Manager Information
Resume:
Keesha Tynes
Chesapeake, Virginia 23324
************@*****.***
To obtain a challenging career that will utilize my knowledge and skills to create solutions to help run the business more effectively.
WORK EXPERIENCE
OHI Verification Specialist
Anthem – June 2014 to Current
-Support all Medicaid and Medicare markets in resolving OHI requests received from internal teams.
-Research data entered into GBD Facets and make any necessary changes.
-Utilize other health plans provider portals and make phone calls to obtain member health insurance information.
-Works directly with management to resolve escalated issues and projects.
-Research claims in Macess
-Process all
Intake Claims Processor
AppleOne contracted to WellPoint - Virginia Beach, VA - October 2013 to June 2014 Responsibilities
- Receive documents electronically through Macess database.
- Process documents into system according to the specific guidelines for the market you are in.
- Be able to establish and know the market specifics for each state.
- Retrieve customer's information in Facets and locate claim information.
- Create appeals in NextGen Intake System.
- Create mail backs for records that require additional information or have exhausted appeal rights.
- Adhere and meet the daily production goals for the department.
- Be able to recognize and know the difference of a dispute and an appeal. Cash Management Specialist
Dominion Enterprises - April 2009 to November 2012 Utilize accounting policies and procedures in managing customer contracts and account information.
• Investigate, analyze, and update account information to ensure accuracy of stored data in system.
• Perform customer setups; prepare contracts, track sale records, monitors usage and system operation.
• Train new employees on the features and benefits of cash management products and services.
• Processed electronic and manual deposits, account reconciliations and credit memos .
• Ensured the timely delivery of regular reports through the various reporting systems.
• Maintained adherence to internal audit requirements. Billing Specialist
AppleOne - July 2008 to April 2009
• Provide accurate account information to customers.
• Generate daily and weekly reports.
• Provide billing adjustments and credit memos for accounts with billing issues and submit for processing.
• Process account status changes according to posted payments report.
• Audit accounts with billing discrepancies, complex issues and priority status Consumer Relations Specialist
Advanced Services Inc - October 2006 to July 2008
• Assist the consumer in understanding the provisions of the warranty.
• Maintain logs of activities and completed work.
• Liaison between the consumer and the escalation team.
• Schedule and cancel service calls, schedule payments, transmit messages to technicians and order parts. Answer incoming calls from consumers with questions about their GE appliance and/or warranty. Data Integrity Specialist
Value Options - October 2003 to October 2006
Enroll and disenroll providers according to the request
• Update and fax disenrollment spreadsheet of members to managerial staff
• Train new team members on disenrollment process and procedures
• Maintained an effective positive customer service environment for clients
• Resolve clients reporting issues and implemented changes as necessary
• Report directly to manager with the weekly amount of disenrollment members from the network
• Perform manual cleanup of system for provider enrollment department.
• Advise staff of new company procedures and policies regarding system changes
• Modify workflow process for department, and meet weekly/monthly production. Staffing Coordinator
Atlantic Personnel - January 2000 to October 2003
Provide leadership and direction in the recruitment, selection and hiring process.
• Conduct interviews, telephone screenings and criminal background check all new hires.
• Audit new hire paperwork and provide an overview of core values, policies, and procedures.
• Conduct on-site visits with clients and provide feedback to clients and staff in regards to weekly follow-ups.
• Update policies and procedures on training, interviewing, discipline, evaluations, supervision and termination. EDUCATION
Associate of Social Sciences
Tidewater Community College - Norfolk, VA
August 2010 to Present
Certificate in Finance & Customer Service
Tidewater Community College - Norfolk, VA
August 2002
High School Diploma
Indian River High School - Chesapeake, VA
ADDITIONAL INFORMATION
Computer Skills
Microsoft Word, Excel, PowerPoint, Access, Outlook, Tools, OneNote, Adobe Reader, Adobe Air, AS400,Windows XP, Windows 95, Windows 98, Internet Explorer, Mozilla and Firefox. Typing Speed 50wpm
Contact this candidate