Customer Service Data Analyst

KAREN AVINGTON

*************@*****.*** ●214-***-****

QUALIFICATIONS

Highly proficient in various Microsoft applications; (Excel, Word, PowerPoint, VISIO, Access)

Quantitative Help-Desk Support Analyst

Offering years of experience as a Medicaid provider worker

Premium auditor for worker's compensation and general liability

Fraud analyst, Data Analyst, financial analyst

Managed reimbursements and authorization specialist

Excellent technical support & customer service skills

Excellent written and verbal communication skills

EMPLOYMENT

CPAudits (contract), Richardson, TX - 12-1-18 to present

Responsible for processing virtual premium audits for worker compensation and general

liabilities by determining the proper classification and premium for the insured by reviewing 941's and SIA's, payroll journal, cash journal, reported results to insurance companies advised insurance companies of unusual matters or changes in operations or financial condition discovered during the audit.

Crowell and Associates, Houston, TX 5-17-17 to 8-18

Premium Auditor (part-time contract work thru Oasis staffing)

• Responsible for the upkeep of my multi-state territory; processing premium audits for worker compensation and general liabilities by determining the proper classification and premium for the insured by reviewing 941's and SIA's, payroll journal, cash journal, reported results to insurance companies advised insurance companies of unusual matters or changes in operations or financial condition discovered during the audit.

Overland Solutions, Inc., Houston, TX 12/10 to 3/17/17

Master Premium Auditor and Mentor

• Responsible for the upkeep of my multi-state territory; processing premium audits for worker compensation and general liabilities by determining the proper classification and premium for the insured by reviewing 941's and SIA's, payroll journal, cash journal, reported results to insurance companies advised insurance companies of unusual matters or changes in operations or financial condition discovered during the audit.

• Reviewed & worked with ADP and Paycheck’s payroll register's employee paycheck details reports for Overtime, Shift Differential, Section 125, and Charge pay

• Upon completion of the audit, prepare and submit information according to company procedures to individual

Associated Insurance Service, Houston, TX 10/05 to 12/10

Premium Auditor

Responsible for the upkeep of my multi-state territory; processing premium audits for worker compensation and general liabilities by determining the proper classification and premium for the insured by reviewing 941's and SIA's, payroll journal, cash journal, reported results to insurance companies advised insurance companies of unusual matters or changes in operations or financial condition discovered during the audit.

Reviewed & worked with ADP and Paycheck’s payroll register's employee paycheck details reports for Overtime, Shift Differential, Section 125, and Charge pay

Upon completion of the audit, prepare and submit information according to company procedures to the individual insurance company.

CINGULAR WIRELESS, Dallas, Texas 1/99 to 09/05

Fraud Analyst

Responsible for managing and analyzing internal and external fraud data to detect fraud committed against the company; Present findings and evidence of fraud investigators to corporate personnel, law enforcement agencies, and/or prosecutors; Assist with fraud investigations and loss prevention.

HILLCREST/CHILDREN MEDICAL CENTER, 4/93 to 12/98

Medicaid Provider Worker/Financial Counselor & Managed Care Database Analyst/Prior Authorization Coordinator

Managed Care Database Analyst Responsible for prior authorization for inpatient, outpatient & day treatment for behavioral health services from gatekeeper or OFMQ also used a variety of computer programs and databases for development and retrieval of management reports, documentation, monitoring reports, and memos. Tracked managed care contracts and maintains database records.

Medicaid Provider Worker/Financial Counselor: Responsible for counseling families on financial needs and initiating Title XIX application and determines eligibility for Title XIX produced a certification or a denial accuracy and timely. Also selects, assigns, trains, evaluates subordinate personnel, recommended associate personnel actions. Counseled inpatient and outpatient families on obtaining financial assistance for Title XIX

Reimbursement Specialist /Account Receivable Coordinator: Responsible for ensuring timely, collection of maximum reimbursement for accounts. Responsible for reviewing reimbursement invoices against the managed care contracts to ensure the correct reimbursement verified adjustment or reimbursements to ensure payment at the contracted rate and proper adjustment or discount.

Credit Analyst/Bad Debt Liaison

Responsible for accurate and timely processing of credit accounts by analyzing all credit accounts to determine the reason for credit, computing charges and adjustment against the contracted rate to determine the correct reimbursement, issuing refund checks for overpayments prepared refunds checks for patients and insurance companies. Responsible for referring accounts to collection agencies that have turned to bad debt.

EQUIFAX INFORMATION SYSTEMS, 6/87 to 7/93

Premium Auditor

Responsible for the upkeep of my multi-state territory; processing premium audit for worker compensation and general liabilities by determining the proper classification and premium for the insured by reviewing 941's and SIA's, payroll journal, cash journal, reported results to insurance companies advised insurance companies of unusual matters or changes in operations or financial condition discovered during the audit. Upon completion of the audit, prepare and submit information according to company procedures to the individual insurance company. Helpdesk Support/Customer Service: Interact with customers via telephone to analyze and identifies inbound calls providing software product support; answering questions and assist with technical support to customers on tax and insurance software. Directing high-level hardware problem to the correct technician or service center; after assigning reference numbers to follow up on calls to ensure good customer service and a resolution to software question or problem; installed and updated software on computers for field auditors.

EDUCATION

Houston Community College- (Have successfully completed 75% of mandated courses for Associates Degree in Accounting)

The Computer Institute, Atlanta, Georgia Computer Programming, and Computer Operator.

Working on APA 1 and 2

REFERENCES: Available upon request

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