Data Entry Processing Specialist

Nou Yang Lansing, IL ***** 608-***-**** adup12@r.postjobfree.com

Successful Sr Member Health Op Rep with background supporting company daily activities. Highly knowledgeable with skills in managing and coordinating various tasks. Alert and attentive with expert problem-solving skills.

Motivated Customer Services Rep Specialist with 8 years overseeing employees in collaboration with organization leaders. Seasoned professional working with various departments to drive smooth operations. Tactful when guiding and communicating with staff to maintain upbeat atmosphere and peak performance. Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level in all position. Ready to help team achieve company goals. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Accounts Payable and Accounts Receivable

Loan Applications

Operations Management

Mining Operations

Strong verbal & written communications

Self motivator, ability to work in a fast pace

Able to think quickly and handle clients

Proven customer success

Detail oriented

Goal oriented, Team player

Proficient in MS word, excel, powerpoint,

outlook, health rules program, Smart date

solutions

Senior Member Health Operations Representative, 05/2021 - Current NeuGen – Madison, WI

Reviewed and resolved discrepancies with invoices, auth request, referrals and working closely with accounting, legal, claims and customer service team. Collaborated with various departments to support daily activities oversight and coordination. Delegated work and coordinated staff members' daily responsibilities. Independently perform first level reviews of all preauthorizations & referrals received, requesting additional information if necessary; assess and identify issues (network status, benefits, clinicals on request and proactively outreach to members and providers on non-covered services, excluded services and network status.

Bartending, 10/2020 - Current

PROFESSIONAL SUMMARY

SKILLS

WORK HISTORY

Longhorn Steakhouse – Madison, WI

Trained [Number] new bartenders on drink preparation, product promotion, garnish preparation and sanitation protocol.

Communicated frequently with parents, students and faculty to provide feedback and discuss instructional strategies.

Created and developed lesson plans to meet students' academic needs. Modified lessons and curriculum to accommodate diverse learners by using strategies such as peer-assisted learning and group work.

Senior Claims Representative, 03/2019 - 05/2021

NeuGen – Madison, WI

Processor for new claims

Reviewed codes for claim submissions required for medical necessity Review codes through correspondence sent by providers' office Data Entry

Place outbound calls

Proficient knowledge of health plans and coverages, eligibility, STD & LTD products Processing Specialist, 09/2017 - 04/2019

TASC – Madison, WI

Worked to meet or exceed targets as defined in sales incentive plan and assigned by insurance manager. Responded to customer inquiries and requests related to insurance products and membership. Completed coverage by delivering policies, planning future follow-up conversations and evaluating needs.

Process incoming inquiries from participants and clients-related changes to either personal information, plans, and or coverage changes

Eligibility Specialist, 06/2017 - 03/2019

NeuGen – Madison, WI

Reviewed applications for different aid programs and determined which qualification criteria for individuals.

Documented all communication with applicants and inputted information into system using [Software]. Followed guidelines when reviewing applicant data to determine eligibility. Scheduled appointments with applicants to gather information and explain benefits processes. Researching payment delinquencies for individuals members, group health plans and employer groups. Processing billing invoices for LTD & STD groups and members Customer Service Representative Specialist, 04/2015 - 05/2017 NeuGen – Madison, WI

Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.

Offered advice and assistance to customers, paying attention to special needs or wants. Answered constant flow of customer calls with minimal wait times. Answered customer telephone calls promptly to avoid on-hold wait times. Receive and responds to inquires via phone calls, web portal requests and written inquiries, providing information regarding member benefits, eligibility, claims processing and requirements of the benefit plan

Assist with training and orientation of new and existing employees on effective use of online systems, portal, references, while demonstrating effective customer service soft skills; wrote training documents for multiple processes for costumer services department Participated on special projects for costumer services department and other departments for updates on websites, guidelines and health plan changes

Claims Resolution Specialist 2, 06/2006 - 04/2014

WPS Health Insurance – Madison, WI

Coordinated services such as estimates, repairs and replacement rentals. Collected information about rejected claims and developed effective solutions. Processed adjustments and posted refunds.

Explained policy coverage, liability and denials to policyholders, lawyers and other involved parties. Provided inbound/ outbound customer service calls

Data Entry

Post/reverse payments to provider accounts

Gained extensive wealth of knowledge in Medicare billing guidelines and claims Associate of Arts: Business, 06/2007

Madison Area Technical College - Madison, WI

EDUCATION

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