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Customer Service Quality Assurance

Revere, Massachusetts, United States
January 28, 2018

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Bill White

Cell (617) ***-**** Address: ** Wave Avenue #4 Revere Ma 02151

Professional Experience:

Mass Behavioral Health Partnership, Boston, Ma. 5/2011 to 12/ 2017 Director of Network Management: Garland Russell – office (617) ***-****, cell (781) ***-**** Supervisor: Heaven Barros (617) ***-****

Provider Relations Representative,

. Responsible for assisting Director and Network Management Team with credentialing providers into MBHP.

. Compose, edit company letters to providers, and members.

. Quality assurance review of provider data and entry into mass health database.

. Verify accuracy of contracts being sent to providers. Execute and verify received contracts-scan into database.

. Edit, document, coordinate and executed large mailings to MBHP members.

. License verification, ordering office supplies, professional communication skills. Maximus - Mass Health, Boston, Ma. 11/2009 to 4/2011 617 ***-****

Provider Relations Representative,

. Function as the front-line contact for provider issues with Mass Health members.

. Facilitate resolution of member issues related to transportation, enrollment, and eligibility.

. Educate providers on prior authorization policy, pharmacy guidelines/ procedures.

. Assist providers in enrollment and educate them on managed care procedures Citistreet ING, Quincy, Ma. 11/2006 to 2/2009

(617) ***-****

Customer Service Rep/Benefit Specialist

. Responded to company inquiries regarding their members 401k.

. Assisted customers in making withdrawals, changing contributions, fund allocations.

. Processed account terminations and hardship withdrawals.

. Utilized OMNI production to research account balances and financial data.

. Facilitated with Power Image to review participant documents. Tufts Health Plan, Watertown, MA 11/2001 to 9/2006 617 ***-****

Clinical Review Analyst, Benefit Specialist

. Reviewed clinical data for prior authorization by Tufts Health Plan Medical Staff.

. Interpreted plan documents. Approved and/or denied standard requests for coverage.

. Sent denials to providers for review.

. Assisted providers in responding to patient inquiries. Education: Bachelor’s Degree in Fine Art UMASS BOSTON 1998 Summary of Skills: Strong Editing, Quality Assurance, Documenting and Communication skills. Experience in using word – mail merge, excel spreadsheets, outlook - calendar, and office skype. Cass Production (Mass Health Provider Data Base) and Network Connect (MBHP Provider Database) used in scanning and documenting.

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