Customer Service Quality Assurance
Resume:
W. Jerry Blackshire
Plano, Texas 75074
EMPLOYMENT
**** - ******* **** ***** *** Blue Shield of Texas Richardson,
Texas
Sr Credentialing Representative - Provider
Administration
Research and resolve credentialing cases. Collect
work history data, verify Licenses, DEA/DPS
registration. Query NPDB,OIG and MEDOPT data base.
Set up and maintain provider information on
multiple provider databases to reflect
credentialing activity. Respond to provider
2004 - 2008 regarding credentialing decisions and related
issues. Apply quality assurance processes to ensure
data integrity along with maintaining quality and
volume ratios based on department standards.
Internal and External phone communication to obtain
or give information.
Precertification Analyst-Utilization Management
Division
Worked with Utilization Review area. Taking inbound
calls setting up precerts and referral.
Knowledgeable of all contract interpretation.
Knowledge of ICD9 and CPT4 coding, as well as claim
processing. Collect structural clinical and
EDUCATION non-clinical data. Verify eligibility for MD
office, hospital and subscriber. Approve hospital
admit and discharge cases out of system. Run admit
and discharge reports. Data entry
Customer Service-Membership Division
Extensive written and oral communication with
customers, agents, and internal sources. Verified
and updated database, on policies and pending
SKILLS applications. Set up supplies ordering system for
the department. Set-up 10-day refunds.
International School of Business
McKinney, TX
Collin County Community College
Plano, TX
International School of Business
Dallas, TX
Dallas County Community College
Dallas, TX
Experience utilizing various Windows based software
to include: Excel, Microsoft 98, and Outlook.
Typing 55wpm, ten keys by touch, time management
and interpersonal skills also, trained in
peoplesoft, medisoft, medical management and
eclipse.
References upon Request
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