SuEllen T. Grable

*** **** ****** *****, ************ Beach, FL. 32250

** 904-***-**** (c), 904-***-**** (h)

acz82c@r.postjobfree.com

EDUCATION:

Master’s Degree of Public Administration, University of North Florida, Jacksonville Florida

Bachelor’s Degree of Arts in Communication,

University of North Florida, Jacksonville Florida

Sandalwood Senior and Junior High,

Jacksonville Florida

PROFESSIONAL EXPERIENCE:

CITICORP CREDIT SERVICES, INC., - 14000 Citi Cards Way, Jacksonville, Florida 32258 (Main Office) (Title: Costco Fraud Specialist II, Employment: 06/27/16– present, hourly full-time Management: Melissa Ferguson), GEID # 101*******, SOEID #sg60862

At Citi my superior customer services skills along with my professional demeanor is utilized on a daily basis. I am allowed the opportunity to assist our card members and providing them the reassurance that their data and cards are in the best of hands. My position verifies the card member, reviews transactions, identify fraudulent activity, security closing accounts, and assist our members’ questions. By providing a high level of service, I utilize several applications and software packages for verification and necessary corporate checks and balances. The following are one of the many applications used in my position:

Sawgrass

Lexus/Nexus

3D Secure Management

Apollo

Rumbia

CBR – Credit Bureau Report

Eclipse

EVT tool (employee verification tool)

Future applications/software in development and on its way

COMPLEMENTARY CARE CENTER – 1504 Roberts Drive, Jacksonville Beach, Florida 32250

(Title: Office Manager of Alternative Medical Clinic and partial owner; Employment: 10/03/05–6/27/2016, salaried full-time Management: Dr. Stephen E. Grable, Owner/President)

Complementary Care Center is a medical clinic currently with one Internal Medicine Physician offering alternative and holistic treatments. The Practice offers the blend of both traditional and alternative medical treatments. Overall functionality and progress of the clinic depends heavily on my daily professional performance. My position manages and prioritizes the functionality of several job functions along with a variety of complex tasks. My job duties include, but is not limited to:

Manage and supervise several employees (8-10 employees) as well as assisting physician on staff. Generate payroll and taxes on a bi-weekly basis. Administer annual reviews tracking goals, expectations and outcomes. Offering training and educational courses to staff.

Responsible for patient intake and checkout procedures. Chart patient medical records (process labs, Rx requests, and received imaging scripts). Address patient’s issues and concerns.

Schedule patients’ office visits and discussed alternative modalities that could be provided: Scheduling includes: office appointments, PEMF (pulsed electromagnetic frequency), CRT (computerized regulation thermometry), Massage therapy, and IV (intravenous) therapies.

Insurance filing and processing of claims (i.e, FL Blue (Availity), UHC/AARP (Optimum), Aetna (Navinet), Cigna (Availity), Medicare (PCACE), Tricare Standard (Tricare), etc

Coding procedures (CPT) and diagnosis (ICD-10 CM) codes of patient’s rendered services.

Post adjudicated insurance claims into Practice Medical Management software (MediSoft).

Ensure provider is credentialed and data collection is accurate through CAQH (Council for Affordable Quality Healthcare).

Management of the clinic and staff’s day-to-day operations. Overarching accountability for the functionality and success of the clinic. A patient’s perception of your clinic means everything in running a profitable clinic. Management and decision maker of front office purchases including, but not excluding: computers, medical equipment, supplements, ancillary products, IV solutions, medical supplies (i.e., needles, gauze, medical pads, cotton swabs, alcohol, etc software packages, phone system, filing cabinets, VCR & television equipment, etc.,.

Accounting functions and payroll taxes (i.e, 941 Employee Liabilities Tax, 940 Federal Unemployment, UCT-6 State Unemployment, and DR-15 Sales & Use tax/Dept of Revenue). Accounting functions generated out of “Quickbooks” software.

Updated software inputs and correctional items to Provider Medical Management System named “MediSoft.”

