Mary Outland-Rollins

P. O. Box ***

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

Flora, MS 39071

Cell: 601-***-**** Country of Citizenship: United States Fax: 601-***-****

EMAIL: ad2q6l@r.postjobfree.com

COMPETENCIES

“Possess 12+ years of managed care / medical insurance experience, with emphasis in provider data operations, provider relations, claims processing and medical billing with a proven ability to manage multiple project, while meeting challenging deadlines and awarded excellence through BPQM Quality Audits.”

EDUCATION

Mississippi College, Clinton, Mississippi

BSBA, Business Administration, 8/2011

Hinds Community College, Raymond, Mississippi

AAS, Paralegal Technology, 7/2003

Summa Cum Laude with a 3.8 GPA

PROFESSIONAL EXPERIENCE

United Healthcare, Ridgeland, Mississippi –––March, 2018 Present

Annual Salary: $32,000 Average hours worked per week (40)

Sr. Provider Data Specialist Intake Coordinator

Colleen McDonough (Immediate Supervisor) ---United Healthcare---480-***-****

Phoenix, Arizona 85004 You may contact current employer

Responsible for the management and manipulation of mostly structured data, with a focus on building business intelligence tools, conducting analysis to distinguish patterns and recognize trends, performing normalization operations and assuring data quality.

Knowledge to oversee the end-to-end provider data entry and maintenance to ensure accurate and timely setup for claims payment, member assignment and directory display.

Ability manages and improves databases involving provider data loading, which includes but not limited to demographics, fee schedule and contracting agreements ids.

Skills and knowledge to review and research assigned rosters by navigating multiple computer systems and platforms and accurately capturing the data/information necessary for processing.

Possess strong organizational skills, ability to prioritize and meet deadlines, solve routine problems on own, and work with supervisor to solve more complex issues.

Ability to adapt and learn new tools and processes quickly with little guidance or documentation while maintaining a positive attitude.

Key Accomplishments:

Vault Clean Up Special Project Assignment - - - -August, 2018

Accuracy building for Data Entry course of study Keynomics- - - - July, 2018

Market Alignment Coding in the Vault Special Project Assignment - - - - June, 2018

September, 2017 March, 2018

Annual Salary: $32,000 Average hours worked per week (40)

Senior Provider Data Specialist

Colleen McDonough (Immediate Supervisor) ---United Healthcare---480-***-****

Phoenix, Arizona 85004

Administer the contractual and demographic data setup for the provider network (physician, ancillary, FQHCs etc) to ensure accurate payment, accurate directory depiction in accordance with our contractual agreement with the provider.

Ability to collaborate with the Network Manager, Roster Manager and/or Contract Advocates on provider issues, determines root causes, and coordinates solutions.

Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex technical information in a manner that others can understand, as well as the ability to understand and interpret complex information from others, including but not limited to reimbursement policy standards.

Knowledge and skills to reduce contract/demographic errors that affect members of gated products: C&S, Exchanges, etc.

Possess Extensive proficiency in Microsoft suite – Power Point, Excel to include concatenate, v look up and pivot tables.

Knowledge of Systems: Danner, Emptoris, IEX, NDB, Omega, Phycon, PGAT, PLMI, SharePoint and Vault.

Key Accomplishments:

Suspect Provider Files Special Project Assignment - - - - October, 2017

Bravo Award for Collaboration with Team Mates - - - - October, 2017

March, 2017 September, 2017

Annual Salary: $32,000 + Bonuses Average hours worked per week (40)

Associate Provider Installation Specialist

Dawn Huskey (Immediate Supervisor) ---United Healthcare---218-***-****

Duluth, Minnesota 55802 You may contact current employer

Responsible for overall provider contract and amendment loading and processing using various databases, also including contract loads for adhering to quality measurers and reporting standards.

Managed care and medical insurance experience, specifically in provider data operation, working in provider relations, medical billing (claims) and quality management.

Ability to problem solve issues; including multiple priorities and research conflicting and/or inaccurate data and request to modify a provider record.

