PROFILE:

• Over 15 years of experience in Customer Service, Account Management, Project Management and Billing Analyst positions
• Highly motivated professional
• Strong troubleshooting and multi - tasking skills
• Excellent organizational abilities with precise attention to detail
• Outgoing personality - excellent communication and interpersonal skills

PROFESSIONAL EXPERIENCE:

Confidential, Mansfield, MA

Project Manager

Responsibilities:

• Manage Device Coding and Medicare/Medicaid Reimbursement for 14 Specialty Medical Device lines totaling 1000+ products.
• Manage external Reimbursement Hotline team including all new product and Coding/Reimbursement questions that their team is unable to answer. Process monthly and yearly rollup report with stats from team.
• Work cross functionally with internal groups to formally map our products with correct coding for reimbursement by processing and submitting all applications through Medicare’s PDAC vendor .
• Research and resolve ADHOC requests from internal teams ie: Specific state reimbursement landscapes, local coverage determinations and top 10 state review.
• Work cross functionally with internal Strategic Pricing group to resolve pricing research requests ie: First Databank, Medi-span, Redbook . Answer all external requests for pricing, labeling and pictures of devices. Process yearly pricing update files to send to 3 agencies.
• Collaborate with internal teams to provide required documentation for Medi-Cal Product Category review for our Maximum Acquisition Contracts which allow special pricing for all distributors in the California area for our Incontinence, Urology and Wound Care product lines.
• Handle all state Medicaid bids/Request for Pricing for all product lines and Competitive Bidding programs.

Confidential, Raynham, MA

Consumer Quality/Complaints Specialist

Responsibilities:

• Work closely with sales and consumers to respond to complaint reports via phone and email.
• Evaluate complaint to determine reportability to Confidential and other regulatory agencies.
• Ensuring all orders get handle as a priority per cases, add on’s and traumas.
• Process complaints in system and quality replacement orders within a 1-day turnaround.
• Review and analyze complaint data to determine trends and escalate issues to management or medical safety.
• Closely monitors quality, completeness and timeliness of complaint file to adhere to compliance and company regulations.
• Monitor que of my open complaints to ensure they are closed within guidelines.

Confidential, Canton, MA

Senior Disability Claims Examiner

Responsibilities:

• Manages assigned caseload of 200+ new and ongoing disability insurance claims .
• Evaluates claim eligibility. Interacts with internal and external customers including, but not limited to, claimants, agents, benefit access staff, physicians, service and underwriters to gather the information a make the decision on the claim.
• Analyzes, approves or denies claims for contestable and non- contestable cases while ensuring compliance with state and federal requirements and maintaining privacy of confidential information.
• Makes payment decision, follows up and monitors ongoing claims for payment accuracy and timeliness; follows claim to closure.
• Provide exceptional customer service within the organization.
• Creates written correspondence to collect on overpayments of claim payments.

Confidential, MA

Multiline Claims Associate

Responsibilities:

• Review of Long-Term Disability, Life and Waiver of Premium claim documents .
• Set up new claims via Ultera, Chess, Life Support and Glib systems. Set up Rider Claims based upon LTD claims and policy provisions.
• Monitor Queue and Report daily team activity to management; assign all new claims to team. Ensure all claims are processed within the 24-hour Service Level Commitment.
• Primary taxation lead role on team. Process W2’s; corrected W2’s and manual W2’s in Taxport and via Finance. Resolve all tax inquiries with various internal teams and claimants. Conference calls to resolve complex issues with Brokers and clients.
• Research IRS regulations and gather all applicable publications to train and distribute internally and externally
• Primary trainer of Long-Term Disability; Employee; Customized; Critical Illness and complex claims at Confidential location and Windsor, CT location.
• Highly recognized with multiple s from management and directors along with a promotion prior to reaching 1 year within the department.

Confidential, Raynham, MA

Field Support Coordinator

Responsibilities:

• Processing orders via phone, email and fax for surgical equipment and implants via JDE Edwards One World, SAP, Lynx, FileMaker and Millstone.
• Served as primary back-up to the Consignment team for processing Consignment, Loose Goods, Replenishment and Field Inventory orders and requests.
• Ensuring all orders get handle as a priority per cases, add on’s and traumas.
• Set up couriers and flights out for high priority cases to ensure patient/doctor satisfaction.
• Daily Reporting of all outstanding orders, late returns, missing/broken items to my assigned 5 Sales Regions with 60+ reps utilizing Outlook and Excel. Assisting with additional reporting on an as needed basis/back up
• Assumed responsibility of the emergency pager being on call 24/7 on a rotation basis.

Confidential, Quincy, MA

Billing Analyst

Responsibilities:

• Handle queue of 60+ billing inquiries from discrepancies to retention issues.
• Compare customer issues with the contracted rates on file
• C orrect billing discrepancies after researching via various outlets within the company and customer backup received
• Apply credit to account once billing issue resolved.
• Place bill hold to review structure and corrections made to the account.
• Completed billing inquiries on or before the provided commitment timeframe.
• Handle all Customer Service Web contacts daily via Web Portal as well as Business Transfer requests.

Confidential, Quincy, MA

Escalation Mac / Provisioning Analyst

Responsibilities:

• Process non-complex & complex move, installations and change orders on customer's phone lines-Work closely with Ilec's on getting orders processed & resolving errors
• Handle Escalations of all orders that are in jeopardy status due to Ilec or customer error
• Work closely with account managers and repair department to ensure customer satisfaction with all processed orders
• Priority escalations were worked until completion no matter length of issue escalating to highest possible to get the order completed immediately to ensure no lapse in customers service