Office Service

CONSTANCE Y. BARKER

**** ******* **** ■ Snellville, Georgia 30078 ■ 770-***-**** ■ *************@*****.*** SUMMARY OF QUALIFICATIONS

• Demonstrated positive/effective integrated workflow methods

• Possessed skills with proven ability to analyze, plan, manage, and motivate

• Excellent human relation skills experienced in working with a variety of customers and employees

• Superior ability to achieve immediate and long-term goals

• Ability to multi-task while maintaining attention to detail

• Good time management skills, analytical skills

PROFESSIONAL EXPERIENCE

Provider Engagement & Contracting

Network Management Rep I (June 2006-Feb 2015)

Blue Cross Blue Shield of Georgia /Wellpoint/Anthem Atlanta, Georgia 30326

• Planned, directed, controlled, and achieved the resources and efforts of my assigned workflow tasks of the Network Service Organization.

• Obtained, and managed resources, material, training, and support to effectively and efficiently support operational needs and strategic initiatives.

• Ensured accuracy and timeliness of output and deliverables for assigned functional area.

• Managed maintenance of provider information to ensure accuracy of provider demographic and billing information.

• Develops, maintains, and enhance relations with providers to foster cooperative business relations.

• Coordinated prompt resolution through direct contact with provides, resolving issues, questions or concerns.

• Identified and reported on provider access patterns which have a direct impact on the quality of service delivered.

• Compromised issues that may impact future provider negotiations or jeopardize network retention.

• Analyze sensitive situations and adopted an effective course of action.

• Follow-up on issues/inquiries identified by provider and their offices.

• Organized and maintained file system, which included retrieval of contract copies by request, and provider mailings.

• Assured that all responsibilities are performed consistent with the deliberate plans of the organization.

• Represented the organization well at all times. Supported the mission, goals and objectives, participated as a team player, constantly supporting the workflow. Set an example of high personal and professional conduct for employees and others.

• Educated providers on new protocols, policies, and procedures.

• Facilitated the distribution of provider agreements. Quality Assurance Department//Grievance & Appeals

Clerical II (July 2003-June 2006)

Blue Cross and Blue Shield of Georgia Atlanta, Georgia 30326

• Independently composed routine correspondences (complaint letters, etc) through knowledge, judgement and interpretation of policies and regulations, including confidential cases.

• Analyzed sensitive situations and adopted an effective course of action.

• Organized binders and prepared presentation materials for meetings.

• Created and edited correspondences.

• Tracked and Trended all incoming mail on database.

• Provided overall clerical and backup support as needed. Data Verification/State Health Claims (June 1999 – July 2003) BlueCross BlueShield of Georgia, Atlanta, Georgia 30326

● Followed claim policies and procedures

● Researched and analyze data to address operational challenges in completion of claim processing

● Operated a PC/image station to obtain and extract information; documents information; activities and changes in the database

● Ownership of claims to ensure timely resolution or follow-up.

● Strong attention to detail to accurately enter data and research and resolve questions.

● Demonstrated full competence in department and made significant contribution to work team

● Worked without significant guidance.

● Performed other duties as assigned.

TECHNICAL/OFFICE SKILLS

Computer proficient with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, Access Office Skills Multi-Line Phone System, Alpha/Numeric Filing, Faxing, ICD-10

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