OBJECTIVE:

• A challenging growth - oriented career with an organization that will enable me to perform strong leadership skills as an Office Assistant adding to the company's progressive success.

PROFESSIONAL EXPERIENCE:

Confidential

Service Representative

Responsibilities:

• Responsible for the development, implementation, and monitoring of a Medicaid Managed Care Services (MMCS) specialty areas related to Confidential ’s contractually driven projects.
• Served as an expert on assigned project/contracts.
• Provided communication, education, and promotion of program services.
• Collaborate with medical and other professional staff to meet contractual deliverables within deadline.
• Communicate with MMCS staff and beneficiaries ensuring timely provisions of services and appropriate follow up.
• Document services rendered and provider reporting as required.
• Heavy data entry

Confidential

Customer Service Advocate

Responsibilities:

• Assist members and co-workers by responding to telephone, written inquiries, and emails in a prompt manner.
• Advised members on services, plans, coverage, and contractual agreements.
• Processed requests, and account changes, adhering to company policy and procedures.
• Consistently improved member satisfaction through expert resolution of conflicts, issues, and concerns.
• Research rapidly resolving member conflicts to prevent loss of key accounts.
• Maintained a high level of productivity and accuracy while navigating between multiple systems.
• Researched and advocated customer inquiries resolving complex and escalated issues

Confidential

Claims Review

Responsibilities:

• Analyzed, and approved routine claims that could not be auto adjudicated.
• Applied guidelines to determine coverage, eligibility verifications, identify discrepancies, and applied all cost containment measures to assist in the claim adjudication process.
• Proofed claims, and referrals to determine, member identification, provider selection, and claim coding process.
• Managed claims on desk, and in route/queues within specified turn around parameters in accordance to prescribed operational guidelines.
• Coordinated responses for routine phone inquiries and written correspondences.
• Utilized all applicable system functions available to ensure accurate and timely claim processing.
• Heavy data entry.

Confidential

Member Services Rep/clerk

Responsibilities:

• Integral member of Customer Service Team responsible for handling incoming calls, emails, and correspondence.
• Gathered and verified all required customer information for validation and tracking purposes.
• Addressed and resolved customer complaints empathetically and professionally.
• Defused volatile customer situations calmly and courteously.
• Customer service support including handling contractual agreements, credit applications, monetary inquiries, transfers, payments, credit card support, online chat, bill payment, falcon fraud assistance.

Confidential

Order Manager

Responsibilities:

• Planned and processed orders, coordinate, and provided support to sales team, and installation process.
• Work closely with field techs, test, and activation teams to determine issue and work toward resolution.
• Maintain customer inventory, coordinate with service delivery and close order with customers.
• Responsible for interfacing with customers (internal and external) to handle and provide solution/assistance about a variety of pre-sales or post-sales service functions as beginning -to-end order status management.
• Manage daily reports, and unique situations as business requires.
• Prepare weekly management updates of current order status.
• Arrange transfer of materials to meet production schedules.
• Reviewed, managed, tracked, and audited; supplies, changes, and charges through-out order process.
• Invoicing, as well as handled all billing inquiries including questions, concerns, issues, and complaints.

Confidential

Insurance Verifications

Responsibilities:

• Contact carrier groups to obtain eligibility information from internal lead sources.
• Update eligibility date into internal system as instructed.
• Answer incoming calls from providers, recipients, and other entities in relation to insurance coverage.
• Research eligibility information online with various carriers and update required systems including the state eligibility system.
• Make outbound calls to various carriers to obtain eligibility information.

Confidential

A/R payment Clerk (Data Entry)

Responsibilities:

• Process delinquent tax payments.
• Managed, entered, and balanced payments in general ledger
• Received and managed daily revenue via check, cash payments, and or credit/debits cards.
• Ensured providers that their investment data was entered in the system as specified; that means making sure the correct percent of each payment was allocated properly into each fund selected.
• Provide supporting documentation for audits; as well as issuing out pay checks for our employees.
• Organized and provided documents, reports, and information to department and external clients in a timely and well-organized manner, while meeting all deadlines required.
• Created and maintained active files and database records; processed providers orders, invoices, and payments.
• Processed daily, weekly, monthly and end of year close-outs.