Office Assistant Customer Service

Colonel W. Combs, Jr.

RESUME

Seeking a position which will utilize a dynamic, proactive, people-oriented professional

with excellent skills in problem solving, multi-tasking and leadership.

Amerihealth Caritas 2014 - Present

Supervisor Claims Processing

Day-day supervision of a team of 15 to 20 claims examiners in a production environment.

Track production, error trending, develop workflow procedures and take corrective action on claim system issues.

Assist in backlog reduction, client contact on claim issues, client/provider education, and interdepartmental communication to expedite claim handling.

Ability to give direction and training on extensive claim research, problem analysis and claim payments.

Demonstrated ability to work independently, and establish and accomplish team goals.

Investigate, decision-making, problem solving, interpersonal, and organizational skills required.

St. Vincent’s Cardiology Group 2012 – 2013

Office Assistant II (Temporary Position)

Daily Batch Reconciliation

Process HIPPA, Medicare and various Insurance Forms

Patient Co-pay Collection per Insurance requirements

Front Office Patient check in/scheduling and customer service

Patient Insurance verification and filing process

Baker County School Board 2010 – 2012

Para-Professional – ISS (Contract Ended)

Monitored Student behavior at a one-on-one level

Escorted ISS Students to and from activities, restrooms, lunches and breaks as needed

Monitored Student assignment progress while in ISS

Performed various other duties such as Substitute teaching, monitoring activities, grading papers, Front Office and Educational interventions as needed

AmeriHealth Administrators 2002 – 2010

Supervisor Claims Processing (Office Closed)

Provided Managerial and Technical support to a staff of 25+ employees

Prepared and submitted Payroll

Controlled and monitored unit daily activities for Claims processing

Investigated and Resolved customer issues at an elevated level

Reviewed, analyzed and resolved complex claims within unit

Ensured Productivity and Accuracy levels met and/or exceeded established goals

Forecasted workflow volume, created solutions and adjusted resources as needed

Staff development through coaching, counseling and Performance Appraisals

Monitored unit inventory levels and purchased supplies as needed

Blue Cross and Blue Shield of Florida 1987 - 2002

First Coast Service Option (BCBSF)

Auditor (2001-2002), Supervisor (1998 – 2001)

Audited Claims processed

Supported timely and accurate processing of Written Inquiries and Claims daily

Prepared and delivered Annual Employee Evaluation and staff Development plans

Interviewed, hired and promoted employees based on established criteria

Responsible for monthly reporting: Variance, Budget, Training, Production Management, PTO/Attendance, Systems and various others as needed

Mentored, Coached and Counseled a staff of 25-30 employees

Developed individuals for advancement to ensure Unit and Divisional goals were met and/or exceeded

Supported a Team-based organization to ensure that all goals were met and/or exceeded

Operations Instructor/Supervisor/Claims Examiner/Team Leader/Senior Advisor/Customer Service Representative/Suspense Examiner (1987 – 1998)

Proficient Training and processing of MHS Claims and Customer service, which included enhancing Manuals and referenced Training materials

Delivered training of HMO, PPO, and POS to customer service classes and established fulltime employees receiving promotions

Coached and Counseled Students on Behavioral and Performance issues

Maintained Student Attendance records

Conducted Pre and Post-class and one-on-one Progress meetings with Students and Management

Montana Chemical Company 1979 – 1987

Certified Respiratory Technician, Psychiatric Aide

Respiratory Patient care

Maintained Accounts Receivable and Accounts Payable

Processed Payroll for 10 employees

Created Work Orders for warehouse and customer supply orders

Created reporting for Inventory Control and monitored gains/losses

Front Office Customer service, scheduling and meeting organization

Created weekly and monthly reports for company to monitor losses and gains.

Summary of Skills, Education and Systems Knowledge

Associates of Science Degree in Healthcare (Respiratory)

Business Management/Marketing Courses (Lake City Community College)

HPCS Coding Training

Diagnosis Coding Training

Trained in: CPT, ICD9, RBMS, DRG, Medical Terminology

PPO Professional Claims Processing Training

Certificate CRT to PC Conversion Training

Eastman Kodak Company Reliable Image Training(BCBSF)

Certified Facilitator of Zenger Miller Courses

Dun & Bradstreet Business Education Seminar (The Power of Positive Thinking)

Behavioral Interviewing Workshops

Fundamentals of Leadership Workshops

Fundamentals of Project Management Workshops

Continuous Quality Improvements Seminars

Attitudes in the Workplace Seminars

Langevin (Instructional techniques for Instructors) Training

Athena System/Cardio Dx

Work Keys Skills Testing Completed

Proficient with Microsoft Office Applications

Awards, Memberships, Interests

MVP (Local Group Operations) Customer Service at Blue Cross Blue Shield of Florida

Member of the Florida Society for Respiratory Care

Certificates for Perfect Attendance, Dedication and Teamwork

Awarded for Leadership in the UNITED WAY Campaign

Wall of Fame (BCBSF) Pier Workgroup

Nominee for Outstanding Young Men of America

Recognized for creating a Team game that dealt with Claims processing improvements as the topic using the theme of the “Night Court TV” show

Recognized for accomplishments designing and delivering curriculum for World Class Surveys for soft skills presented to both Non Exempt and Exempt employees

Conducted Training, Publix Unit Appreciation Luncheon

Peoples Choice Awards from National Operations for Excellent Customer Service

1st place winner of the National Quartet Convention talent contest

Top Three Solo Finalist for National Talent Search held at Dollywood Amusement Park

Favorite Tenor and Pianist for the state of Florida in Gospel Post Magazine

Favorite Tenor (Vocalist) for the State of Florida in Gospel Post Magazine

Outstanding High School Senior for Music

Excellent References are available upon request.

Cell 904-***-**** PO Box 424 Baldwin, FL 32234 Email: ********@***.***

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