Customer Service Management

SANDRA PRESTON

PROFESSIONAL SUMMARY

Subject Matter Expert in the areas of provider contracting and pricing, claims processing, testing, medical management, as well as regulatory compliance and government mandates. Strong knowledge of healthcare industry including HMO, PPO, Medicare and Medicaid; with excellent problem solving and analytical skills. Results oriented, highly accomplished professional consultant with over 20 years of hands on experience in the healthcare industry.

SKILLS

Microsoft Office

Microsoft Outlook, Word and Excel

Facets 4.71-5.3

Exceptional interpersonal communication

Seibel Customer Relationship Management

Oracle Software (CRM)

QNXT Skilled trainer

HP ALM Excellent time management skills

SOUP UI Effective problem solver

SQL Process improvement specialist

Effective workflow management

Adherence to high customer service

standards

Exceptional telephone etiquette

WORK HISTORY

Currently working at Wells Fargo as a Collector I

2016-Present

02/2015 to 07/2016 QA/Analyst

Fluidedge Consulting - TMG Health- Jessup, PA- Contract Position

Defined business goals to determine systems requirements.

Provided client support on system operation and troubleshooting.

Performed system analysis, documentation, testing, implementation and user support for platform transitions.

Diagnosed, troubleshot and resolved network and system problems.

Perform queries and create tables for analysis using Access database. (SQL)

01/2014 to 12/2014 QA/Tester

Fluidedge Consulting - BCBS NC-Durham, NC- Contract Position

Created and executed system and integration test scripts. (HP ALM)

Recorded defects and coordinated issue resolution with development team and functional leads.

Maintained a high standard of workmanship by using only approved data, materials, tools and test equipment.

Documented business processes and analyzed procedures to see that they would meet changing business needs.

09/2013 to 01/2014 Benefit Configuration Analyst

Health Tech Resources - Harvard Pilgrim Health Care-Quincy, Ma- Contract Positon

Detailed knowledge of Health Rules software preferred, other transaction system (Oracle, Facets, QNXT, etc.) acceptable.

Assist in the process to define system requirements, design, implement and test configuration of prospective payment systems.

Assist in the documentation of open issues, the configuration design, and the final resolution within the established departmental change management system.

Assist in the quarterly review, design, and update to Oracle of new CPT, HCPC, and diagnosis codes and all associated configuration activities related to new codes.

Design and document processes, procedures and. schedules related to all maintenance activities relative to new code configuration and present to policy and procedure review committee.

Define reimbursement changes and submit to Finance for review of financial impact prior to implementation

03/2013 to 06/2013 System Analyst High Point Solutions

BCBS RI- Contracting Position

Defined business goals to determine systems requirements.

Provided client support on system operation and troubleshooting.

Performed system analysis, documentation, testing, implementation and user support for platform transitions.

Diagnosed, troubleshot and resolved network and system problems.

Proficiency in any SQL query tool ( SQL Navigator, SQL Server Management ) HP ALM

Defect Tracking (system testing)

11/2012 to 03/2013 System Analyst

TEK Systems, Inc. - Excellus BCBS Rochester, NY- Contract Position

Defined business goals to determine systems requirements.

Review change request reports detailing the division, line of business, notes for products and description of changes, analyzing benefit matrices and running validation queries utilizing the access databases.

Supported system developers by creating system models, diagrams, and charts.

Performed system analysis, documentation, testing, implementation and user support for platform transitions.

Perform queries and create tables for analysis using Access database. (SQL)

Provided client support on system operation and troubleshooting.

Diagnosed, troubleshot and resolved network and system problems.

03/2011 to 01/2013 QA Tester

TEK Systems, Inc. – Health Now Buffalo, NY-Contract Position

Development and implementation of software testing strategies and plans with oversight over test script development and test activities for a regional government programs health plan.

Management, direction and support for all activities and tasks required in the planning, validating and testing of the functionality and usability of managed care system components.

Participate in building and executing detailed test plans by outlining test cases/scenarios, specifying test data sets, and performing or coordinating performance of unit and system tests. (HP ALM)

Documented all server and network problems and other unusual events in detail.

10/2010 to 02/2011 Facets Systems Analyst

Tek Systems, Inc. - Excellus BCBS-Rochester, NY-Contract Positon

Worked daily on Facets and Siebel review benefit orders from Sales Team to build and code products, review rate structures to determine accuracy.

Work with the business to refine business requires and translate into Facets Functional Designs.

Perform queries and create tables for analysis using Access database. (SQL)

Define and document Client specific business/development requirements ensuring quality of all deliverables.

Evaluate and Develop functional design specification(s) that align with client overall functional goals.

Analyze processes and data to identify areas for improvement, and work with the business teams to create new process designs.

12/2009 to 06/2010 Customer Service Supervisor

Broad-Path Solution - Cigna Health-Nashville, TN- Contract Position

Strong leader of customer support staff.

Managed work flow to exceed quality service goals.

Facilitated inter-departmental communication to effectively provide customer support.

Assumed ownership over team productivity and managed work flow to meet or exceed quality service goals.

Resolved associate, tool and service delivery issues revealed by statistical reports.

Developed highly empathetic client relationships and earned a reputation for exceeding service standard goals.

Trained staff on operating procedures and company services.

Provided accurate, specific and timely performance feedback for CSRs.

Identified individual development needs with appropriate training.

11/2004 to 08/2009 Travel Consultant Jacobson Solution - Contract Position

BCBS-Wood Hills, CA- Customer Service Specialist BCBS-Seattle,WA--Medicaid

Provider Specialist BCBS-IN-Provider Service Specialist BCBCS- Denver, CO- Project

Manager for Medicare Provider Service Key Functions:

Analyzed call volume and average call time to monitor Customer Service

Representative performance and productivity.

Managed customer calls effectively and efficiently in a complex, fast-paced and challenging call center environment.

Accurately documented, researched and resolved customer service issues.

Mastery of customer service management systems and databases.

Conducted performance reviews for all Customer Service Representatives to reduce resolution time and improve customer satisfaction rates.

Conducted performance reviews for all Customer Service Representatives to reduce

resolution time and improve customer satisfaction rates.

Provided incentive to increase productivity by offering employees awards for best customer service.

08/1997 to 02/2004 Patient Support/Travel Representative

Carilion Health System - Roanoke, VA

Responded to incoming customer and provider calls confidentially professionally ensuring that

they are treated with respect and sensitivity; experienced working with customers of a complex

nature. Successful in negotiations-able to influence internal/external customers through presentations and data copulation. Established Quality Assurance programs for patient support and customer service functions Accomplished in program design and implementation for Patient Loyalty and Patient

Retention program focusing on

Continuous Quality improvement. Served as a liaison to Patients, Physicians,

Billing, Compliance and satellite offices regarding Unbilled Services, Patient Loyalty and Retention issues. Monitored performance process and metric measurements to minimize financial impacts and loss of business; implemented proven steps and processes to provide favorable outcomes. Reviewed, reconciled and secured Medicare approvals for outstanding un-billable debts with DEGC Inc., in excess of $2.3 million within 120 days. Established workflows and controls to continue to maintain and bill 100% with Medicare approval within 17 days of service.

EDUCATION

1984 High School Diploma:

William Fleming High School - Roanoke, VA

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