Nicole Cleveland

**** ******* ** *********, ** **103

adwnbw@r.postjobfree.com 970-***-****

CAREER PROFILE

Committed, Motivated employee, with exceptional customer service, decision making skills, strong work ethic, and resourceful professional demeanor and great initiative with a reputation for quality, proficiency, and reliability in service-oriented, dedicated to excel at prioritizing completing multiple tasks simultaneously and following through to achieve goals. Looking for a company or position to grant me the opportunity to prove myself and will offer opportunities for career growth and seeking to use medical education and practical experience to healthcare industry.

§Proficiencies: Greenway; MS Excel; MS Word; MS PowerPoint; Typing Speed: 50 WPM, Microsoft Teams, Outlook, Access, Ultra Edit- SQL knowledge, Atmos

§Skills: decision-making skills; written and verbal communication (letters, emails, presentations, face-to-face communications); proofreading and editing; trustworthy; willing to learn new things; customer service oriented; Meticulous attention to detail; Computer-savvy, Superior organization skills; Complex problem solving; Operational improvement; Business operations understanding; Multitasking ability, Flexible; Service-oriented mindset; Leading teams; Strategic Planning; Results oriented; Purpose Driven; Principled Agility; Talent Multiplier

QUALIFICATIONS

Accounting, Payroll, and Banking Systems Healthcare Law HIPAA Compliance Charting Filing Processing Co-Payments Human Resource Management Organizational Improvements Appointment Scheduling Insurance Billing Procedures CMS1450 UB04 CMS1500 Healthcare Claim Cycle Insurance Verification Interpersonal Professional Communications Business Office Operations Medical Office Procedures Medical Practice Management Systems Practice Structure Leadership & Management Medical Terminology Anatomy & Physiology Identify and Analyze Detail-Oriented Reporting Analytical thinking and problem solving

WORK EXPERIENCE

Centene Corporation - Little Rock, AR 02/2019- Present

Senior Member Enrollment Specialist / Eligibility Representative III

Serve as SME (Subject Matter Expert) and resource to Member Enrollment Specialists

Work on complex and exception queues to resolve and redirect errors and exceptions

Assist with complex internal and external inquiries regarding enrollment

Lead research and reconciliation disparities between data files and internal systems and coordinate responses.

Maintain data integrity of member enrollment records transmitted

Develops ad-hoc reports to conduct data analysis and validation.

Confers with area/department to analyze current operational procedures and trends and identify problems.

Research, evaluate and assess the financial impact of issues identified in data/processes.

Analyzes requirements, procedures, and problems to automate processing or to improve existing business systems.

May be responsible for monitoring and reporting to management on the status of departmental projects: Anticipates and identifies issues that could inhibit achieving the project goals and objectives and implementing corrective actions and mitigation strategies.

Provides oversight and resolves complex issues, optimizing performance, resolving problems, and providing timely follow-up on identified issues.

Dive in to help with special projects.

Requests carve outs/ 834 health coverage

Nvsbe Recon

New Jersey Recon

Acero

HPL Aging

Softheon pend OOWF

Embark process to clear exceptions

Perform various analysis and interpretation to link business needs and objectives for assigned function.

Escalated enrollment case work fixing members accounts. Analytical position and requires root cause analysis skills. Reducing escalation case work by 10%.

Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems

Identify and analyze user requirements, procedures, and problems to improve existing processes

Perform detailed analysis on assigned projects, recommend potential business solutions, and assist with implementation.

Performs other duties as assigned. Additional Responsibilities:

Centene Corporation - Little Rock, AR 04/2013-02/2019

Enrollment Analyst I / Member Enrollment Specialist

Maintain enrollment and membership records with core internal systems related qualifications for coverage under contracts or agreements and resolve related issues

Perform audits and analysts on completed member data load processes, monitor eligibility loads, data updates, and all internal/external requests

Work with internal and external stakeholder to communicate and resolve membership data issues

Provide timely, efficient support for the eligibility load process and coordinate with corporate IS department to resolve issues that arise during the process

Review, investigate and resolve inquiries regarding loaded membership

Handle and resolve complex member data issues, such as loading errors, limited reconciliations and direct entry of data into core systems

Generate ad-hoc batch report on membership across multiple lines of business using business objects, access, and other reporting tools

Update work processes

California fallout reports

California APA special projects

Provider 2400 error report

CRM member services and PCP’s workbasket

Contract spans

Division spans

Softheon to umv report

Member diff report

Enter newborns into umv system

Ambetter mailbox

Omni welcome packet and Id cards

CRM welcome packet and Id cards

Help trained on work processes and special projects

Novasys Healthcare / Centene - Little Rock, AR 01/2012- 04/2013

Claims Analyst I

Manually Keyed RX Pharmacy claims

Filed outpatient and inpatient hospital claims into the system to process to pay members

Helped train any individual to process claims

Recognized and processed HCFA Forms

Read Diagnostic codes and CPT code

Carter Family Medicine Clinic - Little Rock, AR 10/2011- 12/2011

Administrative I- PRN Point of Service UAMS - Little Rock, AR 03/2011- 09/2011

Edward O Moody Law Firm - Little Rock, AR 10/2007- 02/2011

Administrative Assistant / Scheduler

Answered incoming and outgoing callers

Scheduled appointments NPT Testing and other appointments

Sent faxes to vendors, insurance providers, and other doctor’s offices as directed

Copied and mailed out-patient appointments reminder letter to patient’s home address

Routed calls into computer PC for nurses and faxed patient’s Medicaid referrals to doctors' office and hospitals

Answered incoming calls and outgoing callers

Verified Insurance providers for patients and faxed MRI appointments to different doctor offices

File patient charts alphabetical order

Scan Medical Claims

Process claims

File x-rays

Data Entry/Excel

Shred confidential paperwork

Make labels for EPF files

Fax MRI appointments NPT testing & other appointments

Enter patient information into PC

File patients charts alphabetical order

DEAN LIST

Nominated on the dean list at Ultimate medical Academy

Attained honors for grades earned during 2017-2018

Recognition of High Scholastic Achievement

EDUCATION

Ultimate Medical Academy Associate of Applied Science in Healthcare Management, 2018

Fully accredited, accelerated program providing instruction in healthcare management, leadership skills, business offices operations, computer applications, healthcare delivery and accounting systems. Program content includes personnel management, customer service, employee benefits and adherence to healthcare laws, regulations and ethics. Research, professional writing, critical thinking, and communications skills are emphasized throughout the program.

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