/P group and will be responsible for taking part in the processing of over 1,000,000 invoices annually. Work with different forms of technology Service the customers of the Shared Services Group, Providing good communication skills necessary in conflict and error resolution. Percent Of Time Duty or Responsibility 70 Process newly received / queue invoices 30 follow up from prior period unresolved issues (communicate with operating locations or offshore team). TD Bank/ Randstad Jun 20 Sept. 21Collection Agent Record information about the financial status of customers and status of collection efforts. Locate and notify customers of delinquent accounts by mail, telephone, or personal visits to solicit payment. Locate and monitor overdue accounts, using computers and a variety of automated systems. Performs more diverse/complex tasks with minimal supervision Acts as a liaison between assigned department and other departments within TD Bank Works to identify and address process improvements Provides support to less experienced staff Responds to inquiries and assists in resolving problems/complaints May be required to find and supply data impacting accounts Protects privacy and non-public information Assists in the prevention of fraudulent activities Reviews application information against host systems for accuracy and completeness Suggests changes or modifications to policies and procedures to supervisor based on day-to- day observations and activities Escalates more complex or unusual issues to lead or supervisory staff Prudential/ Asphire Mar 2020 Apr 2020Claims Processor Our client, a Fortune 500 Financial Services Organization, is looking for several individuals to join their beneficiary services team. This is a great chance for any individual looking for an opportunity to gain experience in a corporate environment. You will learn our clients corporate culture and service lines through an interactive training period.Responsibilities of the Claims Processor: Validate beneficiary information Validate contracts Verify the claimants information Process the cases of the customers Enter the customers contact information into their database Examine file and compare data, such as date of birth and contact information Cross-Reference case information to validate accuracy Requirements for the Claims Processor: Experience processing claims Professional Demeanor: Demonstrating patience, composure, and client service attitude, Problem Solving. Decision Making Skills Initiative: Demonstrate a "self-starter" behavior and a willingness to help others Communication Skills: Communicate effectively both written and verbal, tailor communications to the audience, actively listen and follow-up with questions and updates to involved parties, Multi- tasking, Ambition to succeed, Strong people skills, Flexible, Great Customer Service, and Empathetic/Sympathetic.AmeriHealth Caritas /PeopleNTech Dec 2018 Feb 2020 Member Outreach/Member Services Responsible for responding in a timely and professional and courteous manner to all customer inquiries. Assisting disabled customers get the care needed Assist member and/or provider phone calls or correspondence regarding benefit, eligibility or customer issues. Processing inbound and outbound callsSE Grocers/ BTG (Temp) Sep 2018 Nov 2018Human Resource Preparing or updating employment records related to hiring, transferring, promoting and terminating
Answering questions regarding payroll, anniversary dates, vacation and sick time and pay increases Open cases for leave of absence, FMLA eligibility, assist with on-boarding for new hires Ensuring new hire paperwork is completed and processed Explaining human resources policies, procedures, laws and standards to new and existing employees Assisted with navigation and password resets for the self-service portals Assisted with Benefit Enrollments and Life Events, such as promoting and conducting open enrollment periods when workers can make changes to health care plans and other benefits options. Florida Blue, FL Dec 2006 Jul 2017Provider Contact Center/Member Contact Center Research and educate providers on questions dealing with Claim status, eligibility, and benefits. Provide senior Assistance to outsourced representatives. Managed switchboard, answering all calls from patients and outside sources directing questions and messages to appropriate in a timely manner and data entry Achieved high performance evaluations for call handling ability and quality of services provided to patients in a fast paced, high volume call center. Assisted patients with all aspects of insurance billing resolution or payments and documented any information or conversations in the computer regarding the patient's accounts. Provided information regarding patient accounts to authorized callers while complying with HIPAA guidelines and regulations Resolved problems or forwarded to managers as needed to diffuse intense situations and frustrated callers. Communicated with corporations, insurance and Pharmaceutical companies via telephone or correspondence. Provide support as a corporate operator. Research and review appeal requests and billing disputes from providers. Diamond and Quest Claims processing; responsible for researching, coordinating and resolving written/ telephone inquiries and claim exceptions including claims process for: HMO, Blue Options, PPO products, Blue Care, Blue Choice, and Medicare Advantage. Obtained and analyzed data in order to determine the root causes of internal and external customer issues utilizing internal business tools to include Diamond, Quest, MCG, etc. Coordinated and collaborates with Physician/Provider Relations Specialists to identify formal educational opportunities for Providers and their staff. Other Party Liability knowledge. Share knowledge with team members on Diamond system workflow to ensure consistency in claims processing guidelines along identifying, documenting, and monitoring improvements to the Provider Service Organization processes internally and externally. Educate business partners on Availity capabilities (Eligibility and Benefits, Claims Reconciliation Tool and CareCalc). Supported Blue card customer service call center. Supported Utilization Management department. Supported Strategic Provider Services.Aramark, Jacksonville, FL 2004 2005Custodian Responsibilities: Aided Duval County School board in the challenge to keep Dual public schools clean and presentable. Served as a motivated highly trained custodianCarriage Club of Jacksonville, Jacksonville, FL2001 2004Home Health Aide Responsibilities: Supported and aided in the daily activities of the elderly. Help keep their residence up to par with a strict ritual of cleaning every part of their living quarters. Furthering the residence enjoyment during retirement Wendys, Jacksonville, FL2000 2001Customer Service Representative Facilitated and expedited the experience of the customer in the restaurant. Created an enjoyable and pleasant catering to the customer's needs while dining in or carrying out. |
