Kim E. DeBusk

*** ********* ****

Fairborn, OH **324

937-***-****

QUALIFICATIONS

Highly effective analytical skills working in a fast-paced, multi-faceted environment

Extensive experience working with both internal and external partners to gain information for data and reporting analyses

Highly efficient in the use of Microsoft Office Suite

PROFESSIONAL EXPERIENCE

May 2019 to Dec 2019

EyeMed (subsidiary of Luxottica)

Consultant, Delegated Credentialing

Designed and created the company’s delegated credentialing program for provider organizations contracting with EyeMed.

Created a crosswalk between federal and state regulations versus internal documentation to verify cohesiveness.

Designed and created an annual delegation audit tool utilizing federal and state regulations.

Updated Delegation Agreement to conform to existing standards and processes.

Rewrote the Credentialing Policy and Procedure based on all NCQA, URAC, CMS, and State exception credentialing standards.

Drafted various correspondence to clients alerting them to upcoming audit, advising not all requested documentation received, advising placement of corrective action plan, conclusion of audit, submission of audit report, etc.

September 2016 to May 2019

Assurant

Senior Research Specialist

Performed information gathering and troubleshooting issues and complaints raised by the customer or insurance carrier/agent for multiple clients.

Provided collateral protection services by ensuring all customers were adequately insured as well as adding lender placed insurance for uninsured customers.

Researched/resolved loan level inquiries and exception items through inbound calls, fax, emails, tasks, correspondence, reports, and/or special projects.

Performed root cause analysis of more complex inquiries and research.

Hazard Intraday Analyst

Took responsibility for monitoring real-time intraday via Exony to ensure SLA was met daily.

Reskilled dual-skilled and/or cross-trained agents to support specific contractual agreements.

Updated agent schedules commensurate with eWorkforce alarms in order to maintain schedule adherence.

Processed segment updates submitted by call center agents to the Command Center mailbox.

May 2016 to August 2016

Joseph Airport Toyota

Human Resources

Responsible for all new hire orientations and applicable government systems.

Processed payroll for Joseph Airport Hyundai and Joseph Airport Toyota.

Handled accounts payable transactions for Allstate Insurance Agency.

Created Standard Operating Procedures for all Human Resource functions.

Established and implemented background checks and drug testing for all new hires.

February 2004 to December 2015

CareSource

Provider Operations Project Administrator

Assimilated large quantities of complicated data into meaningful formats for tracking and status requirements.

Handled monthly auditing of all provider data sources and identified exceptions and errors.

Conducted comprehensive audits to ensure critical Network Operation processes were being followed in a timely, consistent, high quality and efficient manner.

Developed Performance Improvement initiatives/corrective action plans to improve quality of provider data and network development.

Performed quarterly review of provider representative panel assignments to ensure equity in assignments.

Developed database structures and reports as needed.

Developed queries to aid in information retrieval, validation and updating of provider databases.

Reviewed provider organizations and systems for development of analyses that supported contract negotiation and provider recruitment processes.

Coordinated and tracked all hospital, physician and ancillary recruitment information.

Performed access analysis of all network data to include integration of Geo Access reports, after-hours calls, appointment availability calls, and member grievances related to access.

WorkForce Analyst

Monitored ACD and Workforce Management system real time reports to ensure staff productivity was being utilized effectively.

Communicated call center performance daily, weekly, monthly, yearly and ad-hoc reports.

Led weekly Production Planning meetings with departmental management.

Trained existing staff and new hires on Workforce Management solutions and processes.

Monitored and managed call queues to ensure Health Services staff were available and appropriately staffed.

Approved employee time off requests across multiple departments.

HEDIS Database Specialist

Researched and validated member eligibility, subscriber ID, Medicaid ID and various demographics to ensure supplemental data was correctly assigned to CareSource member.

Researched and problem solved provider supplemental data received to increase HEDIS administrative data to ensure claims did not already exist.

