Customer Service Administrative Assistant
Resume:
Ophion Technology Group
Re: Operations Customer Service Dispatcher
Dear Sir/Madam:
Enclosed please find my resume. I am writing to you to obtain a position in
a progressive environment with potential growth opportunities, which will
enable me to make a contribution to your organization.
I am a self-motivated individual, able to work independently and take
initiative.
I have recently relocated to South Carolina from New York.
I would like the opportunity to personally meet with you to discuss various
positions. If you have any questions, please do not hesitate to contact me
at my residence 864-***-****.
Sincerely yours,
Janelle M. Stewart
Customer Service Supervisor
Healthcare Maintenance Organization Specialist
Flexible interpersonal skills, including staff supervision, motivation,
training, and ability to work independently and in team work structures.
Advanced-level knowledge of Microsoft Office, over 75 WPM typing, and more
than 16 years experience in office support and the healthcare industry
including an extensive knowledge of CPT, HCPCS, & ICD9 Codes.
Employment Range
Customer Service Supervisor ?Customer Service Representative ?Claims
Examiner/Adjustor
Appeals and Grievances ?Administrative Assistant/Secretarial ?
Sales/Marketing
Areas of Knowledge & Experience
Staff Development ICD-9, HCPCS & CPT Staff Retention Vendor
Relations
Claim Processing/Examination HIPAA Regulations Medicare/Medicaid
UB92/HCFA (CMS)-1500
Staff Training MS Office Suite Data Entry Contract Interpretation
Career Timeline
April 2003 to April 2012 MultiPlan, Inc. - Healthcare PPO ? New York,
NY
Various Positions
MultiPlan, Inc. is one of the nation's largest preferred provider
organization (PPO) healthcare networks - serving more than 25 million
members. The company's national network and on-line databases include
information on more than 4,200 acute care hospitals, 90,000 healthcare
related facilities, and more than 450,000 physicians. MultiPlan's major
clients include HMOs, insurance companies, third-party administrators,
labor unions, and government agencies.
Facility Rate Analyst
October 2007 to April 2012
. Analysis and maintenance of facility rates using appropriate
reimbursement methodology to maximize automated re-pricing
. Act as a liaison between departments to explain the rationale behind
reimbursement interpretations
. Participate in data integrity audits to ensure data accuracy
. Work closely with other team members and departments to research and
resolve all fee related issues.
. Identify and report systemic or recurring problems.
Senior Key Accounts Representative
October 2006 to October 2007
. Effectively supervised and assisted staff of 10 Key Accounts
Representatives.
. Liaison between Key Accounts Representatives and various clients.
. Work closely with third party vendor (Zavata) as well as other
departments and Multiplan clients such as: CIGNA, Aetna, United Health,
Kaiser Permanente, Principal and others.
. Answered 85-100 (ACD) calls per day.
. Reviewed and resolved balanced billing issues, obtain information on
the disposition of inquires and determined appropriate course of action
both telephonically and electronically.
. UB92 and HCFA claim examination.
. Client, Facility, Provider and member education as to Multiplan's
rates, policies and procedures.
Senior Principal Representative
June 2006 to October 2006
Dedicated Clients: Principal
. Work directly with dedicated client Principal to resolve issues and as
a liaison with providers.
. Work with other departments to resolve related issues.
Key Accounts Representative
April 2003 to June 2005
. Answered 85-100 (ACD) calls per day
. Reviewed and resolved balanced billing issues, obtain information on
the disposition of inquires and determined appropriate course of action
both telephonically and electronically.
. Client, Facility, Provider and member education as to Multiplan's
rates, policies and procedures.
. UB92 and HCFA claim examination and adjustment processed on as needed
basis.
January 2001 to March 2003 Heritage New York Medical Group ?Garden City,
NY
Various Positions
Clinical Services/Inpatient Coordinator
. Assisted nurses' with completion of medical intervention forms.
. Provided clinical support for office staff such as: outbound calls
for case managers & receipt and distribution of faxes.
Clinical Services/Reconsideration Coordinator
. Review each request determine if it meets requirements for a Review.
. Maintain database, interacting with Utilization Management Staff &
Medical Directors.
. Other clinical support services.
Customer Service Representative
. Processed pre-authorizations for providers and members
. Providing issue resolution to providers
. Data entry and claim processing
. Answered 100-150 (ACD) incoming calls per day.
September 1999 to December 2000 Care Manager Group ?Lake Success, NY
Customer Service Representative/Claims Adjuster
. Answered 100-125 (ACD) incoming calls per day.
. Research and resolved all issues received from providers and clients
telephonically and electronically.
. UB92 and HCFA claim examination and adjustment processed on as needed
basis.
November 1993 to September 1999 NYLCare Health Plans of New York ?Jackson
Heights, NY
Various Positions
Claims Examiner Level II
. UB92 and HCFA claim examination and processing.
. Maintain departmental accuracy level of 100%
. Utilization of Coding books and other reference materials.
Claims Examiner Level I
. UB92 and HCFA claim processing and data entry.
. Maintain departmental accuracy level of 100%
Appeals & Complaints Representative
. Reviewed and resolved issues, obtain information on the disposition
of inquires and determined appropriate course of action both
telephonically and electronically.
. Provided superior customer service as well as other support service
as needed
Administrative Assistant - Large & Small Group Sales
. Drafted proposals for groups interested in plan.
. Other office support services.
Education
1986 LaGuardia Community College
1983 August Martin High School
[pic]
Contact this candidate