Worker's Comp- Senior Operation Specialist/Team Leader for referrals

Judy Newton

*** **** ******** ****** *****: 813-***-****

Tampa, FL 33604 Email: ********@*******.***

Objective

Seeking to obtain a position, in which I can utilize my attention to detail and communication skills to advance my position, while making a significant contribution to the success of the business.

Summary of Qualifications

Extensive knowledge of Workman’s Comp. Medical Accounts.

Able to work independently or collaborate in a team environment

Excellent communication skill, able to convey strengths and opportunities while motivating others

Dependable, Flexible, and able to present a professional image

Results oriented, balancing production and quality to ensure standards are maintained

Experienced with Word, Excel, Power Point, FACTS system, Citrix, EDI systems, Time Traks and Risxfacs.

Professional Experience

Aetna/ Coventry Tampa, Florida

Senior Operation Service Rep. May 2000-2015

Data Entry /Referral Entry Team Lead

Manage workflow for Data Entry /Referral Entry Team

Managed the Referral Entry Team Procedures.

Identify opportunities within procedures

Worked on maintaining updates

Providing updates to the team, to ensure clear processing

Trained new and existing employees on Data Entry/Referral Entry Team processes in FACTS system

Complete audits as needed to maintain quality standards of the department

Provide feedback to peers and management on opportunities and strengths, recognize others for contributions

Primary point of contact for questions for Data Entry/Referral Entry Team as well as surrounding areas

Assisted management with any responsibilities and/or projects as needed

Referral Intake Coordinator

Receive referrals and process timely

Ensure all appropriate deadlines are met based on the requirements for each referral type

Maintain exceptional quality standards of all processed work

Identify process gap and recommend changes to eliminate any identified risk

Maintain an awareness of all changes to policies, procedures, laws and regulations to ensure quality work

Ability to learn and adapt quickly to new changes allowing management to utilize my skills for special projects

Workman’s Compensation Claim Analyst

Manage Workflow

Process claims timely

Maintain Exception quality of all processed work

Ensure all claims were inputted in order

Fee scheduled claims

Analyze CPT and Rev codes, to ensure all state guidelines are followed

Workman’s Compensation Claims Auditor

Works independently to conduct audits as assigned

Audit each claim for errors

Correct any claim submissions as needed

Ensure necessary feedback is provided to representatives

Kmart Corporation February 1985 to November 2000

Office Manager

Receiving Manager

Stockroom Manager

Credit Clerk

Invoice Bookkeeper

Cash Rroom Clerk

Computer/Office Skills

Proficient in computer software such as: Microsoft Word, Excel, Outlook, Power point

Education

2000, Certification in Fee Scheduling for the State of Florida

1975, High School, Plant City High School Plant City, FL

Contact this candidate