Customer Service Training
Resume:
Kenyetta S. Gosha
** **** **** ( Phenix City, Alabama 36869 ( *******@*****.*** (
Qualifications Summary
Highly personable Professional with over twelve years of experience in
account management, claims and sales processing, medical and supplemental
practices, and call-center operations within corporate America.
o Expertise in resolving escalated customer service issues.
o Proficient with Microsoft Office System (including Microsoft Word,
Microsoft Excel, Microsoft PowerPoint , Microsoft Access, and
Microsoft Outlook ).
o Extensive knowledge of ICD-9-CM and CPT/HCPCS, Workers Compensation,
and Medicare Billing
o Extensive knowledge of EEOC, and Labor Law to include COBRA, HIPPA,
ERISA, OSHA and benefit law.
Professional Experience
The Hughston Clinic - Columbus GA Current
Pre-Certification Analyst
Professional Reimbursement Department
. Obtain pre-certification and prior authorization for patients
scheduled for a surgical procedure and/or test as ordered by physician
so that they may meet their monthly financial metrics.
. Obtain all necessary information required to obtain pre-certification
or prior authorization to include clinical dictation and test results.
. Provide accurate information to insurance companies based on test
results, clinical dictation, etc. Complete all of the above in a
timely, efficient manner with respect to urgent request.
WELLPOINT INC. (Blue Cross Blue Shield) - Columbus, GA 2003-2007
Senior Customer Care Service Representative (2006-2007)
ITS Department
. Recruited to provide top-notch service to both internal and external
customers.
. Processed Claims adjustments as needed for ITS Host claims, answered
questions, responded to concerns, and alleviated delicate situations
with professionalism and sensitivity.
. Assisted Training Manager in creating and updating training materials.
Utilization Management Pre-Certification Specialist III (2003-2006)
Serve as UM CCS III for Utilization Management Department.
. Contributed to meeting and exceeding all goals in a timely period.
. Instrumental in improving customer-satisfaction ratings through
suggestion, development, and implementation of new reporting
procedures.
. Increased employee knowledge by assisting with development and
implementation of product-awareness program.
. Conducted, monitored, and administered Quality Performance Reports for
a team of twenty plus members to ensure that metrics are being met
department wide.
. Enhanced employee performance and attendance through daily mentoring,
one-on-one discussions and motivational strategies.
AFLAC - Columbus, Georgia
Policyholder Service Specialist III
1997-2002
. My duties included processing Cancellations, Reinstatements,
Additions, Payments and specifically Restorations. I also provided
one-on-one training with new team members under our departmental buddy
system.
. Assist and Correspond with AFLAC DSC's, RSC's, SSC's and SPC's
efficiently, accurately and in a timely manner while meeting team
goals.
. Participated in implementing new paperless process, resulting in
streamlined operations.
. Dramatically enhanced customer-satisfaction ratings by expediting all
claims and ensuring a high degree of accuracy.
Education and Training
Bachelor of Science in Criminal Justice / Psychology/ Social Science
Masters of Science in Management, HRM
( Troy State University, Troy, Alabama
May 19, 2006
December, 2010
Specialized training includes: Telephone Techniques, Medical
Terminology, AFLAC Products Overview, Live link End User, Team Building,
Increasing Personal Effectiveness, Professional Presence, Exceptional
Customer Service, and Quality Customer Service.
Additional training includes: Windows, ITS, Qcare, Athena, Payroll, TPX,
NTRL, NTRF, Workflow, and imaging.
References available upon request
Contact this candidate