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Service Agent Representative

Location:
Brooklyn, NY, 11213
Posted:
May 21, 2023

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Resume:

GLORIA HANLEY

**** ** ***** *** •BROOKLYN, NY ***13 • 347-***-**** • **********@*****.***

PROFESSIONAL SUMMARY

Self-motivated and forward-thinking professional with over 20 years of Customer, HealthCare & Human Services experience

EMPLOYMENT SUMMARY

LONG LIFE REFERRAL NETWORK

Volunteer, Supported Employment Coordinator June 2022 - Sept 2022

Develop community based employment opportunities for people with IDD

Provide work related support service

Communicate with employers & provide clients coaching support

Provide an appropriate level of support and services to candidates, their families, employers & coworkers

Implement training & coaching plans to ensure employer standards are met

PROJECT PANDEMIC SHIELD /PPS CLINIX

Community Health, Lead HealthCare Navigator Aug 2021 - Dec 2021

Serve as a Health Service Agent in the community (NYS Public Health Leader)

Assist patients to learn and utilize the PPS Digital Suite and self-administered Covid Tests

Manage Covid Test Inventory and assist in setting up Covid Test Sites

INDEPENDENT LIVING ASSOCIATION

Direct Care Counselor (part-time) Jan 2020 - Oct 2021

Assisted and motivated disabled individuals

Monitored and recorded client's goals, objectives & behaviors

Provided Direct Care service and medication to clients

Provide DayHab Services during Covid

EMBLEMHEALTH CARE

Grievance & Appeals Supervisor May 2013 – February 2015

Review and audit responses sent to our inquirers to ensure all issues in the cases are addressed

Review, audit and finalize case management accounts, member/provider contract and DOI cases

Attend company Task Force meetings to address corporate issues and concerns (DOI cases)

Run, maintain reports and review inventory to ensure inquiries were responded to within the time frame

Adhere to all CMS and OPWDD processing guidelines

Manage staff and inventory

Facility Reconciliation Senior Analyst Feb 2011 – May 2013

Resolved issues identified by facilities and hospitals

Submit Business Requirement Reports for systemic enhancements on issues identified

Participate in departmental meetings and submit written summations to corporate peers

EMBLEMHEALTH CARE

Medical & Hospital Claims Adjustment Supervisor Oct 2008 – Feb 2011

Ran and maintained daily reports to ensure claims were processed in a timely manner

Handled escalated claims issues and follow-ups on aged payment recoupments

Manage staff and inventory

Participate in departmental meetings

EDI Network Analyst March 2004 – Oct 2008

Responsible for online implementation and testing of new group accounts for the Network Access Database

Review and finalize medical and hospital EDI files not completed on the initial submission

Work with the IT and Rates departments to ensure NA database reflect all mainframe information correctly

Train and educate new team members and temporary employees

GROUP HEALTH INCORPORATED

Quality Assurance/Methods Analyst Feb 2000 – March 2004

Perform and analyze Methods Studies for several departments

Prepare and generate Root Cause reports that reflect the results of the various Method studies and audit findings

Execute Audits on various departments via the phone and paperwork production

Customer Service Representative Jan 1994 – Feb 2000

Informed subscribers, providers, and health facilities on the status of claims and inquiries

Confirm member benefits for providers, facilities and hospitals

Acted as a face-to-face information liaison to subscribers/providers

EDUCATION & Certifications

Registered Behavior Technician

Mental Health First Aid: Certificate

Certified Human Rights Consultant

Borough of Manhattan Community College: Business Management

CPR, AED and SCIP Certifications

Technical Institute of America: Medical billing & Coding (ICD10)

Technical Institute of America PMP: Certificate

Technical Institute of America: Quick Books: Certificate

eCornell: NYS Public Health Leader: Certificate

USIAHT: Certified Human Rights Trafficking Educator

WHO: Disaster Relief Food Safety Training: Certificate

Training in Assistive products: Certificate

REFERENCES

Francis Tompkins, previous Manager at EmblemHealth 718-***-****

Angela Hope Weusi, Social Worker at Long Life 917-***-****

Omar Lamont, Team Lead at PPS/Clinix 347-***-****

Sharnae Lance RN, Friend 347-***-****



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