Medical Customer Service

JAMES MICHAEL JENKINS

**** *********** *****, #****

Cincinnati, Ohio 45238

513-***-****/Cell or 513-***-****/HP

Email: **************@*******.*** or @Gmail.com

EDUCATION:

University of Phoenix, Phoenix, AZ

Master's Degree, Major: Business Administration Minor: Public Administration

Credits Earned: 12.0 Quarter hours

Bachelor's Degree, Major: Healthcare Administration, 08/2007

Credits Earned: 148 Quarter hours

Community College of the Air Force, McChord AFB, WA

Some College Coursework Completed, Major: Healthcare Administration

Credits Earned: 65 Quarter hours

Attended CCAF while on active duty in the United States Air Force. Please see attached transcripts.

Tacoma Community College Tacoma, WA

Some College Coursework Completed, Major: Business

Credits Earned: 49 Quarter hours

Was working on an AAS degree in Business Administration. Had been approved as a VA Voc-Rehab. Student. Attended school on more or less a full-time basis as of 4/1/02.

SUMMARY:

Skills:

Software/systems: MS-DOS, WordStar, DB III, DB III+, K-Man, Apogee, Windows Vista, Windows XP, 7, 10, MS Office 2010 -2013, Office 365, (i.e., Word, PowerPoint, Excel, etc.), MS Access, VA/CPRS, VA/VISTA, VA/VISTA-PCE, CHCS (Comp. Healthcare System) I & II (AHLTA), Forms Flow, Essentris, ORMA (Operating Room Mgmt. App.), Powervision, Amisys, CRM (Call Tracking System) case resolution management system (McKesson), UNET (United Healthcare Network of Systems is a commercial claims payment system, i.e., ISET, MIIMs, HTA, SCI_IDRS, OnBase, CIOX, AdvantMed, Learnsource, etc.), Unix (LDAP or Application, i.e. Galaxy, QStar, CPW, Rosetta, Atlas, CDX, GPS, etc.)

Retired Federal/Civil Service employee

Language: French/Novice

EXPERIENCE:

01/23/17 to UNITED HEALTHCARE, Blue Ash, OH

05/12/17 Documentation Mgt Clerk (contract position through staffing agency/The Judge Group)

Acts as contract employee to work a required 40 hours onsite weekly for a 5-month contract focused on HEDIS data collection efforts for 2016. Performs duties as assigned by UHC Clinical Quality Mgrs., HEDIS Project Mgrs., or Regional HEDIS Managers for market specific annual data collection efforts. Demonstrates effective professional verbal and written communication skills in a virtual environment and across time zones. Demonstrates proficiency in Microsoft Office, Outlook, Excel, and Word & similar applications. Manages various data organized within Excel spreadsheets. Possesses ability to separate & combine PDF medical records in Adobe Acrobat. Complies with records management programs, including retention schedule requirements. Complies with policies and procedures for document management including standardized naming conventions. Completes all training regarding document management procedures and work flow. Ensures all documents are managed and routed supporting HEDIS data collection efforts. Escalates any concerns related to document management to leadership. Identifies documents and appropriately route and process documents. Conducts document IRR. Conducts document indexing. Resolves document indexing or routing exceptions. Supports invoice processing to pay for medical charts received. Works with limited guidance. Translates concepts into practice. Upholds Cultural Values. Maintains HIPAA standards and confidentiality of protected health information. Works overtime as needed.

01/16 to UNITED HEALTHCARE, Blue Ash, OH

05/16 HEDIS Project Coordinator (contract position through staffing agency/The Judge Group)

Acts as contract employee to work a required 40 hours onsite weekly for a 6-month contract focused on HEDIS data collection efforts for 2016. Performs duties as assigned by UHC Clinical Quality Mgrs., HEDIS Project Mgrs., or Regional HEDIS Managers for market specific annual data collection efforts. Demonstrates effective professional verbal and written communication skills in a virtual environment and across time zones. Demonstrates proficiency in Microsoft Office, Outlook, Excel, and Word & similar applications. Manages various data organized within Excel spreadsheets. Possesses ability to separate & combine PDF medical records in Adobe Acrobat. Conducts claims research, determining correct service location or verifying member history. Performs provider outreach, verifying and confirming provider demographics & medical record requests, both by telephone and in writing. Requests medical records and performs follow up of requests within HEDIS database tool. Maintains HIPAA standards and confidentiality of protected health information. Works overtime as needed.

