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Customer Service Sales

Everett, WA
$20.00 per hour
June 12, 2018

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**** ** ***** **. ● Federal Way WA *****

PHONE 206-***-**** E-MAIL



I have experience in the areas of Procedure & Appointment Scheduling, Referral Entry, Prior Authorizations, Provider Network Credentialing, Quality Control Auditing, Project Management, National Accounts Management, Document Control Management, Claims Errors Resolution, Claims Processing, Personnel Training, Supervision and Customer Service Lead, Benefit Administration; Payroll Processing and Salary Reconciliation, Membership & Billing, Customer Service, Enrollment Analyst

Proficient in: MS Office (Excel, MS Word, Outlook),Share Point, Adobe Acrobat (full version),QuickBooks, ADP Payroll Processing System, Epic, Infinity Supervisor, Infinity Telephone Agent, Epic System, Orca, Mindscape, One Health Port, Recondo & Kronos, FACETS, Valencia, IPD Ultera.



Responsible for Specialty claims creation; Management of Prior Authorizations and Referrals; Submission of provider credentialing applications for medical and dental providers; Initiate and oversee all aspects of the credentialing process for Dental Providers into the medical networks of multiple Health Insurance companies; Assist with negotiation of Provider contracts as needed; Billing of specialty and high dollar claims.

PREMERA BLUE CROSS – 10/2015 – 10/2016 Mountlake Terrace, WA

Sr. Customer Service Representative

Provided inbound and/or outbound customer service support ensuring delivery of accurate, complete and timely information pertaining to member policies and coverage, thoroughly documenting all calls. Conducted research to provide claims status, investigated complex as well as routine requests, escalating call issues as required. In depth understanding of the Federal Health Exchange (FFM) and Washington Health Benefit Exchange (WAHBE). Provided high-level service to members, providers and other BlueCard plan members; Performed complex project work; Problem solving and handling of escalated service issues; Assisted members in multiple geographic locations with both individual and group plans; In-depth knowledge of multiple types of insurance coverage including Medicare and Medicaid.

Membership & Billing Department 05/16 – 10/16

Responsible for End to End enrollment for members enrolled through the Washington State Health Benefit Finder;

Duties included Plan Changes, Retroactive Policy Terminations, Reinstatements and Account Reconciliations due

to Rate Discrepancy Issues.


Contact Center Representative

Assisted Patient’s with Access to Services for over 200 different clinics, located in four different service areas, within the UW Medical System. Provided complete registration, appointment and procedure scheduling for both Outpatient Specialty clinics, Surgery clinics as well as Primary Care clinics within the UW Medical System. Handled patient appointment scheduling, pre-registration, verification of insurance eligibility and researching of all patient inquiries as per each individual clinic’s standards and protocol. Demonstrated high degree of diplomacy, problem solving acumen and an in depth knowledge of all UWMC, HMC and UWPN service offerings. Additional daily duties include Coordinating incoming referrals, prior authorizations and on-site Interpreters.

HARBORVIEW MEDICAL CENTER- 02/2008 – 07/2012 Seattle, WA

Lead Operator, Telecommunications

Monitoring and assessing the job performance and efficiency of the operators assigned to my shift. Expertise in state-of-the-art computer software used to manage the medical center’s emergency response teams, including critical life-support code calls. Triage phone calls to appropriate physician/unit/department; Oversaw all aspects of physician on call schedule, schedule rotations and information updates. Proactively led the department in various operating strategies enabling the hospitals 24/7 communication services, including disasters. Regularly assigned, instructed and monitored the work of hospital operators on my shift; Maintained the on-line phone/pager directory and on-call databases. Set up and issued replacement telecommunications equipment.

ARTSELECT- 10/2006 – 09/2007 Fairfield, IA

Accounts Receivable Specialist/ HR Assistant

Provide analysis required by both Accounts Payable and Receivable Departments, utilizing advanced computer skills needed for electronic comparison of multiple spreadsheet reports. Processing of daily bank deposits; reconciliation of payments/deposits using QuickBooks. Processing of weekly and bi-monthly payroll using the ADP system; Salary Reconciliation; Administration of company STD, Dental and Vision Insurance Plans. Submit online Illinois & Iowa State Sales Tax Payments.

ING EMPLOYEE BENEFITS- 07/2001 - 02/2006 Minneapolis, MN

07/2004–02/2006 Business Analyst-Documents

I designed, modified, amended, updated, developed inventory control procedures and created implementation schedules, releases and trainings for proprietary company documents; Worked with Product Development Teams to assess ever-changing needs of our Sales Agents’ and other personnel; Streamlining of operations; Maintained stringent state compliance regulations; Assisted in the design, creation, and revision of more than 350 unique forms for a new Long Term Care coverage product; Oversaw development and implementation of ING’s “iAgent” database; Responsible for leading the “Train the Trainer” classes at the ING Learning Center; Organized required on-line classes, oversaw scheduling, enrollments and records coordination for ING personnel; Instructed and led Procedures training as well as Orientation and Introduction to the ING Learning Center; Led the Accountability and Communications training for management and ING personnel.

07/2001–06/2004 Forms, Filing and Records Retention Coordinator

Managed more than 1200 existing administrative, sales, new enrollment applications and required disclosure statements. Ensured legal compliance by working closely with Sales and Compliance departments, and with end users on correct utilization and information management procedures. Facilitated and assisted with periodic reviews and audits. To address the lack of a system-wide inventory control system for use throughout the US, I worked with the IT department to create a unique JIT inventory control database for tracking and accounting for all forms, applications and disclosure statements. Facilitated relocation of forms from Minnesota to Iowa DMC; Supervised revision and creation of new forms; Ensured legal compliance by working closely with Sales and Compliance areas; Oversaw distribution of forms; Tracked inventory and revision process. Supervised new form creation; coordinated interdepartmental reviews; Oversaw all aspects of ING”s form creation process.

01/1996-07/2001 AETNA US HEATHCARE- Hopkins, MN

09/1999–07/2001 Aetna Pharmacy Management- Direct Member Reimbursement Specialist

03/1999–09/1999 Aetna US Healthcare- Overpayment Unit Leader

09/1997–02/1999 Aetna US Healthcare- Customer Service Team Lead

01/1996–08/1997 Aetna US Healthcare- Specialty Claims Processor


March 2018 Licensed Insurance Agent WA State – Life, Health & Disability

1988-1992 Seattle Central Community College

Seattle, WA University of Washington

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