Customer Service Project

Jermaine L. Simpson

**** * ******* ******, *******, Ca 92806

***/***-****

Email: ***********@*******.***

Summary Demonstrated achiever with exceptional knowledge of international markets, business practices, and trade regulations.

Strong social service, marketing and finance background combined with fluency in French (Reading, Writing and Language

Skilled at learning new concepts quickly, working well under pressure, and communicating ideas clearly and effectively.

Extensive computer training, including knowledge of multiple networking environments and business software packages, incl. HMIS.

Enthusiastic, dedicated & organized social service professional with over 24 years of experience in counseling, program coordination and development and proven supervisory and counseling techniques.

Familiar with administrating CDBG, ESG, DMH and SHP Grants and following OMB requirements

Advanced proficiency in MS Office (Excel, Word, Sharepoint, Powerpoint, Visio, Silverlight, OneNote, Publisher, and Access) Education Masters Degree in Business Administration University of California, Irvine, Irvine, California Present

B.A. Degree in Finance

California State University, Long Beach, Long Beach, California B.A. Degree in International Business

California State University, Long Beach, Long Beach, California Certification in Grant Writing

California State University, Long Beach, Long Beach, California 1996

1996

1998

Career History & Accomplishments

Manager, Provider Configuration, Molina Healthcare, Inc

Development of Provider Configuration Team in support of Corporate Operations Initiatives & Molina Strategic Goals.

Balance Provider Configuration work to ensure all inventory items are completed timely

Develop and assess reduction/ capacity plan with “actual” Provider Configuration receipt numbers and analyze FTE count to ensure staffing is appropriate (Provide Staffing justification, if needed to Director for submission)

Develop Provider Configuration Sharepoint Site on Corporate Operations Site to include reference materials related to implementations

(IE., BRD, SOP SOQ, SOW, Contracts, Amendments, etc.), training and best practice documents

Provide Provider Configuration updates to Claims Managers and/or Claims Supervisors for Operations Calls monthly

Responsible for implementation of Provider Configuration with new health plans and/or conversions of plans to the core processing system, including understanding all state requirements related to provider config. (inbound, outbound and encounters)

Provide oversight of Provider Configuration Operational Meetings in support of Supervisor.

Provide excellent Customer Service and look for ways to provide training opportunities and/or feedback to supporting Staff.

Develop Quality Audit processes for Provider Configuration in conjunction with Corporate Operations Audit Team

Strategize ways to streamline/ systemize manual processes in support of standardized/ centralized model.

Reviewed HOT Claims or High Claim balances, reconciled Accounts for Recover Processes and expedited Aged Claims. Contract Administrator/ Senior Project Analyst, AT&T

Responsible for the creation, revision and control of Client labeling with a primary focus on documentation and contract control through all stages of the change control process.

Completed all editing and development of documents and contracts in compliance with ISO, HIPPA, PHI and FDA guidelines.

Creation, monitoring and reporting of SOP’s, BRD’s, Project Management RAIDs

Implemented Change Management Policies and identified areas of improvement and executed continuous improvement initiatives.

Responsible for Quality compliance, clarity, consistency organization and maintenance of all Contracts, Agreements, databases, servers and other documentation (ie, spreadsheets, etc.)

Set-up meeting with key stakeholders, Sales Managers and other SME in order to verify, correct, understand and mitigate risks, actions, issues and other requirements

Provide Project Management within Projects, including tracking documentation through the entire development process while adhering to strict timelines, maintaining revision control, adding corrective actions and managing stakeholders. Reporting Manager, United Healthcare

Responsible for designing/developing, programming, maintaining and publishing Standard and Ad Hoc operational reports and operational analysis utilized for decision making.

Managed results of Call Center and assisted in mitigating Customer Concerns and Complaints with strategy and Pillar Teams

Responsible for drafting, negotiating, reviewing and monitoring all prospective and active Client and Vendor Contracts/ Docs

Manages and is accountable for professional employees and/or supervisors.

Schedule and/or meet with internal (e.g., Legal; Process Improvement; Finance; Senior Mgmt) and/or external customers in order to gather report requirements, data analysis needs and ensure timely review, approval and reconciliations

Provide Reports & Scorecards that ensure signed contracts are communicated to all stakeholders for awareness of implementations and contract guarantee requirements

Complete functional requirement forms to define project parameters, build report requirements, and identify potential solutions

Responsible for managing department & operating as primary intermediary between Clients, Customers and multiple Departments.