11/15 to LUXOTTICA RETAIL, Cincinnati, OH

12/15 Fulfillment Project Coordinator (contract position through staffing agency/Realsoft)

Provides exceptional customer service and support to EyeMed Members, Providers (DONL’s and panel participants) and Store Divisions (Lenscrafters; Pearle, etc.) Provides member service support, over the phone, in a timely, consistent and courteous manner to EyeMed members and providers. Assists EyeMed members by answering benefit questions, eligibility, web registration, authorizations, provider location inquiries, and claims details. Interfaces with providers to verify member eligibility and authorize services. Reviews claims details, researches payment issues, and investigates provider network details. Uses system tools as appropriate to escalate issues between the various functional areas within EyeMed. Meets Customer Care Center productivity and quality goals. Internally assists Call Center associates and other EyeMed functional areas. Externally assists with Members/Providers.

07/15 to TATA CONSULTING AGENCY, Cincinnati, OH

08/15 Helpdesk IT Consultant (contract position through staffing agency/United Software Grou)

Works on a variety of moderate scope issues where analysis of situation or data requires a review of identifiable factors. Exercises good judgment within defined procedures and practices to determine appropriate action. Documents and responds to questions from customers; gathering detailed information required for Service Order creation, and routing of issues to appropriate teams for resolution. Ability to work in a 24x7 Shift work support environment. Answer phones in a timely manner to ensure responsiveness to customers on all incoming service orders. Gathers diagnostic information per defined guidelines. Learns and understands diagnostic guides, solution terminology and common customer issues across all solutions supported. Review service orders submitted online to ensure diagnostic information is available; follow-up as needed to secure information. Reviews Active Monitoring Board as appropriate. Distributes cases to product and technical analysts in a timely and complete manner, ensuring all information is outlined accurately and per defined guidelines. Collaborates with analysts to answer questions, gather additional information, request feedback and work to streamline customer responsiveness from service order receipt through closure. Works with other organizations as needed to route cases between Support centers in an efficient way, following up to ensure customer cases are assigned and managed appropriately.

04/15 to TRADE GLOBAL (dba/Coldwater Creek), Cincinnati, OH

07/15 Call Center Representative

Represents Trade Global and valued clients, (i.e., Coldwater Creek, Hugo Boss, Cole Haan, Versace, and The Limited), with high regard to providing exceptional customer service. Handles a variety of customer interactions (phone, email, chat) as they relate to both Order Processing and Customer Service. Answers inbound customer calls, accurately enters information into the order management system, respond to emails accurately and in a timely manner, make outbound calls to customer when needed to resolve customer related issues, updates job knowledge by studying new product descriptions. Utilizes the ability to show empathy, possess analytical skills to resolve the customer’s issues. Performs various computer skills, has the ability to learn technical information provided in trainings. Exhibited strong verbal and written communication skills, flexibility and the desire to take on additional responsibility.

01/14 to VA MEDICAL CENTER/FLORENCE HOME BASED PRIMARY CARE, Florence, KY

11/14 Advanced Medical Support Assistant

Performs work involving the collection, compilation and/or tracking of date and statistical information in support of the HBPC's program operation. Assists in the planning, review, and reporting of data/statistical results of the program. Performs a basic analysis of the data and generates a variety of reports. Identifies initiates and organizes process for data collection for the program. Reviews documents and reports, and ensures data entry is complete and accurate. Enters pertinent information into an automated tracking system. Maintains automated system of program-specific data to track and works with Nurse Coordinator to implement a plan of action based on the data. Cancels, schedules, and records no shows, by the completion of the scheduled clinic. Ensures that all outpatient clinic appointments are scheduled in accordance with the business rules as stated in the VHA.

05/09 to VA MEDICAL CENTER, Cincinnati, OH

01/14 Medical Support Assistant (Health Unit Coordinator), 11/11 to 01/14

Receives and directs patient and/or visitors. Receives numerous telephone inquiries for a wide variety of inquiries and problems. Answers the nurse call system when the staff is not available. Provides answers to all inquiries pertaining to Patient Business Services' policies and procedures for Ward Administration.

