Customer Service Quality Assurance
Resume:
Preston E. McClenty
Atlanta, GA
***************@*****.***
EDUCATION
May 2011 Master of Business Administration
(Expected) Health Service Administration
Strayer University
May 2004 BA – Public Relations / Minor Marketing
Jackson State University, Jackson, MS
EXPERIENCE
September 2010 – EDI Watch, Alpharetta, GA
Present QA Specialist
• Responsible for testing company software for quality assurance
before releasing it to clients by simulating daily functions of the
customer and making sure that they all work properly and produce
valid data
McKesson Corporation, Alpharetta, GA
Jan 2008
Electronic Date Interchange (EDI) Support Specialist
June 2010
• Responsible for taking incoming calls to solve EDI claim rejections for
Medavant clearinghouse customers. This involves reviewing ANSI 837
files, 977, 835, 270, 271 and being able to determine what fields in the
Medisoft and Lytec software need to be changed in order to create the
correct loops and segments required by the clearinghouse and the
insurance company in order for them to pay insurance claims, provide
eligibility, and electronic remittance advices
Advised/provide feedback on processes, and clearinghouse options for
•
company development. Provide team training for representatives to be
able to adequately support clients.
Responsible for assisting client’s with the installation of software
•
upgrades, and to also check modem and firewall settings to make sure
that they are compatible with the software requirements for submitting
claims electronically.
P. McClenty Page 2 of 3
Implemented medical billing process including integrating EDI
•
knowledge with actual of billing of paper claims in a new software. This
includes being able to solve errors in the program by going on the “back
end”, by writing DOS commands and queries to find the cause of, and
resolve these errors
ACS State Healthcare (Affiliated of BlueCross/BlueShield),
June 2004
Ridgeland, MS
November 2008
Electronic Date Interchange (EDI)/ Provider Inquiry Support Specialist
• Responsible for over 837 files are received from clients in a timely
matter and error proofing all rejected files in order for providers to be
paid for Medicaid claims on a weekly basis.
Responsible for troubleshooting and corresponding with the EDI
•
Business Analyst as well as the corporate helpdesk in Atlanta in order to
get the best resolution for clients' intricate file rejection issues.
Instructor for Medicaid providers on how to use and install
•
WINASAP2003 software in order to submit files for processing of
Medicaid claims electronically.
Responsible for following through and providing updates on the trading
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partner enrollment process to the potential client.
Utilized the TPMS systems, ACTTNOW, implementation guides, and
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host system in order to help identify file rejection issues that have been
ongoing for a particular provider or clearinghouse.
Assigned passwords and log in information for providers using the MS
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Envision and EDI Exchange software in order to review response files
from ACS.
In charge of trouble shooting inquiries to corporate due to clients not
•
receiving appropriate response files from their transactions.
SAKS, Incorporate (SAKS Fifth Avenue Department)
May 2001
Collections/Customer Service Representative
June 2004
• Responsible creating store accounts for applicants by first determining if
qualified by credit history.
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P. McClenty Page 3 of 3
Responsible for maintaining a healthy relationship with customers by
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calling periodically to inform them of delinquent accounts, certain
promotions, and to make sure account information remains updated.
Responsible for keeping customer records updated.
•
SKILLS
Microsoft Word, SAP, Spreadsheet, Excel, Typing 60wpm, Medisoft, Lytec, Ctel, CSS, Citrix,
DOS
REFERENCES ON REQUEST
Contact this candidate