Social Media Call Center

Cheryl Flowers

*** ******* *****; San Francisco, CA. 94132 317-***-**** ********************@*****.***

Objective: To obtain a career with a growth-oriented organization that will maximize and enhance my experience, knowledge, skills, and abilities.

Relevant Skills

• Technical experience: Microsoft Word, Excel, Powerpoint, Outlook, PeopleSoft, Facets, Trizetto, EPIC, HealthSuite, COD, Cisco, Webstrat, TrueClient, Medhok, Optum360, eClinicalWorks

• Medical Terminology, ICD-10 and CPT coding

• Teamwork and Leadership Skills

• Call Center Customer Care Experienced

• Experience in working with all levels of authority

• Ability to work effectively in a fast paced multi-faceted environment

• Excellent presentation and communication skills, verbal and written

• Self Starter and strong ability to multi-task

Education:

San Francisco City College, San Francisco, CA

Health Information Technology

Employment History:

The Go Girly Agency

Media Marketing Manager- 2022-Present

*Developing and executing Social Media strategies to increase brand awareness, engagement, and sales. Including creating content, scheduling posts, and interacting with customers.

*Planning and executing advertising and promotional campaigns to reach new customers and boost brand loyalty

*Managing a team of twelve to conclude market research studies to understand customer and market opportunities by collecting, analyzing, and interpreting market data.

* Identifying and engaging with influencers to create brand-aligned content

*Work with other departments such as sales and marketing to ensure that social media efforts align with the overall goals of the business.

LDI & Associates, Remote

HEDIS Reviewer Supervisor - November 2019- 2022

*Schedule and confirm appointments, follow up on medical record submission, and provide patient charts.

*Locate and review ALL assigned medical charts, perform abstraction, copy all supporting documentation per specifications and enter date into EPIC software system for all assigned abstracts.

*Prioritize and assign tasks to staff within established time frames

Alameda Alliance for Health, Alameda, CA

Provider Dispute Analyst/HEDIS Reviewer- October 2016- November 2019

*Work with HEDIS team to collect member records by working with provider offices and/or hospital facilities via telephone or onsite visits.

*Knowledge of NCQA HEDIS abstracting guidelines, with the ability to access medical records (electronic and paper)

*Accurately identify required data and information, extract and organize this data and enter into database

*Ensure documentation collected meets state and federal regulations

*Review and process provider dispute resolutions according to state and federally defined timeframes

*Research issues; determine the root cause of the dispute

*Send written responses to providers in a professional manner, free of grammatical errors within required timelines

*Answer provider inquiries regarding disputes that have been submitted

*Maintain, track and prioritize assigned caseload through COD, provider dispute database to ensure timely completion

*Research and evaluate contract terms, interpretation, and compile necessary supporting documentation for the resolution of a provider disputed claim

Health Plan of San Mateo/Aerotek, South San Francisco, CA

Grievance and Appeals Coordinator- May 2016- September 2016

*Logged and tracked processes for both appeals and grievances.

*Contacted members, providers, and other relevant individuals to gather information and communicate disposition of cases.

*Conducted pertinent research to evaluate, respond to, and close appeals in accordance with all established regulatory guidelines.

*Worked with the Quality Improvement Committee (QIC) to review and analyze appeals and grievance trends and recommended corrective action as necessary.

(2014-2016: Enrolled in San Francisco City College for Health Information Technology)

Capitol Administrators, Rancho Cordova, CA

Claims Analyst- April 2012-April 2014

*Analyzed insurance claims to determine extent of insurance carrier’s liability

*Settled claims with claimants in accordance with policy provisions

*Responded to inquiries and complaints related to claims from claimants and physicians

*Encoded and coordinated information related to patient health care while working with health insurance carriers to get claims paid in a timely manner

Anthem Blue Cross and Blue Shield, Indianapolis, IN

Customer Service Call Center Representative III- November 2005-January 2012

*Assisted Medicare recipients with Medicare Part D prescription insurance

*Handled escalated issues assigned by the Centers for Medicare/Medicaid Services that needed immediate resolution

*Contacted pharmacy, LTC facilities, and Congressional Offices for immediate resolutions

*Liaison between third party administrator, pharmacy, and insured.

References:

Deborah Green France

Manager

Alameda Alliance for Health

Alameda, CA

Marcia Elvin Williams

Supervisor

Capitol Administrators

Rancho Cordova, CA

Tiffany McGregor

Manager

Anthem Blue Cross and Blue Shield

Indianapolis, IN

Contact this candidate