Prepares and maintains the active clinical record for each patient on the unit to meet VA and JCAHO requirements. Continually conducts qualitative and quantitative analysis of all medical records, notifying physicians of deficiencies involved for each record. Insures that all patients directly admitted have received information under the new HIPPA Act regarding their rights. Is responsible for verifying the inpatient-computerized roster against current bed census at the beginning and ending of each tour of duty and notifying the Ward Administration Supervisor of any discrepancies. Accurately interprets/verifies/acknowledges physician's order from the CPRS/GUI options to include admission, transfer and discharge orders, transportation consults and ward collect laboratory orders. Completes Admission orders. Notifies nursing staff of STAT and now orders. Schedules appointments in VISTA upon discharge of patient with the clinics and other supportive services and follows up with physician on those requiring consults. Initiates and routes proper forms for patient's funds, clothing services, and lost or stolen articles.

Medical Support Assistant (Call Management Center), 05/09 to 11/11

Responsible for receiving and ensuring any scheduling concerns. Assures that the patients are electronically cancelled and are re-scheduled accordingly. Reschedules according to guidelines or forwards the patient call to the respective clinics. Explains in detail to the veterans about their appointment ensuring they understand when and where they must go. Schedules and provides appointment dates, coordinating appointments for timeliness to avoid conflicts in patient treatment and to meet the schedule for clinic or service to which referred. Continually works with the providers and nursing to change appointments when clinically indicated.

Provides a high degree of customer service i.e.; tact, poise and diplomacy in dealing with veterans who have multiple health problems. Explains VA procedures to the veteran and family members.

Receives telephone calls and visitors to the VA, (i.e., patients, families, and friends of the patients) in conjunction with the availability of, and procedures for obtaining medical assistance, directions, and information for contacting various departments, services and requests for changes in scheduled appointments. Coordinates questions, call/visitor to obtain sufficient information necessary to determine primary need or areas of interest and provides assistance or makes referrals to other responsible VA personnel when a matter is outside the employee’s scope of assignment.

Works in a multi-screen environment, uses Vista and CPRS screens/ bilaterally. Scheduling clinical appointments facility wide. Also, responsible for making reminder calls to patients for most clinics in the facility as well as sending them letters to remind them of clinic appointments to help bring down no-show rates.

09/04 to MADIGAN ARMY MEDICAL CENTER/ JOINT BASE LEWIS, McChord, WA

02/08 Medical Support Assistant, Department of Surgery

Answers telephone and screens callers, directing as necessary to appropriate unit or professional staff. Provides information of a non-technical nature. Sets records up for the following day's appointments, assuring all forms needed to record treatment and all information and preliminary work pertaining to visit is contained in patient's record. Maintains data on patient visits for use in workload reports. Makes appointments via computer that use the Patient Appointment System (PAS/CHCS) and verifies all patient information. Reviews computer listings for no-shows/cancelled apt and updates database. Prepares/assembles needed forms and records for medical boards and TDRLs, checks for completeness and ascertaining that all required laboratory studies, x-rays, tests, etc., have been obtained based on physician's request. Ensures the timely flow of clinic operation and continuity of follow-up appointments. Schedules next apt or consultations. Completes medical board record, gets appropriate signatures. Uses various software programs to create database files; retrieve reports, rosters; prepare reports; develop forms; etc. Utilizes knowledge of clinic procedures for receiving patients for treatment, confirming their eligibility, providing general info and scheduling apt. Utilizes knowledge of medical terminology, ICD-9-CM, CPT, etc. as needed, on a regular basis.

Credentials Technician, Credentialing Dept. Department of Quality Services, 03/04 to 09/04

Temporary assignment. Serves as assistant to Credentials Mgr., performing a variety of administrative and technical duties. Administers assigned credentials review and clinical privileging portion of the Madigan Army Medical Center (MAMC) QI Program for all physician and non-physician health care practitioners who require individual clinical privileges. Credentials review and clinical privileging includes initial granting/renewal of clinical privileges, appointment/reappointment to the medical staff, augmentation/modification of clinical privileges, mgmt. of adverse privileging actions, and maintenance of all practitioner credentials files (PCFs).

