Customer Service Process

LUCINDA WAKE

**** ******* **., ******, ** *****

H- 303-***-**** Cell- 303-***-**** email: *********@*******.***

PROFESSIONAL OBJECTIVE

To obtain a position where my experience in healthcare can be utilized

to further the success and productivity of the business.

SUMMARY OF QUALIFICATIONS

. Ten years of extensive work with contracts and providers in

healthcare.

. Proficient in process mapping for the creation and implementation of

operational policies and procedures.

. Superior legal researching skills and a solid understanding of

federal and state regulatory agencies.

. Over five years experience in developing and implementing customer

service training tools.

EMPLOYMENT HISTORY

Office Team Contract with CIGNA Healthcare

Dec 2008- Jan. 2010

Plan Services Coordinator

. Responsible for processing up to fifty cases a month to see

through the migration process.

. Identified and researched problems with internal personnel on

each case and resolved in a timely manner.

. Effectively completed case work on a monthly basis with daily,

weekly, and monthly goals and achieved successful results in the

migration process.

. Ensured accuracy and efficiency in the migration process before

giving to the migration team to process the case.

DaVita Nephrology Partners (DaVita Inc.), Lakewood

May 2008- Nov. 2008

Credentialing Coordinator

. Within ninety days processed and updated all credentials for 26

Physicians, Nurse Practitioners, Clinical Nurse Specialists,

Physician Assistants, Renal Fellows and privately employed RN's in

eight states.

. Maintained application information into SyMed Credentialing

database to ensure current and ongoing updates so that accurate

reporting could be generated on a monthly basis.

. Tracked and researched approval dates for initial credentialing

and recredentialing for each provider at each facility and hospital.

. Requested and distributed practitioner expirables such as state

license, malpractice insurance, CDS certificates and DEA

certificates to the facilities.

United Healthcare, Denver

Jan. 2007-

Jan 2008

Provider Relations Representative

. Over saw the credentialing process from information received through

the Provider Relations Reps.

. Maintained credentialing data

and appeal data in MSOW

credentialing database.

. Worked extensively with internal and external personnel responding

to their needs and inquires regarding provider relations and their

credentialing status.

. Worked extensively with Medicare and Medicaid state and federal

policies.

. Responsible for all appeals and

grievances at the site level,

conducted meetings for approval

or denial process.

. Supported provider representatives with projects regarding providers

and their respective territories.

Colorado Access, Denver Dec. 2004- Oct. 2006

Provider Contracting & Information Representative

. Prepared accurate and concise documentation for provider additions,

changes and terminations.

. Responded in a timely manner to provider data requests from the

claims processors and case managers.

. Made determinations of the provider's participation status, correct

demographic and billing information.

. Central contact for the credentialing unit to assure accuracy of

credentialing data from providers.

. Responsible for all procedures to be completed in the contract

clearance cycle including credentialing.

. Coordinate notification and dissemination of contract terms and

relevant information to other departments as appropriate.

Colorado Access, Denver June 2002- Dec. 2004

Project Support Technician

. Coordinated projects, focused on customer service, claims submission

and accuracy in eligibility and enrollment.

. Developed corporate and departmental policy and procedures for the

Customer Service department for state audits.

. Provided support and analysis for projects involving behavioral

health, correctional care, Medicaid, and CHP lines of business.

. Developed and implemented customer service procedures for all of the

Customer Service Representatives.

LUCINDA WAKE

2818 Jasmine St., Denver, CO 80207

H- 303-***-**** Cell- 303-***-**** email: *********@*******.***

Colorado Access, Denver Sept. 1998- June 2002

Eligibility & Enrollment Specialist

. Responsible for enrollment processes for newborns in accordance with

Division of Insurance regulations and contractual requirements.

. Provided education to mothers, providers and internal staff on the

newborn enrollment processes.

. Performed comprehensive research in enrollment source files as well

as internal databases to verify accurate member eligibility.

EDUCATION

Bachelor of Arts in English Literature Metropolitan State College of

Denver Graduated 1997

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