Provider Relations Representative
Resume:
KEVIN MORRIS
Lithonia, GA *****
adqgk8@r.postjobfree.com
PROFILE:
Self-motivated professional with strong interpersonal and organizational skills, detailed oriented, resourceful, and thrives on problem solving. PROFESSIONAL EXPERIENCE:
DELTA DENTAL INSURANCE COMPANY
Provider Relations Representative
October 2013 - November 2018
Alpharetta, GA
● Education of all dentists and dental office staff regarding Delta Dental’s insurance product portfolio and how those products impact their practices- administratively and financially.
● Conduct educational forums for network dentists to learn “best practices” in claim submission, eligibility verification and efficient dental office management and to promote Delta Dental, its strategies and initiative, as needed.
● Recruitment and management of Delta Dental's networks, achieving both specialty and geographic distribution goals.
● Review provider contracts and processing policy changes with network dentists.
● Respond to inquiries from dental offices regarding issues related to provider contracts, reimbursement, and network participation and credentialing.
● Prepare, schedule and perform Contract Compliance Reviews at dental offices.
● Research and provide accurate responses to verbal and written complaints from members and dentists.
● Research information from Director for fraud and abuse cases.
● Attend open enrollment meetings when needed by Sales.
● Attend and assist with provider seminars and conferences.
● Assist Professional Relations assistants with phones when needed.
● Special projects as assigned by Director.
Customer Inquiry Representative II
March 2011 - October 2013 Alpharetta, GA
● Receive and completely handle incoming inquiries (any communication channels as are offered) for benefits and eligibility information as well as for calls related to claims.
● Proficient in Metavance system, Enterprise Business Desktop Tools, Adjustment and Recovery to claims.
● Review, research, and accurately resolve claims processing issues.
● Respond to written inquiries as needed.
● Maintain paperwork inventory within department guidelines.
● Processed incoming correspondence via mail, website registration, or website request in a timely manner.
● Processes claim inquiries through the appropriate departments to complete claim’s problems.
● Enhanced analytical and research skills for enrollees, providers, and groups’ escalated issues.
● Document all calls received via online systems.
● Refer incoming calls to other departments if unable to fully handle. Customer Inquiry Representative January 2008 – March 2011
● Receive and completely handle incoming inquiries (any communication channels as are offered) for benefits and eligibility information.
● Documented all calls via online systems.
● Address envelopes to assist in returning x-rays to dental offices in a timely manner.
● Remain current with all departmental procedures.
● Refer incoming calls to other departments if necessary.
● Assist with other department functions as requested. ESC LOYALTY (TSYS) December 2005 – May 2007
VIP Specialist II Alpharetta, GA
● Made accurate, cost-effective travel arrangements, to include air, auto rental and hotel reservations, for point redemption clients.
● Met and maintained advance performance requirements for receiving calls and booking travel.
● Maintained high level of competency for building Passenger Name Records
(PNRs) utilizing Computer Reservation System.
● Resolved customers issues and elevated when appropriate in a professional manner.
● Developed and maintained a full understanding and working knowledge of departmental client programs, policies and procedures.
● Effectively communicated (written and orally).
● Actively listened.
● Had consistent attendance.
● Assisted Team Leads (Managers) with training and development of new hires.
● Worked successfully and efficiently with little supervision.
● Maintained a favorable working relationship with company employees to foster and promote a cooperative and harmonious working climate while maximizing employee morale, productivity, and efficiency.
INTERNAL REVENUE SERVICE January 2001 - July 2005
Data Transcriber Chamblee, GA
● Entered alphanumeric information into computer using Windows NT Operating System applying knowledge of tax codes and laws to key correct information from source documents.
● Maintained and operated Integrated Submission and Remittance Processing Workstation.
● Reviewed tax returns to guarantee completeness and validity prior to data entry comparing notes and instructions on source paperwork to update information to ensure accuracy and conformity with established policies and procedures.
● Corrected and recommended errors to supervisor for correction.
● Processed more than 5000 tax returns of varying types each month.
● Consistently met or exceeded quality and quantity goals. INTERNAL REVENUE SERVICE July 2001 - January 2001
Clerical Chamblee, GA
● Managed and maintained all folders for the suspense wall.
● Sorted replies and placed into chronological order.
● Input various information into computer.
SKILLS
Microsoft Office: Word, FrontPage, Excel, Access, PowerPoint, Windows, Amadeus, Aergo
EDUCATION
2004 B.S. in Computer Science
Georgia State University, Atlanta, GA
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