Customer Service Quality Assurance

Education and Training

Completion Date Issuing Institution Qualification Course of Study

**/**** ************ ********* ******* Associate's Degree General Studies

**/**** ************ ********* ***lege Associate's Degree Counseling/Guidance

Resume Free Text

Buffy Beltramea

Phone:727-***-**** Email: abo6sr@r.postjobfree.com

Address: 2249 Roselawn Dr. Holiday, Fl. 34691

Summary of Qualifications

Accomplished and results-driven Professional with 10 years of experience in health

insurance, customer service, and Office management. Possess solid analytical,

communication, interpersonal, and problem solving skills coupled with a proven track-

record of improved quality and productivity. Currently seeking a position which will

effectively utilize all acquired skills, abilities, and areas of expertise as follows:

rOperations

rProcess Improvement

rCost/Expense Reduction

rQuality Assurance (QA)

rPerformance Evaluation

rProgram Development

rBusiness/Revenue Growth

rCustomer Satisfaction

rClaims Resolution

rProblem Solving

Career Achievements

Ongoing revision of processed and procedures to accommodate company and clients including

financial planning notes

Detail-oriented individual, productive employee and punctual professional who maintains

productivity and ensures quality

Complete responsibilities/tasks within designated time; work well with diverse customers

and employees; listen to new ideas

Learn new methods and procedures quickly in busy workplaces; Internet and E-mail - work

with Microsoft Word and Excel

Plan, develop and implement appropriate, workable and profitable procedures according to

specific company guidelines

Respectful individual, success-driven person and loyal leader who completes duties from

start to successful conclusion

Work with team in achieving deliverables in a timely manner (timely completion of

deliverables)

Incorporate a continuous quality improvement philosophy as part of all activities

Manage multiple tasks simultaneously at various stages

Buffy Beltramea Page 2

Phone: 727-***-**** Email: abo6sr@r.postjobfree.com

Address: 2249 Roselawn Dr. Holiday, Fl. 34691

Professional Profile

Florida Medical Quality Assurance Inc. (FMQAI) . Tampa, FL

(Oct-May2012)

Case Review Clerical Support

rResponsible for coordination of physicians and HMO for reviewing charts; included

contacting physicians and HMO: charts to be sent to specialists, physicians, and case

managers.

rProof-read team materials and correspondence: assisted in updating and typing merge/form

letters.

rEntered data into the approved software applications.

rResponsible for tasks: verbal communication and written correspondence.

rFiled records, correspondence and reports in the required manner and time frame.

rUpdated various case review databases as needed.

rAssisted inventory coordinator in maintaining and ordering supplies.

rResponsible for assuring HIPAA guidelines were followed at all times.

rWorked with numerous individuals at all position levels in a professional and supportive

manner.

rManipulated/utilized various programs: CRIS, PRS, Right fax, Word, Excel, Power Point,

Internet, access, and Fed-Ex/Copiers/Printers. Typing speed of minimum 45 words per minute

in which required transcribing while navigating various CMS-approved databases.

rInterpreted documents, routine reports and correspondence before groups of clients, and

employees with-in the organization.

rIdentified issues/concerns and prioritized work flow.

Well Care Health Plans . Tampa, FL

(Sep 2009 - Feb 2011)

Pharmacy Technician

rEntrusted with multiple lines of business: Medicaid in numerous states, and Medicare.

Results increased quality.

rProvided assistance when processing prescriptions to various pharmacies in which

included: day supply, quantity, and cost.

rAssisted doctors and practitioners with requests for medications in which are not

provided by insurance through a Drug Evaluation Review form (DER). Advised of non-

compounded medications and generic medications that are available with-out the use of

(DER).

rEntrusted with multiple physicians office to provide tier exceptions, appeals, and any

other escalated calls.

rAdvised of various diagnosis codes.

rResponsible for ensuring call center compliance with all CMS and state regulatory

requirements.

rAchieved QA goals and AHT goals to management satisfaction which improved customer

satisfaction and reduced FTEs.

rImproved customer service and lowered administrative costs.

rLiaised between pharmacies and member Services and physicians to ensure customer service

was adequately provided and all services were followed through as assured by Medicare and

Medicaid.

rUsed various programs: WHI, Paradigm, Sidewinder, Diamond, ICD, and HMS.

Harbor Chase . Tampa, FL

(May. 2009 - Dec. 2009)

CNA P/T

rResponsible for assisting the residents in their adult daily living (ADL) in which

included bathing, dressing, ambulatory Care, dining, and medications.

Buffy Beltramea Page 3

Phone:727-***-**** Email: abo6sr@r.postjobfree.com

Address: 2249 Roselawn Dr. Holiday, Fl. 34691

Professional Profile - Continued

Omaha Valley Hope-Ralston, NE. (May 2005-May 2009

)

Office Manager(Aug. 2007 - May 2009)

Promoted from

Administrative Assistant(May 2005-Aug.2007)

rGreeted walk-ins; answered phone calls and provide detailed information.

rAnticipated needs and implemented processes with team members to complete incoming work

volume/on hand inventories.

rResponsible for patient intakes and processed admissions. Acted as a technical expert

and provided guidance to team members in resolving complex questions and issues. Scheduled

and made assessments.

rAccountable for maintenance of the records of the incoming patients. Processed accounts

payable, disputes. Set insurance contracts in Winpims. File insurance and discharge

patients applying the filing system of JACHO. Set up Financial Responsibility Agreements

and loan paperwork and collected on loan payments or any delinquent accounts. Set up

billing in Outpatient Services and the accounting software.

rRecognized opportunities for improvement and recommended improvements to management

regarding product, process, and system enhancements.

rCommunicated via phone with insurance professionals to verify benefits and acquire

detailed information and all contact with in accordance to sessions per one-on-one and

group therapy to collect payment. rCalculated and made bank deposits daily. Prepared

nightly closings and maintained general ledger. Prepared Admissions Communications Report.

Maintained spreadsheets on patient information and referral logs. Ordered office supplies.

Ensured the best possible customer service.

rProvided new hire training and refresher classes for the startup of the Kansas City

Office.

Pacific Pizza/Godfathers

(June 1994-Mar.1998

)

Assistant Manager (May 1997-Mar. 1998)

rWorked in all areas of restaurant management. Gained ongoing practical experience in

computerized business, sales and bookkeeping. Inventory control. Coordinated time sheets

for staff members.

Shift Team Supervisor (May 1995- May 1997)

rServed as a working supervisor handling numerous responsibilities and duties.

Cashier (June1994- May 1995)

rWorked directly with customers to place and provide food and beverage orders.

Education Associates Degree with a major in Professional Studies, Metropolitan Community

College, Omaha, Nebraska, 2005

Associates Degree, in Chemical Dependency Counseling, Metropolitan Community College,

Omaha, Nebraska, 2005

CPR credit

CNA cert.

Papillion-La Vista High School, Papillion, Nebraska, Graduated with a Diploma, 1997

References

Available Upon Request

Contact this candidate