Nicole Purnell

• St. Louis, MO •

Cell 314-***-**** • adwwhv@r.postjobfree.com

Professional Profile

Highly motivated team player with strong communication skills; more than 20 years Health Benefits/Customer Service experience and has obtained the trust and admiration of various Business Establishments. Seeking to obtain a challenging position where my various skills will lead to the ongoing success of the organization.

Professional Experience

Talent Burst/Thermo Fisher

St. Louis, MO

Covid Test Kit Coordinator /Data Entry Clerk

11/2021-04/2022

●Assists with quality assurance and data entry, as needed.

●Assists with making sure all supplies and paperwork are ready for vaccine events.

●Manufacturing COVID test kits.

●Manually assembling parts within the assembly line.

●Ensuring products are built/completed to company quality standards.

●Work cooperatively with the production team to meet company goals.

●Communicate any quality and equipment issue to Lead/Supervisor.

●Assists clients in talking through misinformation, fear and mistrust of by acting as a bridge to clinical teams.

●Maintain a clean and safe work area.

●Follow all written and verbal instructions.

Express-Scripts

St. Louis, MO

Client & Benefit Analyst – Benefit Operations-PBM Services

05/2019-11/2021

●Communicating with internal teams and conducting research

●Review and analyze claims and expenses for eligibility to be reimbursed

●Process new as well as aged claims

●Provide support with Benefits, Group Structure, Copay Grids, Client

●Website and other important information needed to implement the

●new Medicare/Commercial

●Quality control documentation for accuracy and regulations

●Adaptable to client specific & workflow changes

●Review and prepare required documentation

Centene Corporation

Ferguson, MO

Advanced SR Claims Analyst II

02/2017-05/2019

●Research and documents information as needed to process claim as well as work with other departments within the organization to provide resolution

●Review and analyze claims and expenses for eligibility to be reimbursed

●Process new as well as aged claims

●Coordination Of Benefits

●Assist co-workers as needed in reaching department goals

●Review and prepare required documentation

●Assist in controlling the cost of processing claims

●Comprehends the need for a sense of urgency with all work activities

●Follow all policies and procedures established for the department

●Performs other duties as assigned.

U.S. Post Office

St. Charles, MO

Rural Carrier Associate

2016-2017

●Sorting mail in delivery sequence

●Obtaining and preparing mail for casing

●Load and deliver the mail along an established route

●Stand for long periods of time

●Stretch, push, pull and twist your body

●Lift and carry up to 70 pounds

●Deliver mail in all kinds of weather

Cigna Healthcare

St. Louis, MO

Pharmacy Specialist/ Claims Representative

09/2015-11/2016

●Assist members daily with service inquiries which could include:

oBenefit and Eligibility Information

oBilling and Payment Issues

oCustomer material requests

o Physician assignments

oAuthorization for treatment

oExplanation of Benefits (EOB)

oMail Order Rx

●Providing results in a timely and efficient manner

●Entrusted with complying with Hipaa and accuracy of procedures

The Parallon Group

Maryland Hts.

St. Louis,MO

Patient Accounts Representative

09/2014- 09/2015

●Entrusted with complying with Hipaa and Hospital credit/collection policy and procedures

●Assist Patients with the most appropriate method of resolving the balances due on their accounts

●Accepting and Collecting payments via; credit card, check by phone and/or offer payment arrangements

●Follow all required FDCPA regulations and system procedures

●Resolve client discrepancies and short payments

●Verifies Insurance coverage and updates insurance information

●Responsible for maintaining assigned account/customer calls, acct adjustments, small balance write-off and reconciliations

●Providing customer service regarding collection issues and results in a timely and efficient manner

United Healthcare Group

Maryland Hts., MO

Medicare/Medicaid Claims Specialist/Customer Care Agent

09/2010 – 09/2014

●Assist members daily with service inquiries which could include:

oBenefit and Eligibility Information

oBilling and Payment Issues

oCustomer material requests

o Physician assignments

oAuthorization for treatment

oExplanation of Benefits (EOB)

●Process and adjust claims

●Peer Training

●Entrusted with complying with Hipaa and accuracy of procedures

●Accepting payments via; credit card, check by phone or offer payment arrangements

●Case set up along with coordinate appeals and grievances

●Providing results in a timely and efficient manner

Lutheran Senior Services

Webster Groves, MO

Receptionist

02/2009 – 09/2010

●Managed the daily care of residents

●Type and distribute routine correspondence and memos

●Answer multi-line phone system (10 lines)

●Provided quality and professional customer service

●Sort and deliver mail throughout facility

●Prepare and schedule rooms for meetings

●Order office supplies and materials

Office Team Staffing

St. Louis, MO

Referral Specialist/Customer Service Representative

01/2007-12/2013

●Per Referral guidelines, provide appropriate clinical information to specialist

●Medical terminology of ICD/CPT codes

●Inbound/Outbound call center

●Verify claims and update account information

●Data entry using Microsoft word and excel

●Assure quality customer service

Home Repair Inc.

St. Louis, MO

Office Manager

01/2006-02/2008

●Create and produce contract bid proposals

●Responsible for various correspondence

●Make routine calls to scheduled clients

●Provide quality and professional customer service

Summary of Skills/Qualifications

●Proficient in document preparation typing 65wpm, data entry computer literate

●Excellent communication, analytical, and customer service skills

●Proven results and desire to work with in professional business settings

●Analyzed & Improved Data for Processing

●Utilization Review & Appeals Processor

●Review all Incoming Medical Records & Route to correct Nurse Que for Approval

●Prior Authorize Pre & Post Payments

●Process & Review Claims to Prevent Unnecessary Costs

●Concurrent Reviews for Patients to ensure that any extensions are Medically Justified & are Documented in Patient’s Medical Records

●Identify Problems Related to the Quality of Patient Care & Refer them to the Quality Assurance Committee

●Maintained a 98% Satisfaction Rating Over a 24-Month Period as a Customer Care Representative

●Developed or Implemented New Procedures or Systems

●Received Promotion from Analyst to Senior And-Or Advanced Analyst in Less than 12 Months

●Created Brand Ambassador Group; Which Assisted with questions & tours for All New Hires per Company Site

●Actively work to make Improvements

●Always taking Initiative to help Others Team Members

●Chosen Leader 90% On Special Projects

●Dedicated Team Player with excellent Time Management Skills

●Medical terminology, knowledgeable in Medicare /Medicaid, Cosmos, AS400, Care One, ICD-10 codes, Facets, IDRS, Appeals/Grievances, Mail RX, Kronos,

●Knowledgeable of Microsoft Word, Works, Excel, PowerPoint, Outlook and WordPerfect

●Guiding, Directing and Motivating Subordinates

●Establishing and Maintaining Interpersonal Relationships

●Making Decisions and Solving problems

●Organizing, Planning, Manage multiple priorities effectively

●Coordinating the Work and Activities of Others

●Strong Attention to detail

●Implement/Update Benefit Plans & Programs

●Assist in controlling cost of processed claims

●Comprehend the need for a sense of urgency with all work activities

●Mail sorting/Mail casing

●Load/Unload vehicles

●Delivery/safe driving skills

●Knowledge of process for providing customer satisfaction

●Can operate fax, multi-line phone, scanner, printer, 10-key calculator

●Good Cooperative Attitude, very dependable

●CRM Systems-Analytical and Operational

Education

University of Phoenix Graduation 12/2023

Bachelor's Degree in Healthcare Management

PROFESSIONAL REFERENCES AVAILABLE UPON REQUEST

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