Proficient in Microsoft Word, and Microsoft Excel (ability to create and edit documents in Microsoft Word)(ability to sort, filter, create tables, and search data in Microsoft Excel).

Responsible for compliance in maintaining standards for database integrity to include quality assurance, communication written/verbal, presentation skills; strong analytical mindset and problem-solving skills.

Ability to prioritize and meet deadlines from multi-staff members within the department, strong organizational skills with advance level of proficiency in tracking, trending and reporting on metrics.

Key Accomplishments:

Awarded for Quality Assurance Excellence Second, Third and Fourth Quarter 2017

February, 2015 March, 2017

Annual Salary: $30,000 + Bonuses Average hours worked per week (40 – 50 + depended on need)

Claims Adjuster Representative

Nathan Russell (Immediate Supervisor) ---United Healthcare---256-***-****

Nashville, Tennessee 37116 You may contact current employer

Ability to review and research assigned claims by navigating multiple computer systems and platforms and accurately capturing the data/information necessary for processing (e.g. verify pricing, prior authorizations, applicable benefits)

Skills to ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/ certificates)

Possess the communicate skills and collaborate with members and providers to resolve claims errors/issues, using clear, simple language to ensure understanding

Learn and leverage new systems and training resources to help apply claims processes/procedures appropriately (e.g. on-line training classes, coaches/mentors)

Ability to work a flexible work schedule that could include required or optional overtime

Knowledgeable of computers and previous experience with CSP Facets (claims processing systems) Citrix, CareOne, EDSS, IDRS, Macess, Knowledge Central, Pega, Unix and Webstrat.

Key Accomplishments:

Awarded for Quality Assurance Excellence First, Second, Third and Fourth Quarter 2016 First Quarter 2017

American Family Life Assurance Co. (AFLAC), Columbus, Georgia March, 2006–– November, 2016

Annual Salary: 28,000 Average hours worked per week (32)

Insurance Agent

Christian Lavern (District Sales Coordinator) ---AFLAC –601-***-****

415 Grant Ferry Road, Brandon, Mississippi 39213

Entrepreneurial Insurance Agent licensed to write Accident, Life & Health with an oath to maintain ethical and moral professionalism.

Dedicated and tenacious sales expert with a comprehensive knowledge possess the ability to clearly articulate Aflac’s insurance products, services and best practices.

Self-starter, who excelled in a service-oriented industry, meeting overall market share by successfully executing the sales and marketing initiatives, by cultivating positive relationships and expanded customer base through word-of-mouth referrals.

Developed, implemented sales plan and manage all phases of the sales cycle-from prospecting, to close and follow-up support.

Established rapport, maintaining confidential records, and providing customer relationship after the sale for each account servicing quarterly and maintaining current accurate data within Company’s marketing database.

Representing a full line of insurance products, serving as a trusted advisor to businesses, individuals, surpassing customer and employer expectations.

Processing initial applications/conversions, change forms, reinstatement, and cancellations for Insured’s policies.

Maximizing operational effectiveness by coordinating effort to meet customer demand and maintain all records for account responsibility.

Demonstrating outstanding problem solving and active listening skills; diffusing difficult situations with tact and ease.

Key Accomplishments:

Ranked as a CAE Elite Performer January September 2014

Awarded for Quality Assurance Excellence January-September 2014

Honorary Sales Bonus recipient for sales quotas in First, Second and Third Quarter 2014

Professional Awards:

Aflac Top Associate Most New Accounts Second Quarter May June 2010

Aflac Fast Star Award Winner; Fireball/Star Series Qualifier May 2008

Honorary participant 2006 State Convention exceeded annual sales quotas of $250,000

Promoted to Sales Coordinator in Training (CIT) within the first year of employment

Professional Affiliations:

Insurance Licensure Number: 10031091 March 2006

Woman Business Enterprise (WBE) Certified June 2004

Member of Zeta Phi Beta Honors Society May 2004

COMPUTER SKILLS

PC and Macintosh Operating Systems •Microsoft Office • Microsoft Word •Access • Excel •Outlook• PowerPoint •Intranet• Internet

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