Quality Assurance Analyst

Arnetta McMahan

*** ********** *** 586-***-****

Columbia, SC 29229 **********@*****.***

PROFESSIONAL PROFILE

Dedicated and goal oriented professional with valuable experience on various levels. Experience includes key business functions in Management, Operations, Client Relations, Billing, Auditing and Customer Service.

SUMMARY OF QUALIFICATIONS

Effective communication, public speaking and organizational skills

Problem solving, analytical skills, negotiation and persuasion skills

Effective Leadership skills

Effective Employee Coaching and Training

Experience working remote

PROFESSIONAL EXPERIENCE

Membership Analyst June 2021 -Present

BlueCross BlueShield – Columbia SC

Produce medical benefit contracts and booklets

Extract medical, dental and vision benefits from the benefit system

Communicate with Account Representatives regarding validity of benefits as needed

Submit booklet print request to print shop if requested

Ensure that member and group level benefits materials are produced with accuracy and timeliness

Demonstrate oral and written communication skills

Analytical thinking skills

Accounting Technician II Oct 2018 – June 2021

BlueCross BlueShield – Columbia SC

Perform billing for assigned groups

Process/Generate adjustments to billing

Process group reconciliations

Process refunds

Research payments that are placed on cash suspense to identify where they should be applied

Generate daily, weekly and monthly financial reports

Identify errors on reports, research and resolve

Process/Apply payments

Quality Assurance Coordinator Oct 2015 – Oct 2018

BlueCross Blue Shield – Columbia SC

Served as subject matter expert and work leader for Membership processors

Trained staff

Assumed managerial tasks in the absence of Supervisor and Manager

Assigned, monitored and audit work of team via Departmental Database

Ensured audit performance and reporting deadlines were met

Provide customer satisfaction through continuous quality improvements

Sr. Quality Assurance Analyst Nov 2013 – Oct 2015

BlueCross BlueShield – Columbia SC

Conduct quality audits to evaluate accuracy and effectiveness of departmental functions

Conduct quality assurance audits of technical documentation; customer service/call center; membership; processing support systems; procedures and claims

Identified problems, analyze cause and effect and suggest recommendations for improvements

Met with Subject Matter Experts (SME) to document work instructions and procedures

Update and maintained Databases

Update and maintained Table of Content for access via Divisional Web Site

Ensured documentation format followed corporate policies and standards

Coordinate, Scheduled and Facilitated Meetings and Training

Provider Enrollment Analyst Aug 2010 – Nov 2013

BlueCross BlueShield – Columbia SC

Reviewed, researched, and processed provider and supplier enrollment CMS 855S applications

Educated DME providers and suppliers on DME applications requirements

Verified documentation to confirm authenticity and validity

Processed applications per Government regulations

Keyed data in Secure Government database

Provide quality customer service to internal and external customers via phone and email

Issued Medicare number to providers upon application completion

Accounting Clerk Jan 2009 – Aug 2010

BlueCross BlueShield – Columbia SC

Processed monthly invoices and mail according to departmental guidelines

Audited Florida Combined Life Dental billing for validity and submit reports of findings

Processed re-bills to correct rate adjustments, member changes and billing periods

Conducted Accounts Receivable Audits upon request

Researched funds erroneously applied and assigned to the correct appropriation for posting

Cancelled groups, sent final invoices, and issued refunds when applicable

Processed daily deposits

Processed data in various systems - CES, PIRS and FIPS

EDUCATION

Master of Arts: Management and Leadership

Webster University

Bachelor of Science: Business Management

University of Maryland University College

Blue Streak - Toastmasters Member – Competent Communicator

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