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Customer Service Sales

Location:
Buffalo, NY
Salary:
75k
Posted:
September 24, 2018

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Resume:

Elisse A. Graham

*** **** **. **** ***

Buffalo, NY 14203

716-***-****

ac65pq@r.postjobfree.com

Professional Summary

I am a qualified and experienced Business Analyst through all stages of the project lifecycle with experience in various domains; with strengths in analysis, strategy and process improvement. I have extensive healthcare knowledge being a Cost Containment Analyst for over 10 years. I have demonstrated an ability to perform consistently exceeding expectations the functions of a Business and Cost Containment Analyst.

Skills

Able to communicate clearly and get along well with other coworkers.

More than 15 years’ experience in customer service, management, accounting and cost containment.

Stakeholder Management.

Licensed Life, Accident and Health Agent.

Ability to train, motivate and supervise employees.

Assisted in the implementation of the Cost Containment department with Nova Administrators and the Negotiation department with Meritain Health.

Working knowledge of all Microsoft programs.

Ability to accept and learn from criticism.

Able to perform with minimal supervision.

Ability to meet deliverables while managing multiple projects

Great problem solving and analytical skills

Successfully completed CAPM training 12/2017- scheduled exam certification 10/2018

Member of the PMI Organization- Buffalo Chapter since 10/2017 Work History

Senior Business Analyst 4/2018 thru 8/2018

Global Quest contracted with M&T Bank

Served as Test Coordinator for large project initiatives involving multiple applications to ensure all testing needs are met across all interfacing applications.

Communicated project updates via phone, email,instant messaging, webinars and face to face meetings.

Gained thorough understanding from Stakeholders and end users of their day to day process to communicate functionality requirements to the technical team to create business required documents.

Facilitated bi-weekly meetings during UAT/SIT phase of projects’ with technology, stakeholders and end users tracking deficiencies identified during testing using ALM.

Coordinating and providing estimates for complex projects and complete estimates for assigned component for large projects, inclusive of timelines, application and project phases.

Re-assessing operational risk associated with the business and reporting to Stakeholders.

Extracting, loading and transforming data on the Oracle platform.

Participating in and documenting data mapping for integration of systems, conversion, and acquisition related projects.

Ensuring c hange requests to functional specifications are consistently documented, reviewed and resolved to identify impacts to overall project plan and budget, technology, customers and clients and ensure application is working to support products and services required by the business

Responsible for ensuring any issues that arise from testing or implementation are escalated and resolved appropriately in an efficient and timely manner. Ensure issues, incidences and questions are documented, reported and resolved as required. CDD KYC Analyst 5/2017 thru 4/2018

Strauss Group contracted with HSBC

Managing risk and ensuring compliance of Anti Money Laundering(AML) and Anti Terrorist Financing(ATF) in accordance with HSBC’s policies,controls and regulatory standards..

Liaison between Clients and Relationship Managers to gather detailed and supportive information required to complete the CDD profile.

Identifying, managing and escalating applicable AML, ATF,sanction and reputational risk to compliance.

Managing the client experience throughout the onboarding of new clients while maintaining the highest standards of customer service, while taking into account the changing economic market conditions, legal,technical and regulatory procedures.

Re-assessing operational risk associated with the business and reporting to Stakeholders.

Up-dating business requirement documents.

Business Analyst 8/2016 thru 12/2016

P&A Group-Buffalo NY,14203

Effectively served as a liaison between IT, Operations, Sales and Management within the organization.

Determined if solutions have fulfilled the requirements.

Participated in the development and refinement of internal controls to enhance the P&A Groups business process.

Identified business trends utilizing real data, compile analysis reports that are delivered to stakeholders and then follow up on results.

Identified risk-related issues needing escalation to management.

Assisted with the implementation of SOC 2 auditing and compliance process for the P&A Group.

Documented and identified required changes and communicated them to required members of the organization.

Created, implemented and revised Business Required documents

Work with pertinent vendors and technical team to gain thorough understanding of project functionality and provide insight on implementation.

Trained and created documentation on how to utilize secure email software.

Planned, organized and facilitated weekly meetings with management.

Ensured operational compliance with company policies and procedures.

Worked with Stakeholders to evaluate Cost/Benefit Of functionality prior to solution.

Credentialing Specialist 2/2016 thru 3/2016

CSI Companies/Contracted with Blue Cross Blue Shield- Buffalo NY 14207

Performed necessary queries and background checks on providers required by regulatory agencies by accessing various agency data banks and web sites.