Serves as a Co-Action Officer and recorder for the Credentials Committee by preparing PCFs for presentation at committee, preparing agenda and voting records, coordinating review of risk mgmt. cases referred from the Clinical Risk Mgmt. Committee, briefing Chairman on agenda items, advising Chairman and committee members on regulatory requirements, preparing minutes, and obtaining appropriate signatures on privileging documents following the meeting.

02/04 to VA MEDICAL CENTER - SEATTLE (VAPSHCS), Seattle, WA

03/04 Claims Clerk, Fee Services

Temporary appointment. Assigned to resolve all outstanding hospital claims issues for VA as payor, for all WA. State vendors. Utilizing knowledge of, and ability to comprehend extensive Federal Laws, VA and local policies, regulations and procedures pertaining to eligibility for authorization for inpatient/outpatient care in Non-VA facilities at the VA expense. Knowledge of medical terminology, ICD and CPT codes. Knowledge and ability to work with Fund Control Points. Ability to communicate effectively orally and in writing with VA Staff and Public. Assembles and summarizes data, background information, and other materials into report or presentation formats. Performs filing and clerical duties associated with the retention, maintenance, disposition and control of veterans claims files. Performs other related duties as assigned.

08/98 to PHYSICIAN HEALTH SYSTEM/NETWORK (PHN)/ C/O ST JOSEPH MEDICAL

12/01 CENTER/FHS – CHI, Tacoma, WA

Credentialing Coordinator, 07/99 to 12/01

Manages all credentialing activities in conjunction with contracted verification organization for provider organizations, associated payors, and contracted third party administrator. Responsible for the development and ongoing operations of the credentialing program, including Delegation and Sub-Delegation programs to meet National Committee for Quality Assurance Standards (NCQA) and payor requirements. Responsible for provider and facility site visit process in addition to medical record audits, again ensuring they are accomplished to meet regulatory agency and payor requirements, etc. Responsible for the credentialing software/database inclusive of the loading and updating all provider demographic information for contracted providers. Responsible for notifying all payors, health plans, and contracted third party administrator of provider contracting and appointment. Responsible for updating and maintaining all departmental policies and procedures in regards to the credentialing of providers. Credentials review and clinical privileging includes initial granting/renewal of clinical privileges, appointment/reappointment to the medical staff, augmentation/modification of clinical privileges, management of adverse privileging actions, and maintenance of practitioner credentials files. Provides oversight of work performed by clerical personnel in support of credentials function.

Provider Relations Rep. /Credentials Analyst, 08/98 to 06/99

Responsible for being operational liaison coordinating activities between providers, health plans, and contracted third party administrator. Responsible for resolving provider issues related to accounts management including billings, tracking of outstanding accounts receivable, follow-up of open claims, and periodic reporting requirements (inpatient/outpatient).

Additionally, responsible for identifying and resolving issues pertaining to referrals/ authorizations, capitation/fee-for-service reimbursement, payors, and related health care agencies. Also, responsible for implementation, oversight and compliance of credentialing program for all categories of providers, both contracted and contracted-facilities. Credentials review and clinical privileging includes initial granting/renewal of clinical privileges, appointment/reappointment to the medical staff, augmentation/modification of clinical privileges, management of adverse privileging actions, and maintenance of practitioner credentials files.

07/97 to MEDALIA HEALTHCARE (Providence-Franciscan Health Systems), Seattle, WA

07/98 Credentialing Analyst/Medical Affairs

Responsible for implementation, compliance and oversight of credentialing for all categories of providers (employed, contracted, contracted-facility) for Medalia Healthcare, specifically, in accordance with standards established by the National Committee for Quality Assurance (NCQA), and all other applicable accrediting agencies, etc. Also, responsible for timely review, analysis and written evaluation of all delegated credentialing programs, conducts on-site audits, audit preparation, etc. Acts as liaison between Medalia and delegated providers, the credentialing verification organization, inter-departmental staff, etc., in regards to credentialing. Credentials review and clinical privileging includes initial granting/renewal of clinical privileges, appointment/reappointment to the medical staff, augmentation/modification of clinical privileges, management of adverse privileging actions, and maintenance of practitioner credentials files. Provides oversight of work performed by clerical personnel in support of credentials function. Serves as an authority on the credentials review and clinical privileging process. Provides advice/regulatory guidance to practitioners and staff regarding routine/complex privileging matters, requiring in-depth technical/specialized knowledge of credential review and privileging process.

