Customer Service Manager
Resume:
Amanda Smolka
Email: *********@********.***
Address: ***** ******** ****, *-*
City: Avon Lake
State: OH
Zip: 44012
Country: USA
Phone: 440-***-****
Skill Level: Management
Salary Range: $54,000
Willing to Relocate
Primary Skills/Experience:
See Resume
Educational Background:
See Resume
Job History / Details:
AMANDA L. SMOLKA
33803 Electric Blvd, #G-7 - Avon Lake OH 44012
*********@********.***
OBJECTIVE
A position in the healthcare and/or business field where I can utilize my knowledge of health science and business applications.
EDUCATION
University of Phoenix August 2008
* Master of Business Administration (MBA)
Ohio University, Athens OH November 2001
* Bachelor of Science
* Major: Health Services Administration
* Minor: Business
PROFESSIONAL EXPERIENCE
The J.P. Farley Corporation, Westlake OH December 2001 - Present
Founded in 1979, is a privately help third-party administration and consultation firm. The firm delivers added value to employee benefit plans that are self-funded.
Claims Manager (August 2012 - Present)
* Oversee the entire Claims Department, including claims processing, customer service, claims adjustments and application of some refunds and voids/reissues, plan building, and provider maintenance.
* Manage 8 direct reports.
Plan Builder & Claims Examiner (January - August 2012)
* Build medical, dental, vision, disability plans in the Claims system according to client specifications and manually load accumulators when necessary.
* Update amendments to plans and any plan changes as needed in the system.
* Process claims for assigned groups and respond to claims appeals.
* Handle customer service calls & vendor calls.
* Update fee schedules and CPT/HCPC/ICD codes in system.
* Knowledge of EDI capabilities such as receiving and working with electronic claims.
Line of Business Manager (January 2011 - January 2012)
* Manager over the Indigent line of business and plan building.
* Oversee all activities related to the Indigent clients.
* Key player in converting to a new claims system (year long process).
* Conducted training on new Claims system and audited functions on new claims system.
Plan Builder (October 2005 - January 2011)
* Build medical, dental, vision, disability plans in the Claims system according to client specifications.
* Update amendments to plans and any plan changes as needed in the system.
* Audit claims processing daily.
* Respond to claims appeals.
* Handle customer service calls & vendor calls.
* Process short and long term disability claims.
* Create plan documents.
* Update fee schedules and CPT/HCPC/ICD codes in system.
* Knowledge of EDI capabilities such as receiving and working with electronic claims.
* ISO team (4 years) - conduct internal procedure audits
* Wellness committee (1 year) - create a wellness program for employees to promote a healthy lifestyle
Claims Examiner (September 2003 - October 2005)
* Processed medical, dental, vision claims and handled customer service calls.
Claims Registrar (February 2002 - September 2003)
* Received and returned calls to health care providers, facilities, and employees/clients.
* Started precertification in the Gbas system, entered log.
* Registered claims daily.
Utilization Review/Intake (December 2001 - February 2002)
* Received and returned calls to healthcare providers and facilities.
* Entered precertification requests into the claims system.
* Entered precertification logs from other Utilization Management vendors into the claims system
Sally`s Beauty Supply, Elyria OH June 1997 - February 2002
The largest retailer of professional beauty supplies in the world.
Inside Sales
* Handled customer service.
* Inventory counts weekly.
* Calculation of end of day sales.
ADDITIONAL EXPERIENCE
The Cleveland Clinic Foundation, Cleveland OH September - November 2001
A non-profit academic medical center provides clinical and hospital care.
Health Services Administration Internship
* Worked in the Human Resources department.
* Contacted potential job candidates to schedule typing tests & interviews.
* Helped conduct interviews of job candidates.
* Completed a project dealing with customer care (Mystery Shopping).
St. John West Shore Hospital, Westlake OH June - July 2001
Medical Center provides exceptional medical and health services in a variety of practices to patients in the Cleveland, Ohio area.
Health Services Administration Practicum
* 200 hours
* Shadowed mainly the Chief Operating Officer along with directors and staff of various departments within the hospital.
* Completed a small project for the Chief Nursing Officer involving Service Recovery.
SKILLS/COMPETENCIES
* Windows 95, 98, XP, 7
* Microsoft Office (Excel, Word, PowerPoint, Microsoft Outlook)
* Gbas claims system
* Corbel system (plan documents)
* Virtual Benefits Administration (VBA) claims system
References Furnished Upon Request
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