Customer Service Quality Assurance
Resume:
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
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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