Jeanee’ Swanson

**** ** ******* ***** *********, OR 97008 503-***-**** ac20wv@r.postjobfree.com

OBJECTIVE

Seeking a position within the company that will allow me to fully utilize my communication, organizational, and problem solving skills.

SKILLS PROFILE

Strong analytical, problem-solving, and process-improvement skills.

Organized and detail-oriented with demonstrated project coordination skills. Effective at managing, prioritizing, and balancing the competing demands of multiple projects.

Versatile and resourceful team player, with the ability to work independently. Willing to do everything necessary to complete goals and meet deadlines.

Strong communication skills with a commitment to excellent customer service. Ability to work well with all levels within an organization.

Computer skills include MS Word, Excel, Office, Access, ABS, and Salsa.

PROFESSIONAL BACKGROUND

Health Net Health Plan of Oregon, Tigard, OR

Sales Assistant II - Quality Auditor/Sales Operations 04/05-09/17

Quality Auditor – Sales Operations

Developed and implemented audit process of new and renewing commercial groups and associations prior to their effective date. Included review of all GSNs, group contracts, and post-renewal changes prior to group set up in ABS. Reviewed same in back-end audit against ABS.

Improved team accuracy and quality on output of GSNs and contracts from 70% to 97%. Reduced re-work, redundancy and improved effectiveness, assuring accurate information to downstream units.

Reviewed contracts and amendments prior to dissemination to groups/brokers in order to meet compliance regulations, underwriting guidelines, and accuracy.

Assumed responsibility of back-end audit process for Broker Relations to ensure commissions are paid accurately and timely.

Implemented a Quality Review tracking log to identify areas of improvement - department accuracy ratio, error trends, and training opportunities.

Analyzed quarterly accuracy results for each associate while identifying trends in audit results. Worked with Supervisor to implement associate specific training to achieve accuracy goals.

Responsible for providing Geo-Access and Disruption reports to Executive Managers. Coordinate RFP and RFI completion with HNCA proposal department and subject matter experts to ensure completed, reviewed, and submitted accurately and timely.

Implemented Termed Group Process to ensure termed group requests are processed timely to meet compliance standards and prevent retro-activity.

PacifiCare, Hillsboro and Lake Oswego, OR

Provider Delivery Systems – Claims & Contract Analyst

Quality Review

Claims Processor/Analyst

Authorization Department – Review of Emergency Room Claims 1996-2003

Provider Delivery Systems – Claims & Contract Analyst 04/98-05/04

Auditing and Research

Reduced provider accounts receivable of outstanding claims payment issues by 96%. Coordinated claims research for processing discrepancies and provider dispute resolution.

Managed problem-solving projects to ensure resolution in a well-communicated and timely manner.

Developed procedures to ensure correct payment of home infusion and chemotherapy services.

Devised Processing Guide to ensure accurate payment of injectibles/chemotherapy drugs per contracted AWP Redbook Pricing.

Contracts

Developed strong relationships with providers, working with them to ensure mutual understanding of contract terms.

Conducted on-site aggregate claim audits to determine proper reimbursement to clients using eligibility, claims review, and contract interpretation metrics.

Implementation of provider agreements in an accurate and timely manner, including thorough auditing and review to ensure contract appropriately administered.

Served as liaison with Claims Processing Managers and Network Managers to ensure claims were processed according to contractual language.

Claims Processing 03/96-04/98

Consistently achieved over 99.5% accuracy in personal claims processing performance audits.

Managed numerous projects for payment audits of atypical, critical, and confidential claims.

Assisted in the streamlining of EDI process to manage workflow of EDI claims.

Authorization Department – (Temporary Position) Review of Emergency Room Claims 01/96-03/96

EDUCATION

Courses at Portland Community College & Miscellaneous workshops

Communications, Conflict Resolution, Leadership Skill Development, Goal Setting and Time Management, Principles of Management and Supervision

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