Sales Quality Assurance
Resume:
william Staten
Email: *********@********.***
Address: *** ****** ******
City: worcester
State: MA
Zip: 01607
Country: USA
Phone: 310-***-****
Skill Level: Management
Salary Range: 96
Willing to Relocate
Primary Skills/Experience:
See Resume
Educational Background:
See Resume
Job History / Details:
William Staten
Worcester, MA 01607
*********@********.***
SUMMARY:
Seasoned and well-rounded Business Development, Financial and CRM Professional with 10 years of experience offering a solid foundation in budget planning, micro-lending, credit & financial analysis, underwriting, contract negotiations, accounting, public speaking, sales & marketing, technical assistance, client & vendor relations, project management and an understanding in current mid-level financial trends seeking Business Analyst position.
AREAS OF EXPERTISE:
Sr. Business Analyst
15+ Healthcare Industry Experience
Current Life, Health & Annuities Insurance License
Certified in Medical Terminology
9+ Medical Billing Experience
Medicare/Medicaid Benefits
Medicare Chapter 2, 3, 4, 11
PCUG
EXPERIENCE:
IkaSystems Southborough, MA
Senior Medicare Business Analyst, 2010 - 2012
Provided product and solution definition, roadmap creation, testing guidelines, and rollout of solutions and enhancements
Ensured product development maintained on-time delivery of development milestones and deliverables
Provided detailed progress reporting and assisted in documentation development
Conducted comparative analysis against competitors and provided strategic planning of product direction and features
Monitored product performance and recommended appropriate actions
Served as liaison between groups and divisions, providing business requirements and technical expertise to the product development team
Worked in collaboration with sales executives, company leadership and strategy team, internal product planning groups, and technical design and implementation teams for the purpose of product development and implementation
Reduced client complaints and worked to provide stellar performance to clients and Medicare recipients
United Healthcare, Member Relations - Cypress, CA
Regional Medicare Sales Consultant, 2008 - 2009
Ensured department exceeds expectations enrollment/retention and selling of specific Medicare Advantage health plans
Conducted quality assurance call monitoring for staff based on member satisfaction of Medicare enrollment
Monitored Policies & Procedures, guidelines and newsflash to stay compliant with (CMS) Centers of Medicare/Medicaid, Local, State and Federal Regulations
Provided support to Member Relations, Medicare Enrollment, Retention and Sales team with job aids, daily goal settings, training and auditing based on CMS requirements
Conducted weekly staff meetings to discuss membership enrollment dissatisfaction and retention
Participated in Town Hall Meetings to educate prospect and existing Medicare Advantage members with chronic condition plan options
Reviewed and audited Medicare Advocate`s enrollment activities
Developed track and trend surveys for Marketing team based on Medicare`s enrollment retention
Enrollment & Reconciliation Supervisor, 2007 - 2008
Ensured team is meeting quality and accuracy standards
Audited enrollment applications (paper, telephonic, etc.) data entered by vendor
Processed re-enrollments and reinstatements
Researched and resolved enrollment related issues as needed
Handled Monthly Dual Eligibility Report
Audited monthly Medicare/Medicaid Enrollment low income subsidy denials for members
Facilitated staff meetings to remain current with Medicare Advantage health plans with specific of the Medicare Managed Care Manual Chapter 2
Provided support within service operations for Medicare members and prospects
Blue Shield of California, Appeals & Grievance - Woodland Hills, CA
Appeals & Grievance Supervisor, 2004 - 2007
Researched, reviewed and resolved member/subscriber grievance, appeals and complaints
Interpreted and explained health plan benefits, policies and procedures to respondents
Responsible for compliance with State and Federal laws regarding the handling of appeals
Ensured compliance with the applicable accreditation agency`s standard section regarding member`s rights and responsibilities
Assessed, investigated, and resolved challenging issues to achieve member satisfaction when possible
Answered incoming calls from members, providers, member`s representative or power of attorney, regarding medical insurance services
Researched and processed medical claims according to member`s medical benefits
Served as claims adjudicator liaison for the processing of radiology claims utilizing HCFA and UB92 claim forms
Provided orientation and training of Medicare Advantage supplemental and Commercial plan benefits to entry level Coordinators
Senior Billing & Enrollment Specialist for Medicare & Commercial Book of Business, 2000 - 2004
Provide training of Medicare Marketing guidelines and California Department of Insurance statues of limitations to enrollment team members
Acted as liaison for updates to CMS marketing guidelines and benefit/enrollment materials
Scheduled, organized and conducted team meetings regarding Medicare and Commercial updates to Benefit summaries
Coordinated marketing and pre-enrollment activities according to guideline requirements
Prepared and submitted weekly enrollment and retention reports to management
Provided detailed notification to staff regarding payment determination out of network Medicare billing contracts
Benefit/Eligibility Specialist, 1997 - 2000
Maintained accurate eligibility records for individuals and/or assigned employer groups
Processed all enrollment, plan changes and disenrollment transactions
Provided daily support on incoming verbal or written correspondence from enrollees regarding eligibility and processing status
Communicated policies/procedures and benefits clarity to team members
Complied with Medicare, IFP (Individual Family Plans) and state sales, marketing and enrollment requirements
Answered inbound provider calls related to claim status or payment issues for Medicare, Medical, Healthy Families, IFP and AIM plans
Documented resolution of provider dissatisfaction and report trends to department management
EDUCATION:
Pacific Coast Bible College - Sacramento, CA
A.A. - Theology, 2002
Discipleship Certification, 2001
Kaplan University
Continuing Education Certification, 2012
California Department of Insurance Certification, 2012
QUALIFICATIONS/CERTIFICATION:
*Microsoft Office - Word, Excel, PowerPoint, Access, Visio
*Cosmos, Nice, Resolution, IDT, PEAS, Marks, SMS, Marx, CRM and Medicare Gateway
*Received numerous achievements including #1 Regional Sales Manager for West Coast
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