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Customer Service Representative

Location:
Millington, TN, 38053
Salary:
32.000
Posted:
April 21, 2016

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Resume:

Veronica Hudson

**** ***** **

Millington, TN ***53

Cell 901-***-****

acuge9@r.postjobfree.com

** *****’ experience in customer service, problem solving and research. Experience in insurance guidelines and Medicare/Medicaid, program development, quality improvement and program monitoring.

Education and Training

EDI, Commerce, State Technical College, Memphis, TN

Microsoft Excel 2003 Intermediate / Advanced

Microsoft Office

XCELYS Subject Matter Expert (SME)

Cisco IP Phone 7960 Series

Customer Focus

Remedy

Professional Experience

Forest Hill Cemetery Jan 2013 to present

Contract processing and quality control

File Maintenance

Payroll Responsibilities

Banking duties- cash receipts entry, deposit slips, and bank deposits.

Accounting Duties (A/P, Billing, Deposits)

Deed and Certificates Processing

Maintain records of all memos, e-mails, corporate policies, and programs implemented

Aid and Assist at Home July 2012 to Sept 2013

Build and maintain a relationship between the agency and the MCO Case Management staff to facilitate resolution of issues as they arise.

Serve as the initial point of contact for the field staff of Resource One in an effort to prevent miss communication, scheduling and billing errors.

Monitor and master the Electronic Visit Verification dashboard software system

Update dashboard with current authorizations from MCO’s for home visits.

Keep staffing current on dashboard as notified by Team Leads.

Track Billing and Payroll errors as relates to EVV, reporting to Supervisor unresolvable issues

Keep Electronic Time Sheet reporting.

Collections

Scheduling

Resource One Medical Staffing (September 2011 to July 2012)

Electronic Visit Verification (EVV) Specialist

Build and maintain a relationship between the agency and the MCO Case Management staff to facilitate resolution of issues as they arise.

Serve as the initial point of contact for the field staff of Resource One in an effort to prevent miss communication, scheduling and billing errors.

Monitor and master the Electronic Visit Verification dashboard software system

Update dashboard with current authorizations from MCO’s for home visits.

Keep staffing current on dashboard as notified by Team Leads.

Track Billing and Payroll errors as relates to EVV, reporting to Supervisor unresolvable issues

Keep Electronic Time Sheet reporting.

Scheduling

WR Community Services

Data Entry Specialist (April 2011 to September 2011) LAYOFF

In charge of setting up scheduling according to state authorization ( for Homemakers,Personal Care and Attendant Care and Respite Care )

Communicating the set schedule to members and staff

Keeping track of all issued authorization

Medical Billing Keeping

Payroll and daily calculation of hours in Sandata

Handling all members and staff and Area Managers concerns

Performing all basic clerical duties as needed

Scheduling

Amerigroup Corporation (formerly Memphis Managed Care) Company Closed

Memphis, TN 1994 – 2009

Business Analyst (2006 – 2009)

Maintained over 160K eligibility records in Diamond system mainframe and State of Tennessee - TennCare insurance files.

Managed operator security for mainframe users in regards to Federal HIPAA regulations.

Tested all Diamond system improvements before production.

Produced SqL, Access and Proclarity software for all reporting and recording systems.

Eligibility Coordinator (1995 - 2006)

Designed original company Family Care Health Plan intranet and website.

Generated, monitored and maintained eligibility reports for over 180K members, including uploading patterns and all data into mainframe reporting systems and manual entries.

Managed complete scope of eligibility data including pattern identification and event marketing.

Served as department liaison regarding in- and out-patient services.

Customer Service Representative (1994 - 1995)

Maintained and disseminated company Family Care Health Plan information to enrollees, providers and community.

Maintained quality statistics at over 98% as required by the State of Tennessee - TennCare regulatory guidelines.

Tracked PCCM (Primary care case Managers) changes, developed eligibility spreadsheets and served as department liaison to IS / IT department.

Knowledgeable In

Medicare / Medicaid Guidelines

HIPAA Standards

State of Tennessee Insurance Regulations

XCELYS Claims Processing System

References

Upon request



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