We provide IT Staff Augmentation Services!

Guest Engagement Specialist Resume

SKILLS:

Knowledgeable in the following systems: Gems, Fastrak, Ililiad, Oscar, Cims, Epic, Tapestry, Caps, MHS, Rims, Erisco, Epoch, Guest Interface, Badger, Nice, Diamonds, Data Flex, PowerStepp, PowerQ, Meditech, and Columbia Business Systems (Cubs), Envenis Claims System (ECES) Interact, Validator, ACES, Manage Care Workstation, Interplan - processing system, Siebel, Convergence, Rumba, and several homegrown systems. HMO’s, PPO’s, IPA’s, Indemnity, and Individual, Medicare, Medicare Supplemental, Medicaid, HIPAA and Coordination of Benefits. Medical Terminology, Procedure codes (CPT), Diagnosis (ICD-9), and Microsoft Word, Excel, PowerPoint, Project Manager, Visio, Outlook, GroupWise and personal computers.

EMPLOYMENT:

Guest Engagement Specialist

Confidential

Responsibilities:

  • Conduct conversations with the guests to understand their needs, answer questions, and provide personalized solutions.
  • This means being able to perform various roles.
  • This includes (but is not limited to) - advising, selling, responding to inquiries/requests, and resolving guest issues/complaints.
  • Deliver excellent service by answering back-to-back calls and responding in a friendly, timely, and consultative manner, using discovery principles to uncover the Guest needs and matching to the appropriate Hilton offering or solution.
  • Develop an understanding of Hilton and partner offerings (e.g. timeshares, car rentals, credit card, etc.), and then utilize that knowledge to maximize revenue through consultative selling.
  • Demonstrate competency proficiency combined with meeting specific sales and guest service.

Confidential

Consultant

Responsibilities:

  • Audit analyzed and evaluated claims transactions by processing claims for accuracy and utilizing available resources.
  • Applied policies and procedures consistently and accurately in order to evaluate claims transactions.
  • Identified differences between established standards and claims processing procedures, and recommended modifications that conformed to standards using MHS Imaging interface.
  • Medical Billing for several Durable Medical Equipment Companies verified medical benefits and eligibility.
  • Submitted medical claims for payment using Availity and Meditech, verified said payments through vendor systems.
  • Posted said payment to patient accounts and billed patients for coinsurance, deductibles and non-covered charges. Provide Guest services for said patients.
  • Set-up delivery of new equipment as well as taken orders for said equipment.
  • Researched different insurance carriers via the company website for provider for specialty opening for credentialing.
  • If, an insurance carrier is accepting applications for durable equipment providers, the application was submitted and if additional information was needed it was provided in a timely mannered. Maintained the applications and ensured that re-credentialing was performed in a timely manner.

Auditor Office of Inspector General

Confidential

Responsibilities:

  • Audited and evaluated pharmacy prescriptions for accuracy of dispensing according to physician’s directions and quantity prescribed.
  • Ensured that prescriptions were dispensed and billed in compliance accordingly to the Confidential program.
  • Access findings and penalties according to the Confidential program.
  • Examine, investigate, and review records, reports, financial statements, and management practices to ensure legal compliance with state statutes and internal regulation; and conducting audits for program economy, efficiency, and effectiveness. Supervise the work of others. Work under limited supervision with considerable latitude for the use of initiative and independent judgment. Develop audit scope, objectives and project procedures and deliverables as well as statistical sampling plans.
  • Prepare audit reports using Teammate including the preparation of outlines, specification of internal reviews, preparation of drat reports, review of drafts with the clients, preparation of the final reports incorporating client comments as appropriate, and submission of the final reports for review and approval.
  • Recommend changes in business processes, accounting and/or management procedures.
  • Define audit issues by researching specific topics through interviews, document reviews, prior audit findings, and other research techniques.
  • Conduct post-audit assessments, and special investigations into questionable accounting practices and records.
  • Coordinate, review, and oversee work of staff engaged in verifying financial accounting or management operations records.
  • Perform and evaluate compliance testing of significant controls to determine electronic system reliance.

Claims Examiner

Confidential

Responsibilities:

  • Analyzed and evaluated claims transactions by processing claims for accuracy and utilizing available resources.
  • Applied policies and procedures consistently and accurately in order to evaluate claims transactions.
  • Identified differences between established standards and claims processing procedures, and recommended modifications that conformed to standards using MHS Imaging interface.
  • Audit claims using MHS and several difference claims systems.
  • Managed enrollment and assisted with questions regarding eligibility, benefits, and claims.
  • Assisted with inquiries regarding enrollment and billing questions with accurately using ACES, Manage Care Workstation, and Interplan processing system.

Claims Specialist Auditor

Confidential

Responsibilities:

  • Sought recovery for claims, which were identified as duplicates, overpayments and inclusive with other procedures.
  • Performed independent audits as well as statistical audits regarding the finance cycle.
  • Information was updated and documented using Validator software, Word Excel, and Access.
  • Used MHS at a pharmaceutical company that provide compound drugs for the State of Kentucky.

Hire Now