Customer Service Sales
Resume:
Johanna F. Ache
Bunnell, FL 32110
SUMMARY
Solid managerial and administrative experience
Exceptional versatility and adaptability.
Dedication and drive as a hard-working individual.
Superlative communication and team-building skills.
Ability to manage multiple tasks in a pressured environment.
Proficient in using personal computer skills in such programs as Corel,
Microsoft Windows, Microsoft Word, Excel, Outlook, AS400, PAI, Enterprise,
Explorer, Office Trac, Firefox and Netscape.
EMPLOYMENT HISTORY
Receptionist at Atlas Behavioral Health, 21 Old Kings Road N, Suite B208,
Palm Coast, FL 9/08-4/09
. Responsible for opening office and scheduling appointments for 4
therapists and 1 Nurse Practitioner on Office Trac.
. Answering phones, taking messages with pulling appropriate charts for
response by the ARNP, calling patients back with response.
. Verifying insurance on new patients, creating new charts with new
patient information, copying insurance and ID cards.
. Retrieving faxed prescription requests from Pharmacies as well as
calling Pharmacies with prescription refills.
. Calling patients the day before to remind them of their appointments
and pulling all charts.
. Held accountable for collecting all co-pays prior to services rendered
and charging all appointments with appropriate CPT codes.
. Faxing doctor referral acknowledgements and medical record requests.
. Filing dictation and charts at the end of each day.
Member Services Grievance & Appeals Commercial Supervisor at Florida Health
Care Plans. Inc (FHCP), 1340 Ridgewood Avenue, Holly Hill, FL a Health
Maintenance Organization (HMO) 10/95-2/08
. Responsible to analyze, research and respond/delegate, whether
written, verbal or in person in a timely manner to the member
grievance/complaint or inquiry by keeping within the standards of the
State of Florida Statutes (AHCA) and Medicare Grievance regulations
(CMS/Maximus).
. Acted as a Member Advocate to 65,000+ members, being able to diffuse
difficult situations, while at the same time present and justify the
organization's actions in relationship to the member's
grievance/complaint.
. Exceptional working knowledge of medical terminology, all
Commercial/Medicare benefits and patients rights.
. Interacted with a variety of personalities by contacting Social and
Regulatory Agencies outside of FHCP and or divisions within the
organization on the member's behalf and provide members with
exceptional service and resolution.
. Conducted performance improvement as needed.
. Served as a liaison between the Member Services Counselors and
Administration.
. Supervised staff with a 0% turnover rate, as well as perform job
performance evaluations of staff.
. Weekly review of 100% of cases assigned to the Commercial Counselors
with tracking and trending of the progress in a written report using
Word or Excel, which was provided monthly to the Administrators.
. Delegated and worked as a team to assure maximum coverage of the
department regarding staffing issues, phone coverage and on call
scheduling.
. Held accountable for and maintained ongoing training and meetings on
new policies and procedures, product lines, CMS regulatory changes,
State of Florida regulatory changes and equipment and maintain
documentation of the same.
. Interacted with staff and utilized excellent organizational skills on
the work and case assignments, assisted with Independent Review Entity
(IRE) cases during case formation and upon the completion prior to
submission to the IRE.
. Trained and assisted with expedited Fast Track Appeals including
action as the Organizations liaison with Florida Medical Quality
Assurance, Inc. (FMQAI).
. Track, appropriately code, and document in the AS400 system complaints
from date received to date of resolution in the appropriate format,
including written information gathered and set up a case file in the
appropriate format, which was set up and approved by URAC.
. Established a system in the Member Services Department by URAC
standards in housing all denials and accountability from three
separate departments due to an accreditation change from JCAHO to
URAC.
. Collaborated with and presented cases to Chief Medical Officer
(CMO)/Physician Administrators, Division Administrators and or medical
staff in determining resolution to the grievance/complaint.
. Entrusted to review and copy confidential medical records with keeping
in compliance and knowledge of the Federal HIPAA regulations.
. Certified through this organization for customer service,
communication skills program, basic ICD-9, CPT/HCPCS, patient safety-
risk management.
Office Manager at Danforth Brace & Limb (Prosthetic/Orthotic), 1240 Mason
Avenue, Daytona Beach, FL 2/93-10/95
. Responsible for scheduling all appointments, gather complete patient
demographic information, gather complete financial information, verify
insurance plans and obtain benefit information.
. Responsible to collect co-pays, deductibles and cash-self pay on non-
covered services.
. Assist with the fitting, repairs of orthotics and prosthesis as well
as physical therapy needed for all patients.
. Certified as a mastectomy fitter through Amoena, which qualified me to
measure and fit all prosthesis and bras for patients.
. Responsible for organizing setting up and keeping the facility clean.
. Responsible for ordering stock, equipment and supplies as needed.
. Reported daily functions to main facility located in Orlando via phone
or fax.
Manager at Fina Oil & Chemical (24 hour Truck Stop/Convenience with Hot
Deli), Ridgewood Avenue, Ormond Beach, FL 10/86-1/93
. Accountable for daily sales operations, daily bank deposits, accounts
payable (vendors) and accounts receivable (special accounts with
vendors for fuel/merchandise).
. Accountable for payroll and employee records
. Entrusted with large sums of money.
. Managed 16+ employees with low turnover rate, training all employees
for all the district stores in the area.
. Certified by State for hot foods, accountable to Health Department on
a quarterly basis for surprise inspection as well as having pumps
certified by the state as well as EPA inspections.
. Accountable and responsible for sticking tanks prior and after all
fuel drops.
. Oversaw construction of store, with a downtime of 6 months on internal
sales, with only the fuel/gas pumps open. Made recommendations for
improvement of this facility. Getting the approval on upgrades, such
as a scale for the truckers (CATSCALE), shower accommodations, dining
area with more truck parking.
. Increased sales by 50% within 3 years.
. Maintained inventory control on a monthly basis with 0%
shrinkage/theft.
. Served as an Administrative Assistant to the Region Supervisor for 9
convenience stores located in Volusia and Seminole Counties in
Florida, which included traveling.
. Reported daily sales and receipts via computer to main company located
in Dallas, TX. Sent backup paperwork weekly by Federal Express for all
stores.
EDUCATION
Albany Business College-General Studies, Majoring in Business.
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