Customer Service Management

Isha M. Green

**** ******* ** *** * . Metairie, LA 70006 . ********@*****.***

Contact: 504-***-****

Qualifications Summary

Highly personable Customer Service Professional with experience in Medicare

policy and procedure, account management, claims processing, and call-

center operations within the collections, insurance, and entertainment

industries.

o Talent for identifying customer needs and presenting appropriate

company product and service offerings.

o Demonstrated ability to gain customer trust and provide exceptional

follow-up, leading to increased repeat and referral business.

o Track record of assisting in the implementation of reporting

procedures that improve

customer-satisfaction ratings.

? Expertise in resolving escalated customer service

issues.

? Secured numerous company achievement awards for delivery

of exceptional

customer service.

? Proficient with Microsoft Office System (including

Microsoft Word, Microsoft Excel,

Microsoft PowerPoint , Microsoft Access, and Microsoft

Outlook ).

Professional Experience

Coventry Healthcare- Metairie, LA

Provider Relations Representative- (February'2012-July' 2013)

. Assisting in the full range of provider relations and service

interactions with contracted providers.

. Working on end to end provider claim and call quality, ease of use of

physician portal and future service enhancements, training and

development of external provider education programs.

. Assist in the design and implementation programs to build and nurture

positive relationships between the health plan, providers (physician,

hospital, ancillary, etc.) and practice managers.

. Supporting those who direct and implement strategies relating to the

development and management of a provider network, identify gaps in

network composition and services to assist the network contracting and

development staff in prioritizing contracting needs.

. Involved in identifying and remediation operational short-falls and

researching /remediating claims.

. CAQH- assuring providers adhere to the guidelines for

credentialing/recredentialing. Reviewing applications, outreach to

providers for required documentation, etc.

Provider Contracting Coordinator (March'2008- February'2012)

. Serves as the department's primary resource for Coventry National

(First Health) provider contracts and maintenance.

. Assuring that the provider record is in compliance to the contract,

and making any necessary updates accordingly.

. Prioritize and process large amounts of provider demographic data

changes.

. Assist with the resolution of all claims processing questions and

concerns when attributed to contract load issues.

. Review provider inquiries within contract guidelines to resolve

discrepancies according to contract, as well as, provider demographic,

and other detailed information pertaining to request.

. Applying the negotiated contracted rates to the provider record to

assure accurate claims payment.

. Knowledge of programs- CPD, Navigator, NATMGR, PCM, WCMS, MCPS, Word,

PowerPoint, Outlook.

. Assist with departmental projects as needed.

Coventry Health Care - Houston, TX

Customer Associate Communications Specialist (May'2007 to February' 2008)

Developed and enhanced client relationships by responding to inquiries and

coordinating internal resources to resolve issues for the new Medicare

Private Fee for Service department. Selected as a representative of a new

product the Medicare Savings Plan introduced for 2008. Conducted training

to new employees of plan knowledge, qualifications, and call handling.

Knowledge of programs, IDX, Navigator, SIR, And Regulus. Served as the

point of contact for representatives in regards to:

. Provided product knowledge of Medicare advantage plans to customers

and employer

groups.

. Outbound calls to providers and members to resolve any billing

discrepancies and

service issues by determining the problem through researching and

discovering the best

way to handle the situation by the CMS guidelines, then applying that

to correct the

situation.

. On average, I handled between 55-100 calls daily.

. Received outstanding positive comments from team members on

employee reviews, as

well as exceptional feedback from senior management.

Spherion/Hewitt Associates - Woodlands, TX

Health and Welfare Benefits Specialist (May'06-Feb'07)

. Received incoming calls to enroll participants in their health

benefits, pension, as well as

payroll. Provided information to participants about their 401K,

including what loans the

participants qualified for based on guidelines through company.

. Educate participants on rules and regulations per their employer

for benefit

qualifications

. Resolve discrepancies made to the participant's account

. Guide and provide information to the participants on their health

plan coverage to allow

understanding of what is being offered.

. Give support to other associates regarding participant's account.

. Provided insurance verifications for customers

. Received numerous awards for providing superior customer service.

Education and Training

Pursuing BA in Management

Contact this candidate