Executive Assistant Customer Service

Objective

To gain a position with potential for career growth and development that provides daily challenges and learning opportunities, while drawing on my educational, consulting background and experience with customer service and customer care.

Professional Skills

●Grievance and Appeals Analyst

●CPR and First Aid Certification

●Licensed Administrator with the State for Adult Foster

●Adult Foster Care Consultant for the Metro Detroit area

●Proficient in Microsoft Office Access, Word, Excel, Qnxt, PowerPoint, Carelink Documentation, Strong computer skills

Work History

●Front End Collection

10/2019 - 07/2022

Credit Acceptance

-Analyze customer accounts to determine whether it is considered delinquent.

-Prepare and send notifications of payments past due.

-Assist customers in finding a way to meet financial obligations without getting further behind.

-Place phones calls to customers to remind them of payments and account balance.

●Grievance and Appeals Analyst II 04/2015 - 06/2019

Aetna Better Health

-Review, analyze and process non-complex grievances and appeals in accordance with external accreditation and regulatory, CMS and State guidelines.

-Create ADHOC Grievance and Appeals meeting details and agendas for Committee members.

-Assist with reviewing components of NCQA accreditations to implement desktop procedures for the Grievance and Appeals department.

-Analyze and render determinations on assigned complex/non-complex grievance and appeal issues and completion of the respective written communication documents to convey the determination.

-Run daily Provider and Member Timeliness (TAT) reports from DAG Dynamo system for State quarterly and yearly reporting.

-Liaison between grievances & appeals/medical management/legal/service operations and other internal departments for State Fair Hearings.

-Analyzing, investigating and processing non-complex grievances and appeals:

Reconsideration of Prior authorization

Resubmission of claims processing

Provider contract review (Credentialing)

-Pre audits for NCQA and Create Advent files for Corporate Compliance

●Deputy Administrator 09/2008 – 03/2015

Pettway Baylis Adult Foster Care

-Executive Assistant for CEO

-Prepared agendas, and scheduled meetings(Outlook)

-Inbound calls and messages

-Assisted with timecards and ADP payroll

-Distribution of all payroll checks

-Prep for new hire orientation

-Monitor compliance with state, and agency contracts

-Assisted with all inspections and training

-Assist in new processes for compliance initiative implementations

-Liaison for the Provider and the agency

-Management of 60 employees, conducting all interviews and orientation

●Deputy Administrator 01/2006 – 08/2008

Hamilton Nursing

-Assist in Medication refresh training

-Monitor compliance with state, and agency contracts

-Assisted with all state inspection

-Assist in new processes for compliance initiative implementations

-Liaison for the Provider and the agency

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