Christine Lorenc

*** *********** *****

North Tonawanda, NY 14120

716-***-****

ad0xa0@r.postjobfree.com

OBJECTIVE: Promote effective problem identification and resolution, resulting in optimum customer care.

HIGHLIGHTS OF QUALIFICATIONS

·Currently researches and processes Medicare, Commercial, and Provider appeals and grievances in the Benefit Unit.

·Organized and detail-oriented; knack for understanding procedures specifically to CMS regulations.

·Skillful with computer systems: Facets, Vita, Health Rules, Siebel, Microsoft Excel, PowerPoint, and Word.

·Exceptional customer service skills, notable abilities in written and verbal communications.

·Advanced knowledge of claims processing systems, member contracts, and corporate medical policies.

RELEVANT EXPERIENCE

Customer Care

·Identify standard and urgent issues regarding claims, referrals, authorizations, benefits, and customer service.

·Work closely with Legal, Compliance, Medical Directors, and other departments to gather information in the decision making processes.

·Worked Medicare Enrollment and Billing Premium Verification and Premium Paid buckets generating letters confirming correct current premium rates.

·Representation at Medicare member and prospective member meetings in WNY and Rochester.

Organization & Time Management

·Compile and provide accurate and timely files to MAXIMUS Federal Services for independent review of appeal decisions.

·Facilitate Administrative Law Judge Hearings.

·Give quarterly presentation status updates on star rating projects and their impact to service staff.

·Work Medicare Enrollment 185 Transaction report making sure each member’s premium payment method matches CMS’s (Centers for Medicare and Medicaid Services) method of payment report.

·Worked the Medicare Part C CMS Complaint Tracking Modules for customer service.

·Complete appeals within regulated time frames such as 72 hours, 30 days, 60 days.

Implementation

·Identify education opportunities and communicate to customer care staff’s management for training.

·Created training documents for working SIR, claims history report, and explanation of benefits buckets.

·Volunteered to create desk level procedures within Medicare Appeals processes.

·Represented the Medicare Customer Service Department on the interdisciplinary Medicare Star Rating Health Evaluation Steering Committee.

·Helped create the Medicare Quality Departments Mission Statement.

·Worked the 2013 sales verification application audit.

·Tested the 2014 Sales file scripts in CRM.

·Created a small focus group to establish a Medicare Member Service Onboarding Team. The group worked to develop and propose themes to improve service processes and member experiences.

·Help audit appeal cases ensuring proper documentation is applied to each one.

EDUCATION & AWARDS

Niagara County Community College, Associate’s Degree, Emergency Management

·2008 Niagara County Community College Outstanding Achievement and Contribution Award

·2007, 2008 Dean’s List and Honor’s List

·2007 Niagara County Community College Team Building Recognition Award

Work History

Independent Health Inc., Buffalo, NY, Contractual Review Specialist, Senior, 3/2023-present

Univera Healthcare, Buffalo, NY, Medicare Appeals and Grievances, 01/2014-07/2021

Univera Healthcare, Buffalo, NY, Medicare Customer Service, 8/6/10-01/2014

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