INCEPTURE, Blue Cross and Blue Shield of Florida – 4800 Deerwood Campus Parkway, Jacksonville, FL. 32246

(Title: Project Manager /OPD (On-line Provider Directory, Employment: 3/3/03-9/30/05, Contractor full-time, Division: Product Line Management, Management: John Wagner, Director)

My position placed me as the Project Manager for creativity, modifications, and updates to FL Blue’s Online Provider Directory (OPD). My position allowed me to work closely with IT, Marketing, and Sales Staff to create, implement, and execute a new improved OPD. My immediate Manager was the Director of Product Management, John Wagner. Our Director Champion was Chip Kenyon.

Management of key objectives, goals and roll-out initiatives.

Integrate marketing goals and advertising brand to create comprehensive website development.

Responsible for coordination and tracking of new developments, enhancements, roll-out glitches, communications, and tracking roles and responsibilities. OPD creation allowed unique modifications for ‘all’ product lines.

Coordinated and integrated customer requests along with corporate requirements for roll out strategy of website development.

Developed and executed the “Corporate Decision Memo,” eliminating paper provider directories. The Decision Memo addressed Senior Level Management and Corporate Leads allowing for a cost savings of 2 million dollars.

Implement strategies, programs, and mechanisms explaining the development of OPD and the importance of its existence.

BLUE CROSS AND BLUE SHIELD OF FLORIDA, 4800 Deerwood Campus Parkway, Jacksonville, Florida 32246 << Employment Tenure with Florida Blue 9/5/89-12/2002>>

(Title: Project Consultant, Employment: 06/08/98-12/13/2002 (This specific job function), salaried full-time, Department: Operations Strategy & Policy, Division: GBU Operations, Management: Deborah Baker, Director)

Advisor and Business Lead to workforce initiatives pertaining to Legal mandates: a) Legislative Advisory Group (LAG), b) Legislative Implementation Group (LIG), and c) Operation’s Compliance Implementation Group (OCIG).

Accountable for legislative regulatory compliance, reviewing both senate and house bills. Facilitated and instructed Operational meetings regarding Health Insurance Portability and Accountability Act (HIPAA-AS). Specific HIPAA-AS regulations including Protected Health Information (PHI) and Patient Identifiable Medical Information (PIMI). Also created documentation requirements necessary for the Blue’s to meet National Committee for Quality Assurance (NCQA).

Completed benchmarking and analytical work necessary to complete BCBSF’s 2001-2005 Health Business Strategy. Additional documentation included: Vision Statement, Strategic Platforms and Key Capabilities, Customer Business Outcomes, Supporting Strategies, Service Delivery Target State Attributes, Business Processes and Migration Plans.

Project implementation to improve on customers’ satisfaction. Web-sites implementation, call routing, customer empowerment, extended hours, computer telephony integration (CTI) and provider interactive voice recognition (IVR).

Instrumental in developing and facilitating the Service Deliver Strategy (SDS). This project was developed to enhance and improve customer satisfaction. Responsible for the tactical planning, development, and execution of programs.

Created task, goals and deliverables necessary to meet regulatory requirements of Health Care Financing Administration (HCFA), National Committee for Quality Assurance (NCQA) and the Balance Budget Act (BBA). I also developed facts and summary sheets for the sales staff to comprehend specific requirements (i.e., Delegation/Outsourcing).

Departmental Liaison and Subject Matter Expert (SME) for Operations and E-Commerce regarding corporate workgroups. Workgroups included, a) e-mail development (transmitting/receiving), b) web-site development and (d) PIMI related initiatives (i.e., encryption, digital certificates, computerized keys, etc.).

BLUE CROSS AND BLUE SHIELD OF FLORIDA,

(Title: Project Analyst/Virtual Office; Employment: 4/1/1996-6/26/1998, salaried full-time, Department: Illness Management and Back End Monitoring (BEM), Division: Virtual Office (VO) then changed to Business Change, Management: Jim Olive, VO Manager)

Created Communication Plans to explain Illness Management’s Objectives, Strategies and Vision of Clinical Care Management System.

