Healthcare, Medicaid and Medicare

***LAS PALMAS DR SAN ANTONIO, TEXAS *****

210-***-**** ***********@*****.***

DEBORAH L. XIMENEZ

OBJECTIVE

Seeking a position with a company where I can further develop my leadership abilities, in an environment that will utilizes my expertise.

SKILLS AND QUALIFICATIONS

A self-motivated and organized professional with over 20 years experience providing thorough and skillful support to department managers.

Strong communication, organizational, and problem-solving skills.

Experienced in navigating teams through changing business environments.

Self-motivated, able to implement decisions and set effective priorities to achieve both immediate and long-term goals.

Proficient in Microsoft Word, Excel, Access, PowerPoint, and Outlook; Netscape and Internet Explorer; Adobe Reader, Windows NT to current, Networking, Data Entry and 10 key.

WORK EXPERIENCE

HealthCare Scouts Inc. 06/2015 - 09/2015 Provider Relations Specialist (contract only)

Utilized multiple systems; Share Point, Amysis, TruCare, Cnet, Microstrategy, CDMS Filenet, Biscom and CMS.

Completed various outreach projects as assigned by Management.

Interacted with Nursing Homes, Doctor Offices, Medical Suppliers and Assisted Living Facilities to ensure compliance with company and Medicaid/Medicare guidelines.

Maintained Credentialing and Re-Credentialing for: Doctors, Nursing Homes and Health Facilities.

Randstad 09/2014 - 04/2015 Retirement Plan Specialist (contract only)

Utilized multiple systems; TRAC/SmartDesk, RPA, SONI, SHARE and TA2000/AAMODEL

Processed and audited various 401k distribution requests.

Set-up new 401k/IRA retirement plans customized to the clients specifications.

Interacted with internal/external customers to obtain required information to complete submitted requests accurately.

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CVS Caremark Corporation 04/2006 - 08/2014 Claim Benefits Specialist III / Verification Representative I

Utilized multiple systems; Quantum Leap/Peoplesafe, RxClaim/AS400, ReCap/3270, ACAS, ASD, APMCAS, ECHS, Rumbas and CMS.

Proactively reviewed department policies and procedures to maintain accuracy.

Analyzed and processed pharmacy claims for Medicare/Medicaid members, Dept. of Veterans/Dept. of Defense and member reimbursement.

Audited problem accounts for errors and documented trends in order to improve customer satisfaction.

Instrumental in establishing more efficient methods of tracking daily production and time management.

Implemented new navigational techniques for co-workers to improve their research time and become more efficient.

West Corporation 03/2006 - 05/2006 Aetna Answer Line (contract only)

Assisted customers in advisement of Medicare D eligibility, explaining the benefits of each plan to aid customers in establishing the best plan to meet their needs.

J.P.Morgan Chase & Co. 01/2005 - 12/2005 Inbound Retention Supervisor

Developed interpersonal skills, having dealt with a diversity of professionals, clients and staff members.

Supervised and managed a team of 8 employees on a day-to-day basis.

Team player with good supervisory, coaching, teaching and communication skills necessary to improve customer satisfaction.

Time Warner Cable Inc. 09/2000 - 11/2004 Technical Support Specialist II

Investigated and found quick resolutions to problems and issues associated with members High-Speed Internet Connection and Digital Receiver.

Motivated self-starter with the ability to develop and establish more efficient methods to improve resolution time.

Troubleshoot and configured members software in order to resolve system problems.

EDUCATION

National Institute of Technology 10/1993 - 08/1995 Associates Degree in Computer Engineering Technology (ECET) GPA 3.83 of 4.0

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VOLUNTEER WORK

Relay For Life 8 years

JDRF 8 years

Goodwill Industries 2 years

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