Credit Card Servicing Supervisor Resume

TECHNICAL SKILLS:

Oracle Certified, Microsoft Certified, MetaVance SME, BlueSquared, Facets, TriZetto Networx, Pricer, Legacy, WGS, Ultera Imaging, GPOO, ITFI, ITS, Epact, EDI systems, CA Filenet, CallCare Browser, Lotus Notes and Microsoft Office products. Acted as liaison between platform and Networx Pricer experience of 1.5 years. 2 years’ experience with SAS, SAP Business Objects, KAMES, MMIS, eMAR, CCMS.

PROFESSIONAL EXPERIENCE:

Confidential

Credit Card Servicing Supervisor

Responsibilities:

My responsibilities are first and foremost the security and protection of our military member’s financial information. In doing so I manage teams of 13 - 20 agents to service members financial accounts.
Supervisor of Confidential (Member Security) and Credit Card Servicing
Warrior Leadership Division trained Supervisor
Member of site directors top 10 LOB supervisors

Confidential

DRG Coordinator

Responsibilities:

Review and validate DRG audit documentation submitted by RN Auditors and submit findings to provider Hospital.
Primary contact for hospital medicals records department and business office staff.
Acts as liaison and troubleshooter between healthcare providers (Hospitals, Physician Offices etc.) and Confidential Healthcare.
Follows up medical records and system updates to insure pipeline is within client standards.

Confidential

Medicaid Fraud Investigator

Responsibilities:

Investigate complex cases in response to public inquiries and prepare oral or written proposals based on Confidential for potential Medicaid fraud and abuses.
Identify changes needed to program regulations as the result of changes to federal or state statutes.
Ensures that providers meet all prescribed standards of eligibility mandated by statutes and regulations. Analyzes health care data and explains trends in program cost and usage.
Participate in Technical Advisory Committee and provide reporting and/or information required.
Maintained Risk Management entire client files for Government Critical Behavioral Reporting.
Creator of facility Risk Management database for reporting risk assessments to Cabinet Members
Prepares documents for filing, storage, data entry or other processing.
Prepared annual records and reporting to assist facility reporting to Cabinet Members.

Confidential

Reimbursement Therapy Coordinator

Responsibilities:

Coordinated pharmaceutical care services for patients using the Confidential therapy program by conducted benefit investigations as necessary with client’s health insurance company.
Communicated with medical ( Confidential ) practices, sales representatives regarding the status of cases and provided consultative services where issues arose.

Confidential

Medicare Provider Credentialing Analyst

Responsibilities:

Under CMS guidelines examined a potential provider participant's history and evaluate the practice, training, skill level and capacity to of provider to administer specific services or carryout specific tasks per provider’s medical license.
Assessed the legitimacy of the individual seeking to obtain the credentials. (i.e., institution for higher learning, where conducted their internship, residency and fellowship, Board Certifications and State Medical License(s)) are additional areas that may be explored.
Skill set for this position: PECOS, MCS, PMDB, NPPES, QNXT, File Net

Confidential

Claims Analyst

Responsibilities:

Participates in healthcare special projects, creates training materials for both temporary front end and claims adjustors and assists with the training of full time employees.
Applies contractual PPO pricing, coordination of benefits and Medicare or Medicaid benefits to CMS 1500 and UB 92 claim forms.

Confidential

Business Operations Analyst

Responsibilities:

Created and maintained database to monitor daily and monthly analysis of all interest and penalty requirements for Healthcare claims ensuring claims were paid in a timely manner. This in turned saved Confidential in the course of 9 months. I was awarded the Northern Star for my contributions.
Created all documentation and integrated new processes/products, process enhancements and customized account uniqueness into the Claims Operations Dept. for Confidential, Inc.
Ensured a smooth transition from current client platform to MetaVance platform. Communicated resolution for consistency and accuracy of the departments responses and acted as a liaison between client and all Confidential departments concerning claim development specifications.

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