Andrea L. Turner

Tel: 303-***-****

Email: ac77nu@r.postjobfree.com

Objective:

To maintain a career in a fast-paced environment and provide a high level of service to clients in a growing and dynamic organization where through the utilization of my education and experience, I will have the opportunity to excel and advance.

Summary of Qualification:

10 year’s experience in customer service, sale and analytics including data entry and administrative tasks

Proficient with MS Word, Power Point, Office Outlook, Excel, Access and Salesforce in addition to Mac and PC platforms

Work Experience:

Oct. 2018-Current. Reconciliation Analyst/Auditor

• Identifies root cause and recurring issues which will be included in the analysis summary for to support the CMS monthly enrollment attestation

• Works discrepancies identified in the monthly full file reconciliation between employer group files, CMS files, membership system and pharmacy claim processing system. Identifies and corrects discrepancies, including submission of corrected data to the employer group, CMS’

• Validates other health coverage information using Medicare Secondary Payer rules and CMS regulatory requirements, submits updates timely and accurately to CMS’ contractor, and identifies other coverage for other party liability subrogation

• Performs comprehensive research and reconciliation of out of area flags and other special status flags (ESRD, Hospice, Medicaid, LIS) to ensure accurate membership, CMS capitation payment and pharmacy claim payment.

• Receives and prepares information related to an audit request from client or CMS, or monthly enrollment data validations from CMS’ contractor

Jan.2016-Oct. 2018. Enrollment Specialist/Coordinator, Davita VillageHealth, Centennial, CO

• First resource for field for general People Services questions

• Complete corporate employment verifications and unemployment paperwork

• Coordinate paperwork processing needed for onboarding and off-boarding of new and departing team members

• Coordinate initial claims for leaves of absence, FMLA, worker's compensation and ADA claims

• Data entry and administration of Oracle, Workday and Salesforce and payroll

• Speaking to individuals, educating them about benefits

• Conduct payroll and benefit audits and compliance reporting

Jan. 2015-Dec. 2015- Medicare/Medicaid Claims Analyst, Flagship Services Group, CO

• Process, prepare, and submit business or government forms, such as submitting applications for coverage to insurance carriers. As well as, analyze and review reports submitted

• Process and analyze a minimum of 40 assigned case file follow-ups daily related to Med Pay, No fault, General Liability and Workers Compensation claims

• Organize and work with detailed office records, maintaining files for each policyholder, including policies that are to be reinstated or cancelled.

• Data entry of new daily and bulk referrals, including checking for duplicate entries and starting mapped referrals, etc.

• Provide exemplary support to external clients and claimants

• Maintain Scans folder, CMS documents folder, Fax folders for remote users, documents in FTP, etc.

• Additional general office administrative support, including but not limited to, scanning, faxing, sorting records, data entry, answering phones, etc. for all departments within Flagship, as directed

• Resident expert on all assigned areas and assist with training new employees and answer any questions regarding assigned areas that team members and management may have

May. 2013- December. 2014: Senior Licensed Plan Advisor, Optum, CO

• Taking incoming calls and performing outbound calls to discuss insurance options and benefits including COBRA, Employee benefits, individual/family benefits and small business

• Selling various types of insurance policies to businesses and individuals on behalf of insurance companies, including, medical and dental insurance, or specialized policies

• Interviewing prospective clients to obtain data about their financial resources and needs, the physical condition of the person or property to be insured, and to discuss any existing coverage and speaking with qualified Medicaid prospects

• Calling on policyholders to deliver and explain policy, to analyze insurance program and suggest additions or changes, or to change beneficiaries.

• Seeking out new clients and develop clientele by networking to find new customers and generate lists of prospective clients.

Education: Eaglecrest High School, Centennial, CO, Diploma