Developed and created both Provider and Member Satisfaction Assessments for Virtual Office (VO).

Created internal documentation justifying business expenses (i.e., scope documents, workflows, proposals, business rules, procedures/SOP’s (standard operating procedures), requirements, and project plans.

Utilized the correct methodology (e.g., one-on-one, telephonic or focus group) to carefully select proper improvements to incorporate into our Continuous Quality Improvements (CQI).

(Title: Marketing Coordinator, Employment: 3/7/1994-4/5/1996, salaried full-time, Department: Sales Support, Division: Local Group Marketing, Management: Mike Sapp, Sales Manager)

Managed, trained and interviewed for hire fourteen (14) Tele-Sales Representatives. I held instructional classes providing knowledge to BCBSF’s Local Group product portfolio (e.g., PPO product line, HMO products, Ancillary products, Small Groups 1-50, and Large Groups 51+).

Created sales tools and sales fact sheets for the sales staff to promote Blue’s health portfolio.

Responsible for ‘market segmentation’ whereby integrating and coordinating market mix variables (i.e., product, price, promotion, and distribution/sales) to individual markets. Viewed segmented group markets’ needs and targeted our products and services to meet their demands.

Managed and supervised Customer Contact and Market Coverage Program (CC/MCP). This project initiative was to gain and retain market segmentation. As the facilitator, I coordinated the project results to numerous BCBSF department heads and upper level management.

Designed and created fact-finding sheets, graphs, charts, and cliff notes to assist clients in understanding insurance programs and coverage guidelines.

Selected to advise Legislative Advisory Group (LAG) (created from our Legal Affairs Department) to review, interpret and understand state and federal mandates.

(Title: Contract Administrator, Employment: 4/1/1991-3/4/1994, salaried full-time, Department: Contact and Proposal Administration, Division: Local Group Marketing/Advertising Department, Management: Deborah Jackson, Manager)

Modified and revised PPO and HMO products to meet legislative requirements.

Created and revised Corporate Applications to comply with legislative regulations (i.e., Medicare and More (Ov65) Application, Universal Individual Application, Small Group documentation).

Assisted in the development of new “Allied” product lines (i.e., Dental, Life and Vision).

Identification and redesign of Small Group products and Model POS. The redesign met the requirements of Marketing and Managed Care Strategies.

Created and implemented “endorsements” to our PPO subscribers and “certificate riders” to our HMO members.

Facilitated in billboard promotion related to Blue’s portfolio and health awareness.

Tracked monies utilized for Advertising and Marketing strategies.

Overall accumulation of marketing analysis, advertising expenses, and brand recognition specific to advertising segments and type (i.e., Mass mailings, brochures, radio, billboards, newspaper pamphlets, Ov65, Under65, Small Group, or Large Group, etc

SKILLS AND KNOWLEDGE:

MicroSoft Word, MicroSoft Excel 40 Hour Life, Health & Variable Annuity Class

QuickBooks (Accounting Software) PowerPoint

MediSoft (Provider Medical Management Software) MS-Project

(BLS) Basic Life Support, FR FL05449, issued 02/04/15, renewal 02/2017

CAREER SUMMARY:

My strengths include being a leader, dedicated employee, and getting along well with others. My Master’s degree in Public Administration as well as my extensive professional background has allowed me to acquire a strong knowledge basis of several software packages and a variety applications. I welcome and adapt well to cutting-edge technology and new procedures. I tend to be a leader and a manager by trade, but truthfully, I simply enjoy working. Implementation of projects and utilizing my professional managerial skills are my strongest attributes. All of my projects are completed to any stakeholder’s satisfaction. I offer excellent communication skills to effectively work with upper level management, coworkers, and contractors. Lastly, I ensure projects are implemented in a timely fashion while meeting the project’s overall goals.

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