ANDREA PRICE

**** ***** ******* **** * Virginia Beach, Virginia 23464

C 757-***-**** * W 757-***-**** * adrat5@r.postjobfree.com

SUMMARY Thirty year of practical and supervisory experience in customer service, education, account

management, problem resolution, and medical terminology. Very strong oral, written, and interpersonal communication skills. Service oriented in Healthcare, Hospitality, Retail and Call Center.

EXPERIENCE

01/2014 – Present Operation Expert – Amerigroup Corporation, Virginia Beach, VA

Serves as a mentor. Provides coaching and technical support to operational functions on a customer care level.

Trains, coaches, counsels, and evaluates the performance of 20+ direct reports.

Provides support in resolving escalated issues.

Performs Post Call Survey follow-up.

Initiates system enhancements for Pharm Tool & Atlas.

Monitors quality call expectations and provides feedback when associates fall below company standards.

Participates in various trainings to develop the work ethics of our associates within company policies and procedures as well as new market processes for providing efficient customer service.

Perform callback to members concerning OHI issues that is effective with obtaining customer medications.

Prepare specialized reports.

09/2012 – 01/2014 Quality Analyst Specialist – Amerigroup Corporation, Virginia Beach, VA

Assisted in New Hire Presentation Classes.

Performed one on one feedback with Associates and Management.

Performed audits to monitor efficiency and compliance with policies.

Completed Championship Leadership Training.

Completed Ulysses Training.

02/2007 – 09/2012 Pre-Authorization Associate - Amerigroup Corporation, Virginia Beach, VA

Assisted with the development of COMPASS.

Provided coverage to assigned units acting as the main point of contact in the absence of management.

Aided team members, providers, and vendors with authorizations, inquiries, pended claims, eligibility, denials while performing research and resolution.

Partnered with departmental management staff, quality staff and training staff to identify performance gaps and assisted with developing training for deficiencies.

Documented all pre-certification requests as well as member encounters utilizing the appropriate systems and online resources.

Accurately answered questions from both Pre-Authorization Associates and Nurses that may pertain to clinical or non-clinical processes.

Maintained accuracy for compliance within departmental standards and policies.

Maintained member confidentiality.

03/2006 -02/2007 Provider Services Representative/CCR3 - Amerigroup Corporation, Virginia Beach, VA.

Assisted providers with resolution of claims entered that have denied or paid incorrectly.

Assisted on the Provider Resolution Line, that is utilized for escalated calls and claims issues.

Assisted newly hired teammates during OJT as an instructor.

Facets and Amisys trained.

Software: Competency in Microsoft Office to include Word, Excel, and Outlook

Service Oriented: Healthcare, Medicaid, Hospitality, Retail and Call Center

TRAINING

Virtual Training Classes:

7/06/2020 Tampa - New Hire

10/2020 NC - New Hire Class

06/2021 NV - New Hire

9/2021 VA Beach - New Hire Class

11/2021 VA Beach – New Hire Class

Member Experience Medicaid Pharmacy - Upskill Training/ Q&A Meeting

04/2018

08/2018

Interim Manager - Temp New Hire Class

12/2018-04/2019

EDUCATION

Fashion Design /Norfolk State University, Norfolk, VA

Medical Terminology, TCC, Virginia, VA

References Available Upon Request

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