Customer Service Manager

Tyra Woods

**** ****** **** ****, ******, NC ****2 336-***-****)

***********@*********.***

Objective To obtain a career that will enable me to utilize my

experience and qualifications.

Experienc File Maintenance Analyst

e 2012 - 2013 Hewlett Packard Enterprise Services, Raleigh,

NC

Receive, review, analyze and work all reference file

related customer memos

Interact with internal and external customers to analyze,

define, test, and implement reference file changes

Write Customer Service Requests (CSR) and Request for

Research (RFR)

Gather requirements necessary to implement file changes if

not stated in the initial memo

Interface with SE to develop and review test plans,

documentation

Create File Maintenance Project Document, when appropriate

Follow documented processes of the File Maintenance unit

Maintain and implement information into the MMIS+ reference

files

Verification of Transaction Report (TR) logs

Update resolution manuals

Learn all aspects of the reference files and the processing

of claims through the reference files so as to assist other

business units in file related research

Learn all aspects of the Medicaid business to support the

customer in their desire to implement new services and

programs for the Medicaid program

Commercial Intake Specialist

2008 - 2012 BCBS of North Carolina, Durham, NC

Process admission notifications and \ or requests from

subscribers and providers based on established guidelines

Based on established utilization and medical necessity

guidelines, approved admissions and lengths of stay and

communications determinations to the provider or

subscriber.

Receives telephone authorizations from personal physician's

offices.

Instructs providers regarding authorization procedures

eliminating denied claims and inquiries from providers and

subscribers.

Determine whether authorized services are acceptable per

certificate and policy provisions.

Contact providers when insufficient information is received

to ensure proper claim payments.

Obtain pertinent information for questionable services,

document reason for review and refer cases to ECM or

Medical Review Analyst.

Worked as part of multidisciplinary Health Care

coordination team to identify and task appropriate health

care service delivery for selected patients, providers,

procedures and or diagnose and improve the quality and

cost of efficiency of care and service

Identify situations where current guidelines are not being

followed by the physician and staff.

.Attempt to prevent denial claims when an authorization was

intended.

Review drugs for prior approval and either make a positive

determination or refer case to the nurse for further

review.

Secretary I

2007 - 2007 American Board of Pediatrics Chapel Hill, NC

Provided administrative support to PMCP department manager

Assisted with navigational issues related to PMCP through

the ABP Website by providing verbal and written support.

Prepared monthly distribution of PMCP certificates and

replacement

Processed candidate information from Application Upload

Reports

Handled candidate mailings and emailed address changes

Typed departmental dictation and maintained correspondences

records

Welcomed and directed guests and communicated arrival to

appropriate personnel

Composed and distributed minutes from PMCP Team Meetings

Assisted with departmental mailings and other miscellaneous

projects

Maintained and restocked PMCP departmental supplies in

addition to Kingston building supplies (kitchen, copy room,

restrooms)

Prepared monthly time allocations and calendar for PMCP

department

Prepared departmental documents (e.g. budgets, reports, and

statistics)

Assured proper functioning and maintenance of all office

equipment

Processing Assistant III

2003- 2007 Durham County Government, Durham, NC

Arranged travel arrangements and hotel accommodations for

social workers attending workshops out of town.

Assisted social workers with setting up departmental

meetings off site

Assisted front desk with answering multi-line telephone

system.

Mailed letters and correspondences out to clients.

Performed data entry of parent and child information into

state system I and II

Performed data entry of new client information into MRS

database for statistical reports.

Assisted department manager with maintaining calendar and

meetings.

Scheduled job interviews and maintained applications for

future openings within CPS department.

Set -up and registered new social workers for orientation

and pre service classes.

Maintained and purged client files

Typed office dictation as needed

Relieved front desk receptionist for lunch breaks.

Office Assistant/ Data Entry Specialist

1999- 2002 Bennett College, Greensboro, NC

Entered demographic locations in database for over 500

students.

Process transcripts, filed and maintained address changes,

and grade changes in student files.

Worked with faculty and staff on room assignments

Typed office minutes from staff meetings

Assisted parents and student with general office

information.

Assisted with graduation ceremonies

Assisted students with spring and fall registration.

Verified degrees for job placement.

Entered fall and mid-term grades into system, process

deferment forms,

Verified health insurance coverage for continual coverage.

Supported the Assistant Registrar when department manager

was absent.

Ordered and maintained office supplies.

Handled UPS delivers and all other bulk mailing for the

Registrar Office

Health Unit Coordinator

1993 - 1999 Duke University Medical Center, Durham, NC

Checked patients in and out in the clinic setting. Made

follow up appointments.

Collected co payments, verified health insurance coverage.

Entered new patient information into database.

Generated referral numbers for Healthsource, BCBS and

Medicaid.

Verified eligibility for Medicaid

Gave authorization for Medicaid patients needing to see

specialists.

Researched health insurance issues pertaining to denials.

Arranged specialist office referrals as needed.

Worked at five different substations in the ER.

Processed and ordered lab work and received results.

Notarized commit papers for mental health patients

Handled admissions for ER

Read and interpreted Cardiac Rhythm Strips for CCU

Education 1984 - 1988 Southern Alamance Graham, NC

1989 - 1990 Alamance Community College, Haw

River, NC

General Office Technology, Notary Public,

Administrative Professional Training Classes

Computer Knowledge : : Microsoft Outlook, Microsoft Word,

Windows XP, Excel, Internet Explorer, Lotus Notes, IDX,

Teams Elite, Web focus, Misys, AS 400, State system I and

II, MRS database, PowerPoint, SAP, Track-It, Abode Acrobat

Reader, GroupWise, McAuto Coder, Magic, Medco, MaxMC,

Rigthfax, Windows live Mail,

NCXIX, Secure CRT, Sharepoints, MMIS, DHHS, NC

Healthchoice, NC Medicaid

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