Patricia Lewis

*** **** **. ~ Wyandotte, MI *****~6528

(734) 322~7177

CAREER

OBJECTIVE: It is my mission to secure a dynamic, progressive career opportunity in a team

oriented department dedicated to providing reliable service to their clients.

SKILLS

Extensive knowledge of Facility Provider Inquiry’s claims processing systems, medical and benefit policies

Knowledge of Professional Provider Inquiry’s medical and benefit policies

Working knowledge of Medicare Advantage claims processing systems, medical and benefit policies

Knowledge of the NICE system call monitor guidelines

Excellent verbal and written communication skills

Software Applications/Systems: FACETS, Med Access, Drams, IRIS, NCSW, 3270 Local and Nasco, Benefit Explainer, Microsoft Word/Excel/PowerPoint, Outlook, BI3, BlueCard, BCR Tool, EOS Thin Client, NICE system and IBM DB2 Content Manager

EMPLOYMENT HISTORY

Blue Cross Blue Shield of Michigan – Detroit, MI

Customer Service Representative III – 5/18 to 3/22

Utilized various systems to analyze, evaluate, resolve inquiries, and respond to customer and provider inquiries via telephone or written correspondence regarding claim, benefit, and financial information.

Responsible for interacting with departmental and corporate personnel as well as others outside BCBSM regarding benefit and claims inquiries.

Provided OJT for new hires and seasoned CSR’s regarding new and/or complex benefits when needed.

Served as Committee Chairperson for department employee Information Organization Committee.

Served as Help Desk representative (CSR III), providing assistance to CSRs and handling special assignments for Team Leaders, Manager, and Director.

Participated in workgroups to improve workflow processes.

Interacted with various levels of management, providing input to develop effective and efficient ways to service our providers.

Exceeded production and quality standards.

Customer Service Representative II – 7/97 to 7/04

Utilized various systems to analyze, evaluate, resolve inquiries, and respond to customer and provider inquiries via telephone or written correspondence regarding claim, benefit, and financial information.

Responsible for interacting with departmental and corporate personnel as well as others outside BCBSM regarding benefit and claims inquiries.

Provided OJT for new hires and seasoned CSR’s regarding new and/or complex benefits when needed Served as Committee Chairperson for department employee Information Organization Committee.

Served as Help Desk representative (CSR III), providing assistance to CSRs and handling special assignments for Team Leaders, Manager, and Director.

Participated in workgroups to improve workflow processes.

Interacted with various levels of management, providing input to develop effective and efficient ways to service our providers.

Exceeded production and quality standards.

Trainer / Apprentice Trainer – 7/04 to 5/18

Conduct classroom telephone and written OJT/OJC (on the job training/coaching) in partnership with the Trainers.

Provide post training and evaluation during the OJT/OJC process.

Monitor performance and provide feedback during the OJT/OJC process as needed on the floor.

Complete trainee evaluation during OJT/ OJC and 30 day post evaluation.

Assist Trainees with the development of organizational skills and time management so that they may effectively prioritize their work day.

Assist on the Help Desk; completing the Help Desk log by identifying potential needs, i.e. gap training, alerts (reminders), and servicing within the unit.

Review Phone Observation Forms to identify potential workflow clarifications or procedure changes to enhance provider servicing within the units.

Create, update and manage the departments’ Online Email folder.

Periodically take incoming calls to sharpen my phone skills, and enhance analytical ability.

Conduct one on ones with CSR II’s when requested by the Leadership Team.

Complete and submit weekly activity plan to Team Leader and Manager.

Inform training of any updated/information changes in floor procedures that would impact training.

Consult with Technician/Analyst regarding issues/questions requiring resolutions.

Develop and generate the floor alerts as needed.

Work with the trainers to review training materials for accuracy, completeness and relevancy.

Identify discrepancies with on-line systems.

Reinforce work performance standards and positive servicing behaviors during OJT/OJC.

Coordinate with the respective Training Team Leader and provide on-going performance statistics and feedback regarding trainees. Monitor phone calls to determine if additional assistance and coaching is required (this is accomplished through the monitoring of calls on the NICE system and performance servicing meetings with the Team Leaders and the review of training test scores and hands on exercises).

Customer Service Representative II – 7/97 to 7/04

Utilized various systems to analyze, evaluate, resolve inquiries, and respond to customer and provider inquiries via telephone or written correspondence regarding claim, benefit, and financial information.

Responsible for interacting with departmental and corporate personnel as well as others outside BCBSM regarding benefit and claims inquiries.

Provided OJT for new hires and seasoned CSR’s regarding new and/or complex benefits when needed.

Served as Committee Chairperson for department employee Information Organization Committee.

Served as Help Desk representative (CSR III), providing assistance to CSRs and handling special assignments for Team Leaders, Manager, and Director.

Participated in workgroups to improve workflow processes.

Interacted with various levels of management, providing input to develop effective and efficient ways to service our providers.

Exceeded production and quality standards.

Interim Technician – 11/01 – 02/02

Revised Help Desk log and procedures.

Addressed (handled) irate calls concerning benefits and claims for both Local and Nasco systems.

Extracted vouchers for in and out of state Hospitals and non-Hospitals.

Verified benefits and revised Desk Level Procedures Manual for Facility and Special Programs department.

Completed special projects for Directors and Managers as assigned.

Served as SME (subject matter expert) and provided OJT (on the job training) coaching for new hires.

Customer/Provider Support Clerk – 10/96 to 7/97

Accessed and interpreted database systems as needed to assist with inquiry processing functions.

Input information to update customer inquiries.

Perform a variety of clerical duties such as date stamping, sorting, counting, batching, coding, and classifying incoming/outgoing/inter-office mail/inquiries.

Requesting data, matching and maintain inquiry controls necessary to generate reports.

Assisted internal personnel in accomplishing weekly inventory objectives.

EDUCATION

Certificate in Information Technology

Kee Business College – Newport News, VA

Bachelors of Science Degree – currently pursuing (36 credits completed)

Information Technology

Central Michigan University – Dearborn, MI

Online

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