Debbie Gale Sam

**** ************ • Houston, TX *7045 • 281-***-**** • ac08ed@r.postjobfree.com

Administrative Professional with over 20 years’ experience in an administrative capacity providing support and assistance to both single department and multiple individuals. My experience in the healthcare industry provided me expert ability to handle and maintain high level of confidentiality with interpersonal matters, proprietary and sensitive information. Advanced skills in Microsoft Word, Excel, PowerPoint, Outlook and Visual Basic. My core competencies include:

Outstanding analytical and problem-solving skills

Knowledge of accounting, bookkeeping, audit

Effective planning and organizations skills; detail oriented, deadline driven.

Ability to work well with little or no supervision; solid work ethic.

Ability to address multiple demands and competing priorities in a changing environment.

Ability to prioritize and remain focused on the essence of an issue.

Skilled at learning new concepts quickly while working well under pressure.

Fast learner, quickly incorporate and implement new procedures.

Dedication to continuous improvement.

Demonstrates effective use of listening skills and displays openness to other people's ideas and thoughts.

Team focused.

Knowledge of insurance such as HMO, PPO, IPA, POS, Medicaid & Medicare

Familiar with system products such as Diamond 950, EZCAP, MHC, Visual Base

Experience

Dell Marketing/NTT Data/Synergy Talent Wave April 2015 – March 2017

Claims Processor, Associate

Effectively analyzed and coordinated benefits for payments on health claims. Processed coordination of benefit claims. Performed customer service to insured's. Analyzed claims for possible fraud. Achieved and maintained quality control levels of no less than 99% monthly. Investigated and resolved provider and members appeals Reviewed medical records to determine correct processing rules Processed medical claims according to members health insurance, supplemental plans.

Cigna Health Spring May 2001 – June 2014

Claims Processor, Sr. Associate

Accurately and promptly adjudicated all claims and adjustments utilizing mastered skills to ensure quality and timeliness of processing. Processed Primary Care Physician, Specialist and Ancillary claims. Developed a working knowledge of all claims to assist with backlog. Assisted as needed in the processing of EDI and PCP claims. Assisted with IHEALTH, VE (Virtual Examiner), status 5 and duplicate reports. Responsible for providing accurate HMO Reports in a timely manner. Assisted with the HMO Blue yearly Audit.

Administrative Assistant, Delegation Oversight

Conducted annual oversight of the delegated functions and provided recommendations regarding areas for improvement or corrective actions, as applicable. Proactively analyze data to identify opportunities for process improvement or corrective action. Prepared annual reports to the Delegation Committee no later than 30-days from the end of their review.

Administrative Assistant, Government Program

Provided accurate and timely administrative support to the Government Programs department. Supported daily operations and special projects with the following: general clerical and project based work; preparation of forms; preparation of reports; file maintenance; and general administrative duties. Assisted with audit, maintained marketing material, files, logs and binders. Updated and monitored CMS report requirements. Scheduled and coordinated meetings with various departments. Assisted in the development of specific audit processes to include procedure, documentation and audit forms/reports as may be necessary, for purposes of auditing activities of the health plan operations to assure compliance and process improvement. Worked in conjunction with all departments’ directors, managers, supervisors and other assigned staff, to complete detailed analysis of all audits. Performed exit interviews with Department Head. Detailed audit regulations and formalized analysis, including recommendations for improvements. Follow up on audit items, post finalization and report quarterly on resultant alterations, modifications and prove documentation of improvements. Conducts claims audits and monitoring per CMS Protocols

Administrative Assistant, Credentialing

Maintained the credentialing database system to ensure credentialing records and data are current and accurate.

Reported all pertinent information related to credentialing, re-credentialing, and privileging to Director of Operations and management designee as appropriate.

Tracked expiration dates of all registrations, licensing, certifications, and notifies clinicians, mid-level providers, and staff of any expiring dates.

Maintained a current knowledge base of credentialing standards and legal requirements.

Administrative Assistant

Wrote, edited and updated Claim policy and procedures under stringent deadlines.

Responsible for all daily reports for Quality and Compliance, Claims and Customer Service.

Updated and reviewed all unclassified drugs with correct pricing for examiners and Oncology Consultants.

Responsible for weekly and monthly Health Plans Reports. Maintained payroll/time off and supplied records.

Developed and maintained a professional working relationship with supervisors, peers, other employees and customers.

Acted professionally and responsibly in job-related matters or situations, including difficult conflictive situations.

West Oaks Hospital March 2000 – August 2006

Admission/Intake Coordinator

Completed initial paperwork with new intake. Ensured clients understood Patient Bill of Rights.

Explained financial responsibilities including estimated insurance coverage to potential clients and family members.

Conducted initial clinical assessments on client as needed.

Collected monies from client or financially responsible parties for payment of services.

Coordinated with the multiple departments, and clinical staff to ensure that the admissions process ran smoothly and clients are adequately oriented to the program.

Participated in training opportunities provided by the program.

Education

1984 Houston Community College

1981 Prairie View A&M University

References

Available upon request.

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