TECHNICAL SKILLS:

Adaptable/Multitasked: Able to adapt oneself to new surroundings; to make suitable change so as to fit new conditions, while handling multiple task in a high volume environment.

Flexible: Manageable and adaptable to processes and procedures in a constant changing work environment .

Self starter/Independent: Ability to work on my own without being constantly supervised.

Consistent: Constant to same principles, not changing.

Analytical: Employing analytic methods; separating things into their parts of elements to provide strategic, positive solutions to every project with consistent communication.

PROFESSIONAL EXPERIENCE:

Confidential, Baltimore, MD

Computer Systems Analyst II

Responsibilities:

• Knowledgeably and professionally representing the Confidential and the Centers for Confidential with Confidential professionals, respectively.
• Proactively and independently analyze and resolve Confidential issues.
• Performs immediate analysis of customer problems and directs the implementation of corrective action plan to restore function and avoid recurrence.
• Functions as the single point - of contact for problem escalation and resolution as required.
• Records all incidents while maintaining accountability and ownership until resolved. Interfaces with appropriate technical personnel for customer problems that cannot be resolved quickly on the telephone.
• Resolves technical issues preventing normal business processes from completing. This may entail resolving file content errors, file transfer problems, user error, etc…
• Trains staff members on production issues.
• Triages research and document findings to complex inquiries that other Computer Systems Analyst cannot address.
• Resolves or expedites issue resolution and answers to questions for inquiries from healthcare providers, as appropriate.
• Uses the Remedy application to log, update and resolve tickets, following all standard operating procedures.
• Escalates inquiries to the appropriate CMS organization or third party for timely resolution.
• Monitors the resolution of open issues and ensures all telephone and electronic inquiries are resolved in a timely manner.
• Handles escalated situations while assuring quality outcomes. Participates with management in identifying volume trends, as well as best practices to create greater process efficiency for the Confidential Clinical Administrative Coordinator.
• Consistently and quickly performing work, and reviewing and analyzing Remedy data to determine trends.
• Tests application functionality and reports test results.
• During high volume periods, answers calls directly and interacts with inquirers, provides accurate and quality responses while adhering to security and PII protection protocols.
• Identifies and recommends improvements to processes, as needed.
• Develops Standard Operating Procedures (SOPs) and detailed work instructions as required.
• Designs business processes, business process models, and performs other tasks that demonstrate technical understanding of production operations.
• Reads and understand Interface Control Documents {ICDs} and system or application requirements documents.
• Develops system and Confidential reports as required.
• Adheres to NGC corporate policies, initiatives, and directives as well as adhering to all guiding principles as required by CMS.
• Conducts One-To-One session with all associates, tracking issues & concerns raised - forwarding the details to respective department

Confidential, Owings Mills, MD

Total Loss Clerk

Responsibilities:

• Complete intake information for customer and insurance carrier notification of total loss. Initiating the release of titles to insurance carriers once settlement funds have been received and applied to the account & complete GAP claims on accounts that have purchased GAP insurance and a deficiency balance remains after the primary insurance settlement has been received.
• Evaluate the vehicle value on accounts where the vehicle has been deemed as totaled (damaged or theft).
• Cancel any additional insurance products that were purchased through the dealership and capitalized in the customer's original loan balance.
• Fax any missing documentation to insurance carriers to process insurance claims
• Contact appropriate agencies/ customer’s to secure information needed to complete processing and request for payment.

Confidential, Elkridge, MD

Associate Clinical Administrative Coordinator

Responsibilities:

• Manages contracts while supporting the Clinical Administrative Coordinator with organizing projects and following through a diversified volume of various contracts to develop assessments for benefits of health intervention.
• Provides technical assistance to develop a national communication and advocacy strategy for Confidential recipients to develop a national communication and advocacy strategy.
• Places a high volume of outbound calls for managed care of the Confidential beneficiaries of the health plan to schedule in home clinical visits with a Physician or a Nurse Practitioner.
• Responds to high call volume projection for Confidential valued members with assisting their inquiries while resolving issues and discrepancies in the entitlement of health plan benefits.
• Validates member demographic information and obtaining additional member data via specific plan scripting using the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to protect Personal Health Information.
• Coordinates the call center data entry records of the Confidential members’ record with accurate information obtained on the call. Resolves any scheduling issues or concerns with Medicare beneficiaries and Medicaid recipient’s issues and discrepancies in the entitlement request.
• Ensures overpayments and debt management are waived penalties for non-compliance with reporting requirements with the penalty provision.
• Trained new staff with health plans financial accounting, purchasing, payments and billing.
• Recommends solutions to managers and program officials on management or program-related policies and procedures.

Confidential, Owings Mills, MD

Customer Service Representative I

Responsibilities:

• Implement health plan strategies with Confidential recipients through telephonic interactions and written inquiries including but not limited to, enrollment, billing, claims knowledge, claims processing of adjustments, interpretations of benefits and contracts, benefit upgrades, coordination of benefits, research of client history, documentation of all client encounters, and collaboration of medical experts to determine needs to managed care intervention.
• Educate Confidential recipients by interpreting contractual language for the purpose of providing benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of service to customers within the business segment through telephone inquiries, written/ and claims adjustments.
• Examine adjudicated claims to identify key elements and processing requirements based on diagnosis, procedure, medical policy, contracts and policy procedures.
• Research, investigate, and initiate resolution of pends by the processing system. Calculate and verifies deductibles, maximums, co-payments and co-insurance for resolving inquiries, facilitating adjustments, initiating extra contractual and reporting of any system processing error, over and underpayments.
• Apply the ability to analyze customer contracts and needs involving current product mix, risk assessment, and revenue impact.

Confidential, Baltimore, MD

Office Clerk II/Collections Rep

Responsibilities:

• Manages state debt collection and underpayments for the Department of Maryland Motor Vehicle Administration by establishing payment arrangements and refunds using the state central system database.
• Manages customer complaints or questions relating to departmental procedures and operations and provides information on departmental services and functions.
• Files reports, records, forms and other material according to office procedures for service request, work orders and follow-up status request inquiries.
• Retrieves and assembles material from files and other sources for the supervisor's review and use for screening purposes to determine accuracy and completeness of personal identifiable information.
• Verifies customer complaints and forwards same to appropriate agencies for resolution; follows-up on customer service requests and/or inquiries not resolved by maintaining logs, records and lists for state budget.
• Completes and forwards Debt management form letters for request of numerous types of files and record for consumer’s requiring state collections.
• Processes, retrieves and updates information using computer software applications.
• Maintain routine statistical and numerical records requiring basic arithmetic computations.
• Provides guidance and support for to staff on correspondence, reports, schedules and other material using a computer, word processor and/or database systems.
• Performs other related duties, and special projects.