Objective:

Looking for a position in which I may be able to share my knowledge as an Analyst and experience in Quality Assurance.

Skills:

• Customer Relations
• International Relations
• Client Relations
• Office Support
• Data Entry
• 10-Key
• Excel Reports with Graphs
• Power Point Presentation
• Quality Assurance in Medical, Dental, and Vision Claims
• Quality Assurance in Medical and Dental Claim Sorting

Employment History:

Confidential

• Perform daily pick up of mail from Post Office
• Sort Mail per PO Box and Document Type
• Make Copies of needed documents to ensure that dark images are lighten and poor image quality items are made better to avoid delay in claim processing.
• Prepare and ship packages based on point of contact per business unit.
• Perform checks and balances for the Mailroom Division and Data Entry Operators to ensure standard goals are being met based on a quality performance level.
• Work closely with management providing feedback on the quality standard of the respective service to include Medical, Dental and Vision Claims.
• Perform bi-weekly review on the data gathered from sorting, scanning, and processing of claims and provide feedback to employee both on strong points as well as critical concerns.
• Perform accountability measures per error found and provide feedback with the employee.
• Monitor and determine where business practices can be updated with improved training measures and reduce the necessary workforce when workloads are below average.
• Develop and maintain Standard Operating Guidelines and Procedures for the workforce to follow including making the necessary document changes when system updates from project plans have been deployed into production.
• Implement and perform the necessary training to accommodate new and improved business practices which will include training, monitoring, reviewing and ensuring new rules are understood and being followed after change implementations.
• Provide the company with detailed reporting illustrated into graphs, charts, Excel Sheets and integrated into a PowerPoint presentation to be presented to the management to give recommendations for profit and financial accountability.
• Report findings on issues and document the appropriate steps taken on correcting the issue to both the company and client leads as well as show what steps of improvement were taken to correct the issue and ensure that the issue will not arise again based on the given findings.
• Respond to client audits by providing feedback including accepting or disputing errors listed in a timely manner with a 24 hour turn around.
• Evaluate and test new or modified software development procedures used to verify that programs function according to client requirements and conform to established guidelines: Writes, revises, and verifies quality standards and test procedures for program design and product evaluation to attain quality of software economically and efficiently.

Confidential

• Provided support for individual department quality control processes
• Ensured accuracy and completeness of medical claim sorting
• Developed and maintained Quality Analysis scorecard
• Updated procedure manual to ensure that guidelines are current with business requirements and changes.
• Assisted in collecting information for staff performance
• Reviewed individual and group performance against established standards.
• Provided administrative support to business operations by performing processing tasks such as scanning mail sorting or similar activities.
• Performed data entry of material from source documents to a computer database
• Transcribed routine pre-coded and identifiable alphanumeric data from source document into an automated system.
• Reviewed weekly statistics and record data necessary for analysis of key processing areas
• Generated daily, weekly, and other periodic reports.

Confidential

• Submitted HCFA claims and Crossovers for the State of Texas Medicaid and Medicare Insurance Programs.
• Provided data entry and verification support to a task, project, contract, or division
• Operated data entry equipment to code, format, and transcribe data from a source document into a form suitable for storing, retrieving, processing, and manipulating within an automated system.
• Entered data into formatted or unformatted screens and/or documents.
• This was an entry-level clerical support position requiring familiarity with data entry and keyboard functions.
• Performed routine data entry functions and assists with simple formatting tasks following established policies.
• Worked under immediate supervision and work was monitored closely monitored for Accuracy and Quality Assurance.

Confidential

• Provided Pharmacy Operation Center customers with quality, customer sensitive contacts, prompt problem resolution, and overall support to ensure exceptional customer satisfaction.
• Served as a primary point of contact between customers and internal staff for issues concerning the Pharmacy Data Transaction Service.
• Served as first tier Tier I of support for customer inquiries.
• Promptly assumed responsibility for resolution of customer problems relating to the Pharmacy Data Transaction Service.
• Worked with customers to define the problem and resolve the issue.
• Diagnosed problems within her scope of expertise, determined the cause, identified customer needs, and escalated ticket/caller if necessary.
• Utilized problem solving and decision-making techniques to develop and coordinate accurate, effective solutions, which result in customer satisfaction.
• Adhered to the PDTS Memorandum of Agreement MOA to include the Privacy Act, which states: Employees shall not disclose any personal information contained in any system of records. All documentation containing Privacy Act Information shall be destroyed in the shredder provided in the POC Support area.
• Represented the Pharmacy Economical Center, the Pharmacy Operation Center, and Program Office at TMA in a positive, professional manner to ensure customer satisfaction and meet all agreements with the customer.