DOMINIQUE “NIKKI” JORDAN

**** *** ***** **** *** 11

RIVERSIDE CA 92503

840-***-**** ad37ty@r.postjobfree.com

Dominique A. Jordan

Profile

•More than 10 years’ successful experience in customer service and support with recognized strengths in account maintenance, problem-solving and troubleshooting, technical support, and planning/implementing proactive procedures and systems to avoid problems in the first place.

•10 years with adequate and successful experience in Medicare/ Medicaid – Government Programs with the dire need to gain more experience to be able advance within the healthcare industry.

•Possess solid computer skills. 50WPM

•Excellent working knowledge using both IBM and Mac systems; Lotus 1-2-3, Microsoft Excel, WordPerfect, Microsoft Word, CJ FACETS, EZCAP, outlook, teams

•Ability to multitask and navigate through multiple portals while providing exceptional customer service while maintaining a professional attitude with proper phone etiquette and

A team player, dependable, courteous, determined, punctual.

Customer service professional with superb attention to detail, can work well with others. And Is always open for improvement and constructive feedback. SKILLED REMOTE WORKER.

08/22-current

OPTUM - PROVIDER SERVICE REP (REMOTE) – Handled between 40-55 c claims calls, assisting with claim status for professional and facility claims. Assisted with internal appeals. Verified eligibility. Utilized multiple systems to provider accurate and detailed information- knowledgeable on CMS guidelines, capitation contracts, Provider LOA- HAD direct contract with providers only assisting with inquiries in a timely and professional manner.

10/2021-08/22

OPTUM - INTAKE COORDINATOR (REMOTE) – Handled inbound calls, fax and web requests- from providers offices in processing and creating prior authorizations and referrals. Utilized facets as well as internal systems-

01/07/2019 – 10/01/21 / Optum

Irvine, - REMOTE CA

Senior Customer Service rep – Inbound call center taking 65 calls plus for a medical group that participates with multiple health plans. Commercial UHC, Aetna, Anthem Blue X, Senior plans, government along with Medicare and medical. Assists members in PCP changes, authorization requests, and specialist inquiries. Established patient relationships, and provided service to provider’s office, with claims status and appeals. Reviewed claims and sent back if needed. EZ Cap, outlook, and internal programs. Received minimal training in ICD codes, with billing, claims, internal appeals, authorization modification requests stat or regular, IT support.

11/16- 12/31/2018 – United Health care

Las Vegas, NV

Enrollment/ Eligibility Rep- Medicaid/Medicare –

Load / enroll all new member or group data into an enrollment database (EAM and Facets) for incoming Medicare and Medicaid Applications. Followed compliance guidelines, through CMS. Works with minimal supervision while executing time sensitive tasks.

Responds to member eligibility questions and verify enrollment status to agents and communication to member services. Works with various correspondents in order to process claims, OOA tracking, transactions from CMS (TRR’s). Working with brokers to gain the appropriate accuracy for member enrollments.

Systems used are Facets which houses member’s eligibility, and EAM to enroll members.

Stay on op of daily reports generated from EXCEL that come from CMs; generating daily letters, for member’s along with processing accurate and clean records to go out to Medicare CMS. Ability to navigate through multiple systems/ screens while able to understand the different products and benefits along with each product. GROUP RISK. Medicaid and Medicare knowledge. Repetitive tasks are to produced daily. Work transactions provided by the state to ensure accuracy in all systems. Reports, and OOA, along with LEP, LIS and date entry.

08/14- CURRENT Optum

Irvine, CA

Customer Service rep – Inbound call center taking 85 calls plus for a medical group that participates with multiple health plans. Commercial UHC, Aetna, Anthem Blue X, Senior plans, government along with Medicare and medical. Assists members in PCP changes, authorization requests, and specialist inquiries. Established patient relationships, and provided service to provider’s office, with claims status and appeals. Reviewed claims and sent back if needed. EZ Cap, outlook, and internal programs. Received minimal training in ICD codes, with billing, claims, internal appeals, authorization modification requests stat or regular, IT support.

EDUCATION

09/01-06/05 Diamond Ranch High School

Pomona, CA

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