Enrollment Administrator Resume Profile Bronx, NY - Hire IT People

Objective: To secure a position within the health care services industry that will allow me to develop my skills and utilize my education.

Enrollment Representative

Confidential

Confidential

Enrollment Administrator/ Data Analyst

Worked in GHI and QCare legacy systems and GHI Market Prominence systems.
Assisted with CMS Medicare Annual Enrollment and membership enrollment.
Inputted data entry into both EH legacy systems and MP Market Prominence System from member Medicare enrollment applications.
Helped supervise other enrollment staff.
Enrolled members into MAPD / PDP / MA contracts with CMS.
Updated members' information to match CMS and Emblem health.
Followed up with CMS Daily Transaction Reply Report TRR for errors and corrections.

Confidential

Enrollment/ Data Analyst

Reconciled eligibility discrepancies, analyzed transactional data and submitted retroactive eligibility changes.
Verified Senior Medicare Enrollment status in the Center for Medicare database.
Analyzed and entered membership Enrollment and Payment Reconciliation with Center for Medicare and Medicaid Services.
Ensured timely and accurate responses to member inquiries via service requests.
Extracted, transformed and summarized administrative healthcare data using Excel.
On-line data entry and error corrections.
Retrieved data from appropriate Horizon BCBS of NJ computer system, and perform appropriate analysis on data.
Assisted in registering new membership in various health care coverage plans particularly Medicare Advantage.
Reviewed and analyzed of reporting to dictate daily/weekly priorities.
Worked within comprehensive understanding of several databases.
Completed other assigned functions as requested by management.
Generated and ensured compliance and accuracy of various types of member correspondence.

Confidential

Referral Coordinator

Contacted insurance companies for precertification of medical procedures
Performed review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.
Contacted Insurance Companies for authorization of Medical/ Surgical
Procedures,
Managed patients' authorization numbers into Misys database for medical billing.
Documented and recorded patients' hospital admissions and discharges.
Maintained and updated patient hospitalization information in computer database.
Entered physicians medical orders into the computer system.
Maintained communication with hospitals to update pertinent patient information.
Assisted billing department to assign appropriate ICD-9 and CPT codes for medical claims.

Confidential

Research Assistant, Vector Surveillance Unit
Participated and coordinated data collection effort on West Nile Virus.
Set up mosquito traps for West Nile Virus surveillance in NYC.
West Nile Virus Quality control/ Assess the impact of safer WNV control efforts.
Participated in the preparation of scientific publications and presentations of West Nile Virus study's data.
Attended and participated in weekly research meetings.
Oversee confidentiality of all research data.
Assisted in reporting WNV finding to the Assistant director of vector control unit.
Assigned to inspect mosquito breeding areas in New York City for spraying
Collected mosquito larvae to NYCDOH laboratory for WNV analysis.
Entered West Nile Virus data for computer analysis.

Computer Skills: Microsoft Windows Applications Microsoft Word, Excel, Access,

PowerPoint