813-***-****

acrzw5@r.postjobfree.com

Joi Freeman

Objective

To secure a career opportunity with an organization that will enable me to maximize my organizational skills, educational background, and to grow and to contribute in the most effective manner as an effective team player.

Qualification Summary

Outstanding organizational and prioritization skills.

Able to execute appropriate decision making resulting in positive and expected outcomes.

Ability to analyze process and documents identifying to identify gaps making recommendations which result in process improvements

Strong decision making and problem solving skills which result in immediate actions leading to positive results.

Detailed-oriented and able to work with persons of diverse populations in a customer service role.

Experience in Consumer Packaged Goods industry in Receivables and Collections

Excellent time management skills and be able to handle multiple, simultaneous tasks effectively and efficiently while maintaining a professional, courteous manner.

10 year secret security clearance issued by the Department of Defense

Skills

Microsoft Office; Excel, Outlook, Power Point, Word, Access

Lotus Notes

Data Entry 9,000kph

Professional Experience

Acosta Sales and Marketing / Repay Specialist

Business Process Solutions 06/2015-present

Determine which cash deductions have been taken in error by the customer and send repayment request to customers

Follow up with customer to collect repayments in a timely manner

Communicate with Client on appropriate cash/claims matches and misappropriate applications of cash to claims

Monitors various reports and works with sales team on resolutions for items on the disallowed ATB/ Disallowed at risk report and disallowed write off report

Acosta Sales and Marketing / Claims Resolution Analyst

Business Process Solutions 06/2015-present

Processes escalated claims, assesses the reason for the escalation, and provides resolution in priority order as directed by the Supervisor

Uses systems, reports, and Standard Operating Procedures to work assigned claim steps and gather supporting claims information

Proactively manages client and customer target dates to ensure claims are processed in a timely manner

Understands types of escalations and uses problem solving and analytical skills to resolve them so they do not repeat

Processes invalid claims in accordance with set policies and guidelines

Works to decrease defects and achieve automation (aka Ready to Clear) targets by keeping Standard Operating Procedures updated

Recognizes and provides solutions for operational obstacles that delay work completion on claims issues

Escalates appropriately to the Supervisor when needed to get information or handle complex client and customer situations

Communicates with clients and customers on a regular basis and provides value add solutions

Discusses defect issues with Sales, clients, customers, and management team and works with them to address the root cause

Cognizant Technology Solutions/ client United HealthCare

Healthcare Claims Analysis Trainer 09/2013-06/2015

Conduct Training Classes for Health Care Analysis

oTrain on processing healthcare claims.

oContinuous refresher trainings for reminders and process changes

oTrain on new system and processes updates

oCompliance Trainings i.e. HIPAA

Conduct Training for Management

oCoaching Trainings

oDiversity Trainings

oLeadership Trainings

Continuous process improvements. Initiate and deliver process improvement projects.

oCreate a reference guide to clarify daily work information for Specialist to utilize when job aid was not clear to process medical authorizations/claims.

oDrive business excellence to add value to client.

oMonitor/ mentor specialist for performance and develop/execute improvement plans.

Developed process and team related metrics and measure

Developed training material for processing

Analyze client process and documentation to identify gaps and recommend solutions to the client.

Cognizant Technology Solutions/ client United HealthCare

Healthcare Claims Analysis 05/2013-09/2013

Implemented outstanding and effective Customer Service relationships.

Provided accurate timely reporting and database updates while ensuring patient privacy and confidentiality.

Verified accuracy of all data, to include personally identifiable information (PII).

Completed over 5000 patient care request referrals without a HIPAA violation.

Displayed adaptability and efficiency with seamless transfer through United Health Care (UHC) ever evolving referral management processes and system upgrades and implementations.

Researched provider misinformation.

Screened for eligibility and benefits. Confirm proper queues and fax question back to provider to clarify inconstancies and keep line with established standards.

Medical terminology, knowledge of ICD-9 and CPT coding;

Processed referrals in a timely fashion, including sorting and processing referrals by indicated urgency and date all while maintaining and exceeding quality standards set by the customer.

Document and enter all referrals appropriately in patients’ medical records.

Verify that providers have sufficiently documented the necessity for the care request and have done the appropriate evaluations prior to sending the patient to a specialist.

Humana, Inc. Account Counselor (Temp) 03/2012 -03/2013

4030 Boy Scout Blvd, Tampa, FL. 33607

Managed and assisted 30 external partners on CMS Rules and regulations to sell Humana Products.

Operated multiple databases to either solve pay audits, or agent’s/brokers transfers to different external partners.

Implemented Humana’s compliance ethics and control guidelines

Responsible for updating any internal databases, which electronically store and organize clients, agents/brokers records, billing details and registration forms

Assisted the Director with special task and projects

Managed Inbound/outbound calls/ screen and direct calls

Delivered great customer service by responding swiftly to a high level of queries and concerns from clients, external partners, and agent’s/brokers via email, telephone

EDUCATION

Bachelor’s degree in Business Management

Concentration in Human Resource

University of South Florida, Tampa Fl. Present

REFERENCES

Dorothy Shackelford- Lead Trainer at Cognizant Technology Solutions 559-***-****

Jestina Shand- Colleague and church member 954-***-****

Yolanda Trojas- Manager of Delegated Operations at Humana, Inc. 813-***-****

Marcia Petitt- Team member at Humana, Inc. 813-***-****

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