Telephone Representative Data Entry
Resume:
Objective
Currently seeking a part time work at home position. I enjoy data entry, typing, problem-solving and customer service assistance.
Qualifications
Previous work history as telephone representative and customer service with a health insurance company. Work History
Previous Employer FROM: January 2017 TO: August 2020 NTT DATA (Working on the Harvard Pilgrim Account) For Employment Verification: 800-***-**** 1600 Crown Colony Drive Company Code 10461
Quincy, MA 02169
POSITION: QUALITY TRANSACTION ANALYST
Duties Included: Identified root cause issues recommending solutions, maintains consistency and accuracy of team processes while auditing co-workers, supports automation and process improvement initiatives, performs root cause analysis on issues identified, reviews multiple contracts verifying payment accuracy, supports team in meeting 100% of all contract obligations and SLA’s, identifies overpayments from audit analysis, supports documentation and training in operational improvements and resolution of processing issues, controls release of confidential information to remain HIPPA compliant, attends meetings that pertain to auditing department.
Previous Employer
HARVARD PILGRIM HEALTHCARE FROM: July 1999 TO: January 2017 1600 Crown Colony Drive For Employment Verification: 800-***-**** Quincy, MA 02169
POSITION: QUALITY ASSURANCE ANALYST
Duties Included: Review data entry from numerous co-workers to identify any errors maintaining consistency and accuracy of team processes, review and analyze potential issues to determine solutions, attends meetings on various processes, analyze root cause issues, reviews account/service history to identify trends, co-developed “on the job” training guidelines with Documentation & Training, keeps current with knowledge of claims adjudication and processing guidelines, supports training and documentation with operational improvements, reviews facility, contracts, verifies accuracy in payment. Carol F. Butler
E-mail: ***********@*****.***
3278 S. Semoran Boulevard
Unit #14
Orlando, FL 32822
Phone: 407-***-****
Carol F. Butler
Previous Employer
HARVARD PILGRIM HEALTHCARE FROM: June 1995 TO: July 1999 1600 Crown Colony Drive For Employment Verification: 800-***-**** Quincy, MA 02169
POSITION: TELEPHONE REPRESENTATIVE
Duties Included: Review member’s history for claim status/updates from provider office, review member benefits, identify annual benefit limits and if they had been met, assess member deductible and out of pocket maximum to identify if they had been met, track necessary call backs for further resolution and documentation needed, track amount of calls taken per day and any follow-up resolution needed, identify and document any issues found, maintain targeted productivity levels, adjudicates claim if needed. Previous Employer
HARVARD PILGRIM HEALTHCARE FROM: December 1991 TO: June 1995 1600 Crown Colony Drive For Employment Verification: 800-***-**** Quincy, MA 02169
POSITION: CLAIMS MEDICAL EXAMINER/DATA ENTRY
Duties Included: Enters information from medical claim submission into the data entry system for processing, reviews any documentation for manual processes of claim, follows guidelines required for each service type, asks questions as needed.
EDUCATION:
HIGH SCHOOL DIPLOMA – 1978 West Roxbury High School Business Courses VFW Parkway W. Roxbury, MA
Please note: Certification of medical coding was not required in Massachusetts, however I am willing to take courses if necessary.
SKILLS:
Typing (approx. 60 wpm) Interprets Contracts
10-key Numeric Entry Microsoft Office
Medical Terminology Various Databases
Outlook Computers (Advanced}
Microsoft Excel Oracle Health Information System
Facility/Medical Coding HCPC/CPT/ICD9 Coding
Root-Cause Analysis
REFERENCES:
Lee Riles, President
Riles & Allen Insurance
Cheryl Rogers, President
Cheryl’s Boutique
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