Processing Clerk Claims Assistant
Resume:
Triston Owens
Woodland Hills, Ca 91367
************@*****.***
Professional Experience:
Molina Healthcare – Long Beach, CA 7/16 – 5/20
Compliance Auditor
Complete Member Liability Denial Daily Audit
Facilitate/coordinate DHMC CAP meetings with leadership Team
Review and provide recommendations for Corrective Actions Plans received from Compliance Incidents
Conduct meetings with Business Area affected by Corrective Actions
Perform quality check on Audit Samples for External Audits
Create workflow for CAP Quality Review Process
Review State Regulation requirements for auditing tools
Complete/ Delegate TAT Audits for Q1
Create Tracking tools for Q1 TAT Audit and Scorecards
Create/implement new Stand Operations procedures
Send out clear written communication to Health Plan Auditors regarding any concerns or errors
Assist Manager with researching audit errors/ preparing additional documentation to be presented to auditor
Complete full validation of universe reports prior to submitting to Health Plan Auditor
Complete full validation of claim samples batches prior to audit date
Delegation of universe selection to Claims Assistant
Assist with reviewing of P&P for revisions
Work with Auditors to assist management resolving audit issues
Lead in the coordination of all health plan audits
Assist with Preliminaries and Corrective Action Plans
Complete all Member out of Pocket Request from Health Plan
Process and forward all misdirected claims
Complete Audit results PowerPoint on a monthly basis
Send out clear written communication to executives and FDRs (vendors) relaying
United States Postal Service – Los Angeles, CA 02/14 – 3/19
Processing Clerk / Supervisor (graveyard)
Facilitate the flow of materials to and from various work sites and departments
Direct shipments according to established routing scheme using computer controlled
Keyboard or voice recognition equipment
Coordinate weekly progress meetings developing improvement strategies
Construct and implement appropriate recovery plans to enhance productivity
Submit documentation tracking mail productivity and clerk performance upon management request
Discharge shipment pallets and distribute to assigned clerks
Assemble mail freight operating forklifts/jacks and automated trains
Condense bulk load freight to manageable measures to induce rapid productivity
Optimize workflow, monitoring operatives throughout processing cycle
Ensure mail productivity to exceed daily volume standards
Mending mechanical errors during processing cycle
Finalize all processed mail timely to prevent delivery delay
Elite Placement– Long Beach, CA
Provider Coordinator - Contract 12/13 – 11/14
Entered in all provider, vendor and facility information
Credentialed and re-credential behavioral providers using Cactus
Performed Primary Source Verification for individual credentialing & confirmation of facility accreditation and licensure
Provided Authorization for all new patients, Managing all PODS for the credentialing department
Worked with Network Operations and other Beacon staff to ensure follow up with providers when applications are incomplete
Provided customer support to Providers and internal staff, answering the phone, faxing, filing, file auditing and creating welcome packets for all new Providers
Completed minute notes for department meetings as well as added all notes to share drive.
Worked varies project that required training for new systems
Trained new employees on day to day tasks as well as crossed trained
Coordinated new training meeting and set up training room and preparing material for training on new software system
Rent a Center – Compton, CA
Credit Manager – 2/10 – 11/13
Disclose company’s contractual terms and agreements to new clients
Conduct income evaluation to determine potential client eligibility ensuring minimal
credit risk
Perform periodic credit assessment to existing customers
Directly worked with Sales Manager developing and updating marketing strategy
resulting in 30% revenue increase
Develop, review, and update company credit policies
Recommend credit policy modifications to senior management
Accountable for ongoing training for 3 account representatives
Significantly reduced amount of delinquent accounts by formulating payment methods
for clients in debt
Performed closing cash drawer audits, monitored payments, and prepared store deposits
Reference: Upon Request
Computer Software Utilized:
Cactus, FlexCare, Trandsmed, Oracle, Sales Force, Microsoft Office, MAPD, QNXT, Electronic Billing, HPMS,OMT, Verify Comply, Epic/Tapestry, MCG, CHC
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