Identify appropriate data sources, report metrics, and tools for providing required information according to clients' requests

Determine scope of requested work in order to assess resource requirements and create work plans (e.g., time; personnel) Dec. 2015-

Present

Sept. 2015-

Dec. 2015

Oct. 2014-

Sept. 2015

Demonstrate understanding of reporting requirements for benefits plans (e.g., health plans; prescription/care mgmt ) & relevant platforms

Demonstrate understanding of business terminology and acronyms in order to accurately interpret customers' requests

Communicate with 3rd party vendors(e.g., conduct site visits) in order to gather and/or deliver info needed to complete reports

Identify relevant stakeholders needed to help define report requirements and resolve issues as needed

Collaborate with Program and Finance Departments to ensure compliance to budgeted requirements, risks through RAIDS, pricing, regulations (where applicable), etc.

Define and/or ensure report parameters are established consistent with data governance requirements (e.g., PHI data) and comply with company and corporate policies

Identify and/or create relevant databases (e.g., fields; libraries) needed to source appropriate data

Demonstrate understanding of relevant software and databases (e.g., SQL; Excel; Access; SAS; Hyperion)

Review and/or identify appropriate report format to use based on customers' needs

Test and review completed reports and associated metrics used in order to ensure accuracy and quality

Ensure customers have appropriate access to reports (e.g., review security provisions; ensure proper documentation is obtained)

Test and verify the accuracy of incoming or received data and/or coding prior to generating automated reports

Develop tests and/or software modules needed to assess the accuracy of data and/or coding used for report generation

Create and/or update presentation docs to summarize results (e.g., written reports; PowerPoint deck; graphs and/or charts)

Ensure that reports are distributed according to service level agreements (e.g., deadlines; performance guarantees)

Responsible for monthly management of financial analysis including: claims reconciliation, audit schedules, rate changes, etc. Senior Financial Analyst, Sure Haven

Tracks financial status by Monitoring variances from plan and determining financial status by comparing and analyzing plans and forecasts with actual results

Improves financial status by analyzing results and variances; identifying trends; recommending actions

Reconciles transactions by comparing and correcting data.

Increases productivity by developing automated applications; eliminating duplications; coordinating information requirements

Provides information to Management by assembling and summarizing data; preparing reports; making presentations of findings, analysis and recommendations

Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations

Completed, reviewed, processed and mitigated Medical SuperBill Transactions on Billing supported database

Negotiated sales of numerous governmental and insurance Company Contracts Director of Programs/ Financial Analyst/ Senior Contract Specialist, New Image

Worked directly with Director of Business Development and Strategic planning on development of grants and proposal for the City and Counties of LA.

Involved in all development of buying and auditing decisions

Coordinated and completed all RFP’s, RFI’s and RFQ’s for Director and Deputy Director

Supervised, selected, trained and evaluated A/R and A/P Staff. Reviewed Employees Time Cards, Leaves of Absences Requests, Monitored Work Assignments, Activities and evaluated all Work Products

Coordinated year-end accounting and budgetary compliance for encumbrances and capital projects. Developed, administered and updated all petty cash and travel expenses/reimbursements.

Monthly financial analysis, account reconciliations, and actual versus budgeted

Use judgment & professional skills in determining appropriate procedures for preparation of accounting records, transactions and reporting, as well as tracking Project Revenues

Reviewing invoices and contracts, gathering support, and drafting invoices

Completed detailed, on-going project management on all Projects and provided weekly, monthly and quarterly status updates

Project job costing, percentage of completion, and project budget analysis, time and material.

Managing and participating in operational and capital improvement budget development and monitoring

Managed the activities of General Accounting, revenue Management, Financial Systems Support and Cost Accounting/Grants

Oversaw the preparation of Annual Financial Reports while providing tech support to CFO, Financial Support Systems & Treasury

Maintained and compiled Centralized database for all clients accessing emergency hotel/motel and meal voucher assistance throughout LA County

Supervised a staff of 60 Employees consisting of Case Managers, Program Managers, Housing Specialists, and Mental Health Workers responsible for regulating applications from over 178 social service agencies throughout Riverside and LA Counties

Formulated database to complete Governmental A.P.R.’s with comprehensive narrative’s outlining program successes, problems, activities, concerns and other pertinent information.

Provide leadership for programs, operations initiatives, performing analytics and metrics research; implement processes that significantly increased department revenue and assisting in marketing efforts to increase market penetration and revenue gains.

Recruit top tier staff to develop effective and cost-conscience business planning focused on bottom line results without compromising quality service; complete yearly performance reviews and conflict resolution.

Manage contract proposals, identify target objectives and draft program design and development procedures.

Responsible for developing forms and databases for Governmental Programs, Maintained Case Loads for all populations, facilitated leadership development classes, life skills, all recreational programs and Coordinated Outreach Programs

Completed monthly, quarterly and annual A.P.R.’s for demographic reporting. Memberships & Affiliations

Member, Case Management Taskforce of Los Angeles, California

California State University Alumni Association

Member, LACHAC

July 2014-

Oct. 2014

July 2000-

July 2014

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