Customer Service Real Estate

PAULA B. MCCULLOUGH

P. O. Box ******, Houston, TX 77269 *********@*********.***

832-***-**** Mobile

Summary of Skills

Proven record of facilitating support services and managing fast-paced

office operations. Strong organizational and communication skills with the

ability to concurrently direct multiple business affairs. A multitude of

versatile skills that maintain high levels of efficiency and productivity.

Advanced understanding of client needs; trusted consultant and liaison.

EDUCATION

. B.S., Business Administration, University of Phoenix 06/2013, Houston,

TX

. Region 4 Teacher Certification Pre Service Training Program 11/2013,

Houston, TX

. eMPA, (In process), Texas Southern University, Houston, TX

EXPERIENCE

Cigna Healthspring, Houston, TX Care Associate Oct 2011 -

Present

Process Medicare authorizations for service according to Medicare time

guidelines accurately 99.9% of the time. Answers inquires, gathers

information, resolves routine matters, and responds to minor complaints or

problems from providers/facilities. Complete health assessments, maintain

documentation for regulatory review. Participate in education of member /

providers regarding plan benefits and claims. Make referrals to other

departments. May handle appeals involving medical necessity. Retroactive

prior authorizations, and/or member eligibility. Complete departmental

statistics reports. Interact with other departments and external vendors.

Optimal In Home Care Inc. Case Manager

Oct 2009 - March 2010

Provided daily supervision for a staff of 150 full-time employees across

multiple disciplines, i.e., front desk, field providers, case workers, and

billing personnel. Conference calls, reporting, managing patient schedules.

Plan and implement procedures and systems to maximize operating efficiency.

Evaluate current business processes to improve methods. Plan departmental

budgets yearly. Address the needs of clients concerns and complaints. Hire

and train new staff. Monitor staff performance including performance

review. Traveled in the service area approximately 50% of the time.

Health and Human Services Commission Texas Work Advisor III

Feb 2008 - Oct 2009

Perform complex technical, administrative, and management work in a Texas

Works direct delivery unit. Assists the supervisor in unit administration

and interpretation of policies for staff and clients. Serves as the team

lead responsible for mentoring and training of staff, which includes

providing direction, support and feedback. Completes periodic unit reports,

special narrative or statistical reports, and responds to client

complaints. Performs case reading functions to determine validity and

accuracy of eligibility determinations made by other staff. Initiates,

monitors, and manages service improvement projects and reports on

activities. Interviews clients, verifies financial and other information,

and determines/re-determines eligibility for Food Stamps, Temporary

Assistance for Needy Families, and Medicaid programs. Processes changes to

client status, overpayments, and adjusts or restores benefits. Provides

general information and assistance to clients regarding programs and

application process. Reviews suspected fraud cases and makes referrals to

invest.

GE Commercial Real Estate Insurance Analyst (Contract) Dec

2006 - Aug 2007

Performs periodic quality control claims audits and participates in

strategic claim reviews to ensure claims are being managed proactively and

in accordance with company's philosophy. Identifies, monitors, and remains

proactively involved in high exposure claims to minimize costs to the

organization, and communicate and coordinate with internal partners. Obtain

underwriting information for potential real estate acquisitions, analyze

risks and provide estimated premium quotations. Participate in the due

diligence process for real estate acquisitions consisting of contract

review, analysis of underwriting information, placement of appropriate

coverage, review of binders, endorsements and premium invoices.

Southern Plan Administrators Provider Relations Rep Jan

2001 - Dec 2006

Responsible for maintaining working relationships within the existing

network. Assisted in the recruitment and credentialing of new providers.

Maintained accurate and current provider databases

relating to provider facilities and physician information. Assisted with

policy and procedure interpretation.

SKILLS

Technology: CPT/ICD-9 coding, Medicaid/Medicare, Microsoft Office Suite,

AS400, CCMS &

EZcap

Other: Medical terminology, Managed care, Provider relationship

building, PPO, HMO, POS

Accounts payable/Accounts receivables, Effective problem-

solving, Training and Organizational Development, Contract

negotiation skills, Excellent oral and written communication,

Excellent presentation skills, Ability to work in a multi-task

environment, Healthcare reimbursement methodologies, Strong

analytical and interpersonal skills, Customer service, Claims,

Insurance verification & CMS guidelines.

References upon Request

Contact this candidate