07/96 to PROVIDENCE HEALTH PLANS (SISTERS OF PROVIDENCE), Seattle, WA

07/97 Provider Coordinator, Puget Sound Region

Responsible for providing operational liaison between the health plan's ten product lines and all categories of contracted healthcare providers/facilities within region (including but not limited to e.g., Medalia Healthcare, LLC; Franciscans West/PHN; Valley Physicians Org., Pediatrics Northwest, The Polyclinic, Minor & James, etc., contracted hospitals and ancillary providers within the region). Also, responsible for conducting provider on-site evaluations, orientations and on-going training of providers, handling all problems relating to plan policies and procedures. Appropriately responds to telephone and written inquiries from plan departments, providers, managed care departments, and business offices regarding credentialing, contracts, fee schedules, referrals/authorizations, capitation/risk issues, etc. Responsible for resolving provider issues related to accounts management including billings, tracking of outstanding accounts receivable, follow-up of open claims, and periodic reporting requirements (inpatient/outpatient). Assists in analysis, design and distribution of materials, utilization reports, statistical data, etc. regarding procedures, policies and contractually required information. Extensive daily computer usage utilizing company-wide network system and customized database programs. Trained on AMISYS system.

12/95 to ST. FRANCIS HOSPITAL (FRANCISCAN HEALTH SYSTEMS-WEST/CHI, Auburn, WA

05/97 Health Information Clerk/MPI Validator

Part-time. Operates CLINSTAR environment/medical management computer system, encompassing patient administration and patient accounting functions, and associated reports. Operates medical transcription computer (MRC) and word processing systems to retrieve data related to transcribed reports. Responsible for validating transcribed reports for completeness and accuracy, also ensuring proper routing. Sorts and distributes daily computer reports, when applicable.

Retrieves discharged records, inpatient data, and laboratory reports from nursing units and ancillary departments. Retrieves incomplete inpatient records and medical data for physicians and staff. Prepares birth verification documentation for processing to state government agencies. Utilizes terminal-digit identification system.

01/96 to PROVIDENCE HEALTH PLANS (SISTERS OF PROVIDENCE), Seattle, WA

07/96 Credentialing Specialist, South Puget Sound Region

Responsible for certifying all categories of healthcare providers/facilities applying to health plan within region are fully eligible in accordance with National Committee for Quality Assurance (NCQA) standards. Processes and validates credentials criteria through contact with local, state and federal agencies involving licensing, education/training certification, malpractice history, hospital privileges, billing information, practice status, etc. Further responsible for delegated credentialing oversight and ensuring that each entity granted plan participation fully meets the standards of the plan and contractual procedures. Performs audits of those entities, prepares reports, correspondence and periodic visits, as requested. Extensive, daily computer usage utilizing company-wide network system and customized database programs.

05/95 to FIRST HILL FAMILY MEDICINE CLINIC (dba Pacific Medical Center), Seattle, WA

01/96 Receptionist/Scheduler

Responsible for meeting/greeting public patients; multi-line phone reception; collection of co-pays and payments; explanation of insurance coverage including accomplishing all referrals. Schedules and confirms appointments, maintains charts and slips, responds to pharmacies. Extensive computer usage including all patient registration and patient data output. Billing documentation and problem resolution support including coordination with various state/federal agencies. Mail and correspondence distribution.

06/97 to UNITED STATES AIR FORCE, JOINT BASE LEWIS, McChord, WA

04/95 Health Services Management Specialist

Medical Administrative Specialist (906X0)/Health Services Management Specialist (4A0X0) - 6/77 to 4/95

Held approximately 15 positions in the Medical Administration field in virtually all-health care areas relating to both patients and facility administration (hospitals, clinics, etc.). Also, received formal training as a Medical Administrative Supervisor. (Supervised up to 7 individuals max.)

03/94 to 62D MEDICAL GROUP, McChord AFB, WA

04/95 Medical Administrative Specialist, Administrative Services

Assistant - Supervisor, Outpatient Records, 06/92 to 02/94

Supervisor, Personnel/Administration, 10/90 to 06/92

Supervisor, Outpatient Administration, 12/87 to 11/88

Medical Administrative Specialist, Bio-Engineering Services, 12/88 to 09/90

Supervised and trained one individual

05/87 to USAF HOSPITAL YOKOTA, Yokota AB, JAPAN

11/87 Supervisor, Outpatient Records (Supervised and trained four individuals)

Supervisor, Admissions and Dispositions, 12/85 to 04/87

Supervisor, Aeromedical Evacuation, 01/85

Supervised and trained seven individuals

Supervisor, Patient Regulating, 05/84 to 12/84

Supervised and trained one individual.

