OBJECTIVE

Position with innovative insurance leader in the health and well being industry, which capitalizes on professional experience and expertise with proficiency. Passionate Health Care enthusiast with solid management experience that has an outstanding insight of consumer friendly services to help people achieve optimal health may serve as an asset.

HIGHLIGHTS OF QUALIFICATIONS

Performance oriented individual with a successful background working with diverse individuals and demonstrated ability to adapt widely to varied environments, juggle multiple priorities and problems solve in a fast-paced environment. Perform both independently or as a team member.

Motivated to succeed, dedicated, versatile, and skilled at organizing workload, resolving problems that arise in day to day activities and meeting deadlines in timely and consistent manne in person and remotely.

KNOWLEDGE & SKILLS

Personnel 20-30 management

Strong analytical, problem solving skills, audit claims, customer/client service management, inbound and outbound call center

CWOS, eCMIS, Maxstar

Various telecommunication software applications: Nortel, and Lucent 5ess, Remedy, Crystal Report; ISDN, frame relay, SONET, dedicated internet service, voice, data affiliated products & service.

Microsoft Office (Word, Excel, Power Point, & Outlook) Word Perfect, Word Office

Collection, Account receivable/Account Payable processing, alpha/numeric, & filling

Knowledge and experience in health/dental management service that include: SIEBEL, business operations, budgets, reports, Medical Terminology, ICD/CPT-9/dental coding, Third party billing systems and EOB adjustments.

Various medical & dental software applications: Medical Management, ProMed1-6, & Soft-dent, Easy Dental, People Soft, Quick book, and Peachtree

Typing 55 WPM

WORK EXPERIENCE

Grant Gateway, North Carolina (Remote) 06/12- 12/2023

Grant Administrator

Responsible for identifying grant opportunities, preparing applications, securing grants of a variety of types, and assisting in the management of approved grants in specified functional and program areas.

Coordinates grant activities, including application preparation, administration, interim and final reporting and miscellaneous reporting of grants from federal, state and other agencies.

Tracks project status, conducts program audits, prepares and reviews grant reports.

MAXIMUS, McLean, Virginia/Social Security Administration, Woodlawn, MD 10/2009-05/12

Senior Employment Network (EN) Payment Specialist

Responsible for reviewing quality assurance on all EN claims (recommended for) payment.

Responsible for producing and updating quality records and reports.

Participated and contributed to all departmental special projects as needed.

Reviewed and negotiated payment allocations for split payment cases.

Researched and resolved all complex claim cases as identified by the Department Manager.

Served as a mentor to recently trained or new hires within the Department.

Tested and provided feedback on all new system enhancements.

Actively participated in International Organization for Standardization (ISO) development and formal documentation for all processes.

Assisted EN Payments Manager with department policies and procedures development.

Provided professional and courteous customer service to ENs, Vocational

Rehabilitation (VR) and the Social Security Administration (SSA).

Kept current on all the SSA and/or MAXIMUS TTWP EN payment rules and regulations, policies and procedures.

Developed spreadsheet for monthly activity.

Processed and developed monthly Auto payments reports for management and Ticket To Work Project (TTWP)

Maintained confidentiality of all client files.

Met and maintained department performance standards. Processed payment claims.

Other duties as assigned by client or management.

Oral and Maxillofacial Surgeon, Memphis, Tennessee 01-07-11/ 10-09

Office Manager

Managing customer expectations and ensuring quality

Implementing new business Fee for Service to ensure revenue of collections of Contacts delinquent, charged-off, customer servicing and recovery activities

Account Payable and Receivable; daily transactions; office statistics, and daily and monthly reports; payer of monthly business expenses

Processing Dental/Medical Insurance Claims, and do follow up on outstanding claims

Resolve customer service grievances

Analyze and interpret provider contracts with Commercial Group Insurance for marketing of preferred business

Working with IT to ensure our program administration is working

Collaborating with legal and compliance areas to meet requirements

Developing policies and procedures as needed for high-risk customers in order to secure payment and determine reason for delinquency on service

Work with customer to establish full balance repayment plans or settlements

Works an established list of accounts on an automated collections system and/or auto dialer.

Resolve routine billing inquiries and negotiate payment arrangements to cure delinquent accounts.

Customers educated on account terms and alternate payment programs and methods.

Contact this candidate