Carrier Associate Rural
Resume:
Nicole Purnell
• St. Louis, MO •
Cell 314-***-**** • ***********@*****.***
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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