Performed primary source verification with provider information from reports (e.g. DEA quarterly report)

Facilitated the process for the assignment of the Council for Affordable Quality Healthcare

(CAQH) number as part of the credentialing process on behalf of the provider.

Reviewed provider and facility enrollment applications and certifications to obtain missing information or verification according to regulatory requirements.

Answering internal and external inquiries of application status via phone and/or written correspondence.

Account Support Specialist 10/2015 thru 1/2016

CSI Companies/Contracted with Blue Cross Blue Shield- Buffalo NY 14207

Verified and updated HIPAA information utilizing Facets, Sales Force and Content Manager programs.

Assisted with new group implementation using Group Library program.

Collaborated with Account Executives on renewals and ongoing service of all assigned employer groups.

Reviewed documents submitted by employer groups and brokers for accuracy.

Performed peer reviews on plan matrices, identified updates and discrepancies prior to implementation.

Provided clients with summaries of benefits and coverage. Cost Containment Analyst 1/2014 thru 10/2015

Nova Healthcare- Williamsville NY, 14221

Reviewed CPT, ICD 9 and DRG codes to insure accuracy for claim processing

Managed Novas’ self -funded client’s dollars by insuring that claims were being reimbursed at the industry standard.

Coordinated with Utilization Management to verify medical procedures and services were medically necessary and covered by their plan.

Processed PPO vendor fees for the utilization of their networks.

Reported generated revenue to finance, management and clients. Personally generated

$386,807.86 in revenue through direct negotiations.

Assisted in monthly profitability reporting for the product lines.

Prepare periodic financial reports with graphics for profitability projections and the progress of new business lines.

P articipate in design discussions and ensure required functional specifications are documented and delivered for application changes for complex projects.

Determined and documented user requirements for business processes. Medicare Sales Representative 8/2013 thru 12/2013

AP Professionals/ Contracted with Independent Health- Williamsville, NY 14221

Insured Medicare beneficiaries understood the product choices available to them.

Enrolled eligible individuals in Medicare products accurately and thoroughly.

Completed and submitted required enrollment documentation consistent with CMS requirements

Assisted members with questions and concerns.

Strategic Cost Consultant 8/2004 thru 11/2012

Meritain Health- Amherst, NY 14223

Negotiated on claims $50,000.00 and higher generating revenue for Meritain Health.

Supervised, coached and trained 15 employees, scheduled work hours and resolved conflicts.

Prepared weekly reports and maintained records of accomplishments as required to coordinate the preparation and communication to senior management.

Corresponded with outside vendors and internal departments ensuring that claims are being processed accurately to provide clients with a superior experience.

Created letters of agreement stating negotiated rate and payment terms for medical services performed by providers.

● Directed and managed the overall client relationship to include quality of work and customer satisfaction.

Responsible for leadership, training, client continuance, management status reports, and billing.

Significant knowledge of healthcare regulations such as CMS, HCFA and COMAR thereby providing critical feedback to business units on regulatory compliance

Scheduled and facilitated project team meetings and document and distribute minutes as applicable to ensure all team members are informed and issues are addressed.

Reviewed business requirements with technology team to ensure understanding of project requirements.

Assistant Store Manager 6/1996 thru 12/2007

Noco Express Shops/Valero Mart-Buffalo, NY 14216

Planned, prepared work schedules and assigned employees specific tasks.

Audited inventories, reconciled cash with sales receipts and prepared daily record of transactions.

Insured compliance of employees with established security measures and record keeping of practices and procedures.

Coordinated sales promotion activities.

Ordered merchandise and prepared requisitions to replenish merchandise on hand. Mortgage Processor 10/2002 thru 8/2004

Personnel Resource/ Contracted with HSBC and M&T Bank- Williamsville, NY 14221

Gathered information and took each file from pre-approval to closing..

Input loan information into system for processing.

Held responsible for insuring that all loan documentation was accurate and complied with company policy.

Verified loan documentation including income, credit approval, appraisal and title insurance.

Prepared loan packages for submittal to Underwriting.

Coordinated loan information between Loan Officers and Underwriters.

Assisted in financial audits of the insurance, appraisal, investment, real estate, lending and retail banking affiliates.

Education

High School Diploma-June 1996

Bennett High School- Buffalo, NY 14214

Life, Accident and Health Agent License-March 2013 Bryant and Stratton College- Getzville, NY 14068

CPC Certification- Current

Allied Schools- Laguna Hills, CA 92653

CAPM Training-December 2017 Certification scheduled for January 2018 Simplilearn -San Francisco,CA 94105



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