Beaumont Hospital William
Resume:
Kelli G. Jones
***** ********* ** *******, ** ***23
M 313-***-**** *****.*******@*****.***
Profile Experience
To obtain and utilize my outstanding customer service skills and work ethic with an opportunity to grow with a company while upholding their standards.
Caregiver
Helping Hands, Royal Oak, Mi
2/21-Present
Working with patients in their homes by helping them with their daily needs.
Customer Service Rep
Dialog Direct Troy, MI
5/17- 3/18
Inbound phone calls, assist customers with benefits, initiate claims, check claims status, update payment methods, escalate situations to upper management such as proof of enrollment, refunds and payment frequency.
Quality Auditor, Dialog Direct 8/16-3/17 Highland Pk, MI
Scored recorded calls of licensed and non-licensed insurance agents who enrolled Medicare members into plans that were available in their areas. I also enrolled .members, as a non- licensed agent, into prescription drug plans during open enrollment.
Parking Attendant, Ultimate Parking Mgmt, Detroit, MI
April 2015-March 2016
Valet parked, assisted guests upon eLJand leaving, cash handling, drawer balance before and after shift.
Registrar, William Beaumont Hospital; Royal Oak, Mi 2002-2014
Medical terminology; 30+11; knowledge and experience of basic office equipment; training employees; multitasking assignments; assisting physicians, updated insurances, obtained referrals and authorizations for surgeries and MRI's/MRA's
Unit Secretary, William Beaumont Hospital; Royal Oak, Mi 1998-2002
Placed orders for patients medications and tests, registered patients, assisted nurses and physicians regarding patients, answered multi-lined phones,greeted patients and family members
Sales Associate, Hudson's Department Store; Southfield, Mi 1993-1996
Balanced cash drawer, sales, inventory, stock for department, displays, gift wrapping, assisted other associates
Leasing/Property Manager
1989-1991
Reviewed applications for approvals for residency; scheduled appointments with applicants; purchased appliances with approved vendors for the units; received rental payments; communicated with residents regarding property issues.
Detroit Business Institute, Certificate
Southfield, Mi 1991
Henry Ford High School, Diploma; Detroit,Mi 1979-1983
SYSTEMS USED
MARx: The MARx (Medicare Advantage and Prescription) system is used to look up the information CMS has on file for a caller's Medicare benefits. A valid Health Insurance Claim Number (HICN) is required to conduct a search. The 2 screen options that are the most useful for information:
Beneficiary Eligibility (M232) Screen contains information on beneficiary's demographic information, current Medicare A & B eligibility, effective dates and LIS data.
Beneficiary Detail Snapshot (M203) Screen contains information on current eligibility, LIS data, enrollment, and premiums for beneficiaries enrolled in a UHG plan. In order for you to access this screen for a particular beneficiary, you must have pre-registered the Contract Number of the beneficiary's current plan in your MARx account.
GPS: GPS is the policy administration system used by UHC MR for Online Enrollment, Billing and Fulfillment
Citrix: an environment by which multiple systems can be used when logged into properly.
MySME:
Bconnected Live: bConnected is a sales management system. It allows agents to create contacts, track and report sales activities, manage sales opportunities, request appointments, reserve seats at community meetings, and send fulfillment materials
RxWEB: RxWeb is OptumRx's company-wide “Intranet” homepage, containing useful links, tools, company updates and announcements. Agents will use RxWeb to assist prospects/members in identifying lower tier alternatives to the medications they are currently taking.
Qfiniti: For M&R Sales management team only: Call recording and quality monitoring software for use by Team Leads, Supervisors, Managers and Trainers. Used for listening to, monitoring, and evaluating phone calls taken by Call Center Representatives.
BA-Behavioral Analytics Member Portal: Tool that houses all recorded and analyzed Member Services calls for E&I and C&S.