Publications and Forms Clerk, 09/83 to 05/84

07/82 to DAVIS-MONTHAN AFB, AZ

08/83 Chief Clerk, Administration, 07/82 to 08/83

Chief, Orderly Room Clerk, 12/81 to 06/82

Orderly Room Clerk, 1/81 - 11/81

08/77 to ROBINS AFB, GA

12/80 Medical Admin Specialist, Outpatient Records, 06/78 - 12/80

Medical Administrative Specialist, 08/77 - 05/78

06/92 to 62ND MEDICAL GROUP, JOINT BASE LEWIS, McChord, WA

02/94 Asst. NCOIC, Outpatient Records

Responsible for safeguarding, charging-out, filing, and maintaining approximately 16,000 medical records. Sorts, files and researches loose medical documentation. Creates new records as required. Additionally, serves as alternate Central Appointments Desk clerk, utilizing the Meridian Patient Appointment System (PAS). Coordinates with clinics regarding schedule needs, cancellations, etc. Compiled and extracted data/statistics for the preparation of daily, monthly, and quarterly required reports. Responsible for training office personnel on Composite Healthcare System (CHCS) and its implementation. Responsible for updating sponsor and dependents info. scanning, registering, and coordinating apt with Madigan Army Medical Center, Ft. Lewis, WA. Trains apprentice technicians in all identified training tasks and certifies satisfactory accomplishments of identified training tasks. Conducts audits and surveys as identified by section supervisor. Additionally, served as alternate CHAMPUS advisor.

TRAINING:

Related Civilian Occupations/Military Experience:

oMedical Record Technician (DOT 079.362-014)

oHospital Admitting Clerk (DOT 205.362-018)

oOutpatient Admitting Clerk (DOT 205.362-018)

oMedical Record Clerk (DOT 245.362-010)

oUnit Clerk (DOT 245.362-014)

oHealth Record Technologist/Technician (SOC 3640)

oGeneral Office Occupation (SOC 4630)

oInterviewing Clerk (SOC 4642)

oStatistical Clerk (SOC 4794)

Training:

oNCO Orientation (PMEI) - USAF Completed 25 June 1980

oUSAF Supervisor's Course (PMEII)/PDS Code 9 - USAF Completed 24 April 1981

oOJT Trainer Orientation Course/PDS Code VC6 - 24 hours - USAF Completed 4 March 1982

oNCO Leadership School (PMEIII)/PDS Code U - USAF Completed 27 May 1982

oDocumentation Management Training - USAF Completed 13 December 1982

oOJT Supervisor's Orientation Course/PDS Code 32X - 30 hours - USAF Completed 26 October 1984

oMAC Quality Assurance Evaluator (QAE) - USAF Completed 22 March 1990

oMedical Administrative Supervisor/PDS Code NRD - 152 hours - USAF Completed 27 June 1991

oTotal Quality Awareness (TQM) Course - 16 hours Completed. 3 September 1992

oTeams and Tools Training (TQM) Course - 12 hours Completed. 10 June 1993

oHow to Supervise People for the Newly Appointed Supvr. and Mgr. -

oRock Hurst College/National Seminars Group 6 CEUs w/Cert.

oNavigating Change/LDR 200 (Providence Health Plans - PHP) - 3 Hours Completed. 20 Feb 1996

oMS Power Point/MS300 (Refresher) (PHP) - 4 hours Completed. 14 Mar 1996

oPHP Diversity Training/PHP100 - 8 hours Completed. 23 May 96

oSexual Harassment at the Workplace/PHP130 - 2 hours Completed. 25 July 1996

oMyers-Briggs Type Inventory/MBTI 100 (PHP) - 4 hours Completed. 28 Aug 1996

oTeam Dev. /TM100 (PHP) - 8 hours Completed. 24 Sep 1996

oComm. /Conflict (PHP) - 3 hours Completed. 12 Nov 1996

REFERENCES:

Available upon request

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