JEFFREY D. TERRELL

PROFESSIONAL SUMMARY

• A healthcare professional with experience in Medicare and Medicaid Compliance

• 15+ years of extensive knowledge and experience with medical claims and provider systems

• BCBS roles included Sr. Benefits Analyst, Pharmacy Network Administrator, Sr. Clinical RX Claims Review Helpdesk Technician, Claims Adjudicator

CORE COMPETENCIES

YEARS OF EXPERIENCE

Familiar with basic PPO benefit structures and medical claim coding/billing instructions, CMS (Medicare & Medicaid) (1995 – 2010)

15+

Strong analytical and research skills with medical PPO Benefits and claims processing

15+

Strong organizational skills and ability to prioritize; Coordinate multiple activities with varying timelines

15+

NASCO – Local and National sides (1998 – 2010)

12

BCBS 1986 - 2010

24

FACETS (2005 – 2007)

2

Local to Michigan, (Farmington Hills, MI)

YES

COMPUTER/TECHNICAL SKILLS

SharePoint, Microsoft Office Suites, Salesforce, Info-Path, Workforce, SQL, PRISM-3270, Oracle – PeopleSoft Enterprise, Yardi-Voyager, Publisher, Windows XP, LoadTech Database & GTG Web Application, LMS Logistics Management Systems, NASCO

PROFESSIONAL EXPERIENCE

STATE OF MARYLAND DEPARTMENT OF LABOR – BALTIMORE, MD 03/2021 – 07/2021

Accenture – Edison, NJ

Unemployment Fraudulent Claims Project Manager

APL LOGISTICS – FARMINGTON HILLS, MI 09/2015 - 02/2021

Account Manager 05/2020 – 02/2021

Compliance Specialist, On-boarding Specialist 07/2017 – 05/2020

Pricing Coordinator 08/2015 – 05/2020

Responsibilities:

• Provide Sales / Marketing Support for APL VP – Director - Global Manager for our Automotive Book of Business Maintain and Provide support for in-house account - Ford Motor Company & General Motors

• Provide Ad-hoc Reports ( Revenue & Contribution Margin )

• Create and submit Invoices ( Ford Motor Company, General Motors Corporation )

• Provide support for Account Receivable & Account Payable Team (Invoicing and Re-Invoicing)

• Manage APL Carrier database for all DRAY Carriers Verify Carrier Certificates – Insurance, MC, VMA, and W-9. Upon request, provide Carrier package (contracts). Set-up / On-board new dray carriers, SCAC codes, ramps, maintain/update carrier profiles as needed. Carrier Maintenance Support…

• Manage all invoicing for customer sales through both regular WMS shipments and manual records for sale

• Reconciles payments and issues formal documentation to all related billing issues Frequent invoicing and payment updates against past invoices (retroactive adjustments)

• Maintain database management for customers with support from Account sales and members

• Facilitates resolution management of internal and customer complaints as related to payment and invoicing issues

• Issues internal month end reports associated with sequencing, sales, pricing updates, and delay in collections

• Collects and files supporting customer purchasing orders, payments, and shipping data as needed with support from sales team

• serves as the primary point between external customers for initial collection of past due payments working closely with sales / accounting group members

• All other duties as assigned by Sales management / Accounting Team

XPO LOGISTICS – SOUTHFIELD, MI 06/2014 – 06/2015

HBS – Bloomfield Hills, MI

3rd Shift Logistics Coordinator / Carrier Procurement

• Tracked / Traced Air, Ground Expedites (Dispatched & Awarded Shipments) Communicated Carrier(s) bids plants for approval or rejection

• Created new expedite / project orders, and exceptions as needed Generated SQL reports, adjusted pick-up / protect times via NLM System

• Responded via email/phone driver(s) exact location upon request from customers Issued Carrier failures

FARBMAN GROUP – SOUTHFIELD, MI 03/2014 – 07/2014

Ajilon – Troy, MI

Salesforce Database Administrator (Short-Term Contract)

• Updated Broker files in Salesforce / migrate data to Salesforce.

• Assigned access to manage permissions for content owners, contributors and visitors. Assisted with training and documentation material.

• Performed data analysis and data entry for the entire migration period.

CRAIN COMMUNICATIONS, INC. – DETROIT, MI 06/2012 – 08/2013

Harvard Resources Solutions – Troy, MI

Customer Service Rep III – Consultant – Contractor

• Technical Desktop Support Level III - Helpdesk and IT Support.

• Data entry, account reconciliations, processed payments, troubleshoot customer log on, Managed client database while merging Business to Business Accounts.

• Processed credit card payments and refunds for various payments. Acted as Sales Liaison for Crain Communications Inc.

BLUE CROSS BLUE SHIELD OF MICHIGAN – DETROIT, MI 01/1986 – 12/2010

SharePoint Administrator / Sr. Benefits Analyst / Pharmacy Network Administrator 08/2006 - 12/2010

• Managed BCBSM Accounts Benefits, Systems, and Facility Professional Claims. Approved/Rejected pending agent portal access - viewed /updated divisional profile.

• Supported MESSA Benefit, Data Security, IT Staff, Memberships and claim module knowledge while auditing all end-users.

• SharePoint Site Administrator / Administered end-user portal access via e Gateway. Gatekeeper managed all permissions for site visitors, content owners and contributors, prepared/documented training material for internal and external employees.

• Rolled out/ presented training material regarding SharePoint

• Regularly utilized SharePoint Designer to design and collaborate on sites. Developed/configured and maintained all document libraries and site collections. Established and maintained all end-user access policies and permissions.

Sr. Clinical RX Claims Review Helpdesk technician 01/1986 – 08/2006

• Expert knowledge of coding, medical billing and benefits.

• Analyzed, charted and tracked pharmacy claims data submitted electronically.

• Pharmaceutical manufacturers, product/cost information via First Data Bank / Data Entry / Managed Provider Network Database.

Other BCBS-held positions include:

Continuous Improvement Principles & Practice – Lean Certified Performance Transformation

• Created paperless environment / Reduced interest paid on all medical & facility claims zero (0) percent / Removed all non-value job functions / Implemented value added functions /

Pharmacy Services Administration (2005 – 2007)

• Created Desk Level Business to Business procedures/ templates for MEDIMPACT SALESFORCE.COM and MEDCO Health, Implemented process Pharmacy Services Administration, FACETS

SharePoint Team Site Administrator

• Approved non departmental staff access to site / Established level of access (read / or contribute) information / Uploaded documents / Granted user access / Invited employees or groups

• Agent Business to Business Portal - eGateway (BI, Customer Provider Directory)

• Trained Information Technology / Benefit Department, MESSA Account

• Michigan Conference Teamsters Welfare Fund RX Claims Consolidation Review – Blue Cross Blue Shield MI $100,000,000 overpayment, performed complete system analysis of previously paid claims (total recovery of overpayment from Client/Account)

• Eligibility CORE (Med Impact) – Submitted Data for Review and Resolution Resolved Business to Business membership eligibility, billing and coding (blue card / local claims) for City of Detroit Human Resource Department, performed a complete System Analysis regarding billed claims Trained Sales Liaison Department on Med Impact Group / Benefit Explainer

• Subject Matter Expert Provider Reimbursement

Claims Adjudicator -- Direct Date Entry - Billing / Coder

• Processed all Medical Facility, DME, Medical Supply, Surgery, Ambulance claims

EDUCATION

• MBA, Healthcare Administration, Stafford University – Alexandria, VA

• B.A., Healthcare Administration, Stafford University – Alexandria, VA

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