CareOne 4.0: CareOne 4.0 is a care management application that allows you to update and manage enrollees’ care plan records. The application is designed to identify and enrollee’s care level requirements and determine the appropriate care management approach. The system allows you to proactively coordinate the care service needs for high-risk enrollees
Idrs-Intranet Document Retrieval System: The iDRS (Intranet Document Retrieval System) application stores scanned paper documents, such as claim and enrollment forms, and provides the capability to view and retrieve documents electronically via the Intranet. These documents are generally stored as TIFF images, and are searchable and retrievable via a Film Locator Number (FLN) number, used for document tracking
ERN- Eligibility Reconciliation Navigator: ERN is a SCC and Eligibility Reconciliation system utilized by the M&R Reconciliation teams for reconciliation of members eligibility and SCC/OOA discrepancies with CMS.
ICUE: The Integrated Clinical User Experience (ICUE) application is a cornerstone of the eSync suite servicing all UnitedHealth Group business segments. This Web-based application connects utilization management with case, disease and health and wellness management functions, providing an end-to-end service delivery across the continuum of care. This platform helps us deliver a more coordinated, integrated experience to our members and the health care communities that support them.
MyApps-ECC (Security Exceptions): This application is used by Remote Users to Request exception abilities. Does require an approved PEX
VCC Desktop (VCCD): VCC Desktop (VCCD) is a core call handling application with advanced telephony features and CTI functionality utilized by all agents on the Virtual Contact Center (VCC) platform. UHG, Optum and third-party vendor agents use the VCCD Application.
SVCKM-Service Knowledge Management: The Service Knowledge Management application is used by Ovations, OPTUM, and UHC. It allows business to create and update various types of knowledge content for storage in a single area.
EDSS-Enterprise Data Storage System: Enterprise Data Storage System (EDSS) is a document management system built on the Datawatch Business Document Server (BDS) product. EDSS stores and manages COLD documents/reports for approximately 83 enterprise document groups, for retrieval by operations, call centers, members, and providers. Types of content include summary checks, EOBs, health statements, letters/correspondence, claims and others.
MIIM-Member Interaction and Issues Management: MIIM is a M&R Customer Service application designed to give call agents a single, end-to-end application to view and efficiently manage member touch points. MIIM ensures a more consistent member experience, as well as improved Compliance, consolidate issue tracking, systematically flag, date and time stamp every record providing a complete source for case management. MIIM is designed to enhance the member experience and provide a holistic view of our members’ interactions with UnitedHealthcare.
ODM- Online Document Management: The ODM - Online Document Management application is used by Ovations, UHC Operations, Evercare, and Prescription Solutions for work queue management and archives
UFE- United Front End: UFE (United Front End) receives EDI & Keyed Claims, Encounters, and Referral transactions and routes those transactions to multiple downstream systems for claims adjudication purposes. The UFE on-line application allows for viewing of submission and routing information for these transactions as well as the UFE Sendback Queue for keyed claims.
ORS- Online Routing System: The ORS - Online Routing System (Host ORS) mainframe application is the functional system that supports the security, record routing, and record storage for all issue management applications.
Cosmos- Comprehensive Online Software for Management and Operational Support (COSMOS) is the COSMOS claim adjudication system. It is the software system designed by UnitedHealth Group to operate and manage their health care business on an IBM mainframe.
NICE- NICE (Newly Integrated Computing Environment) which is the core membership and claims platform used to administer legacy PacifiCare Commercial HMO and POS products as well as the Medicare Advantage and Medicare Part D products sold under Ovations’ Secure Horizons brand. It is a highly integrated system which has numerous subsystems (Providers, Contracts, Membership, Eligibility, Broker Commissions, Billing, Claims, Encounters, Capitation).
Trio-Tactical Ramp Intake Onboarding: This application is used by Call Center personnel to onboard new agents.
M & R Data Analytics (Orbit Tableau): M&R Data Analytics (Orbit) Tableau) is an internally facing tenant on the Orbit - Tableau platform. It distributes business intelligence content (Reports, dashboards, scorecards, statements, etc.) via this platform.
References
Marcia Smith Robinson
Knee and Regenerative Institute
**************@*****.***
Tiffany Moore
Tiffany Sweetz
*****.*********@*****.***
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