Credentialing Coordinator

Reviewed provider applications to ensure completion, accuracy, and identified issues that required submission to monthly Credentialing Committee.

Performed audit functions on files prior to weekly Credentialing Committee Meeting.

Completed Primary and Secondary Source Verifications utilizing Cactus and other NCQA required websites.

Worked on special projects as assigned that included reconciliation projects, processing urgent provider and organization applications, etc.

Provider Database Specialist

Managed Primary Medical Providers (PMP) and Specialists for CareSource Indiana to ensure timely filing with EDS.

Reviewed contracts for accuracy and submitted to CEO/President for signature.

Verified credentialing data to insure provider accountability.

Maintained and insured accuracy of Provider Directory data.

Maintained and researched inconsistencies with non-par claims to assure timely payment.

Senior Administrative Assistant

Expedited written communications for the Executive Management staff in a timely manner to include transcription, drafting, typing, and mailing/distribution of a variety of documents (e.g., letters, memorandums, minutes, and reports).

Took responsibility for coordinating daily schedules/activities of company management staff.

Established/maintained office filing systems to facilitate swift location of information.

Planned/developed social functions for presentations, meetings, etc.

Completed travel arrangements for management staff along with processing of expense reports.

March 1998 to February 2004

Humana Military Healthcare Services

Operations Analyst/Senior Administrative Assistant

Analyzed ACD Agent Performance Reports to verify satisfactory levels were maintained by individual associates as directed in contract and made recommendations to management regarding appropriate Corrective Actions Plans.

Reconciled, analyzed, and interpreted Customer Service Cost Center Budget Variance Reports and Customer Service Headcount Variances.

Analyzed Customer Service Turnover Rate.

Analyzed positions to determine appropriate level/pay rate for associates.

Coordinated all paperwork to support salary and benefit administration.

Created and maintained Customer Service telephone schedule model and subsequent data reporting.

Tracked and reported all vacation/sick time requests, absenteeism, and overtime for the Customer Service department.

Coordinated employee workers’ compensation, short-term/long-term disability, FMLA, etc.

Created and maintained system to effectively track payroll/attendance statistics for approximately 205 full-time associates in appointment setting, customer support, call quality, and health care triage.

Initiated computerized system for military portability operations to attain more detailed government reporting.

Maintained departmental budgets for nine cost centers within the Customer Service department ($5.27 million).

Responsible for travel arrangements for one Director, four managers, and approximately 15 support staff and submitting subsequent expense reports.

Decision-making authority regarding superior's day-to-day schedule.

Responsible for verification and payment of all invoices for the Customer Service department.

January 1989 to August 1997

ConMed Corporation (previously know as New Dimensions in Medicine)

Senior Process Technician/Document Control Administrator

Created and maintained IBM AS-400 MAPICS d/b Item Master Records, Bills of Material, and standard labor routers for purchased and manufactured materials.

Developed and implemented cost project for product improvements and machine efficiency.

Prepared and processed productivity and scrap reports.

Created design drafting job sheets, engineering change requests and temporary manufacturing instructions.

Reviewed and revised controls for documentation (i.e., AutoCAD drawings, process sheets, engineering specifications, etc.).

Manufacturing Systems Specialist

Effected inventory transactions and reports utilizing IBM AS-400 MAPICS d/b.

Assisted in selection of Manufacturing Execution System (MES) software to operate below AS-400 in preparation for ISO 9001 compliance.

Received monetary award for design and implementation of program used to track material, labor, scrap, and overhead costs for cable and wire shop operations.

Effected numerous operation enhancements which streamlined product manufacturing.

MILITARY

United States Air Force

70250A – Administration Management - Office Manager

EDUCATION

American Intercontinental University (AIU)

Business Administration-Project Management (3.89 GPA – Magna Cum Laude)

At-Home Professions

Diploma as a Medical Claims and Billing Specialist (4.0 GPA)

International Correspondence School

Diploma in Medical Transcription/Medical Terminology (4.0 GPA)

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