Data Entry Service Rep
Resume:
DESHAWNTI M. LUCAS
************@*****.***
Southfield, MI 48033
OBJECTIVE:
To obtain an Analyst position that will allow me to utilize my communication, analytical, methodical and organizational skills while improving overall efficiency, enhancing processes that allow optimum performance.
Professional Profile:
Extensive knowledge of Medicaid, Medicare, 10-key Data Entry Skills, Strong Analytical Skills, Problem Solving, Time Management, Phone Etiquette, SharePoint, Project Coordination, Provider Credentialing, Claims, Billing, Creating medical forms/reports.
WORK EXPERIENCE:
Blue Care Network, Southfield, MI
Analyst,
5/22-Present
Daily input and maintenance of enterprise practitioner /provider pricing data.
Detect relevant issues and route to appropriate department for action and solution.
Perform department functions such as: data preparation/presentation, interaction with internal and external sources to resolve inquiries.
Research, analyze, identify, and assess data from assigned problems to evaluate existing and potential trends and problems.
Recommend, communicate, and implement solutions to identified problems/root of issues.
Communicate results of analysis to management via reports/presentations and assist management in implementing programs that provide solutions.
Centria Healthcare, Farmington, MI
Billing / AR Coordinator, 9/20-5/22
Investigate and resolve account discrepancies/irregularities to drive down bad debt.
Communicate with payors as needed about payment status on outstanding invoices.
Ensure all incoming payments are received and processed timely.
Manage and follow up calls on delinquent invoices.
Review and update clients’ accounts in Arbor daily.
Request EOBs to accurately post payments to accounts.
Centria Healthcare, Farmington, MI
Payroll Coordinator, 9/19-9/20
Accurately process payroll, submit weekly Payroll to Finance Department.
Problem solves situations that occur with staffs, hours, pay rate and documents.
Ensure strict confidentiality of client’s records adhering to policy and procedures.
Extensive knowledge of computer data entry systems and protocols.
Successfully perform other duties like entering internal training shifts, TB Test for reimbursement and deductions.
Communicate effectively, orally and written with internal team and external staff members.
Perform other related duties and projects as assigned.
Concerto Health, Southfield, MI
LTSS Coordinator, 09/18-05/19
●Enter authorizations in TruCare for HCBS Waiver and Personal Care Services (PCS) and forward information to appropriate rendering service provider (such as “AAA”)
●Assign referrals to LTSS Social Workers in accordance with policy and/or other direction from Supervisor
●Track authorization expiration dates for when reassessments are needed
●Submitted waiver applications to the Michigan Department of Health and Human Services via Waiver Supports Application (WSA)
●Perform ongoing communication with Care Management staff to ensure accuracy of work and proper coordination of LTSS services
●Perform ongoing communication with rendering service providers (such as “AAA’s”) to ensure proper coordination of services
●Assist with Care Management staff training related to LTSS and waiver services
●Follow up with members to ensure timely receipt of DME, supplies, and long-term services and supports as assigned
●Review home modification and LTSS service estimates with leadership and obtaining necessary approval for completion of services
● Resolved member grievances by reporting issues to agencies and constant follow up
● Audit HBCS (Home and Community Based) waiver applications from LTSS Supports Coordinators for quality review and compliance before submitting them to the MDHHS for approval
● Complete quality reviews of Service Level Plans and Personal Care Assessments for accuracy and compliance
● Schedule appointments for LTSS Supports Coordinators to meet with their members to complete assessments
Concerto Health, Southfield, MI
Patient Care Coordinator 01/18-08/18
●Schedule and Coordinate Level 1 Assessments, Integrated Care Team Meetings, Care Plan Updates and Transitions of Care Visits
●Schedule appointments for members to see PCPs and Specialists within 1 business day upon receiving request
●Conduct research to locate member phone numbers, addresses, determine member’s PCP and document all efforts
●Assist with member referrals for dental and vision services with 2 business days and document interventions
●Supported with transitioning members by scheduling post discharge appointments with provider(s) and scheduling transportation within 1 business day of notification of discharge
●Assist with Transition of Care process (TOC), upon receiving inpatient notification calls
●Facilitated document collection from hospital and Utilization Management team to provide Case Manager with a comprehensive view of the patient’s inpatient experience and discharge orders within 72 hours of discharge
●Followed up with members to ensure timely receipt of DME, supplies, and home health services within one business day of receiving request from Care Manager
●Tracked patient complaints and notified manager to ensure resolution in a timely manner
●Reported any potential issues or identified quality of care issues to manager to ensure an optimum patient experience with the goal of complete patient satisfaction and retention
AmeriHealth Caritas VIP Care Plus, Southfield, MI
Personal Care Connector 5/2015 – 12/2017
●Handle in/out-bound provider and member calls
●Utilize excellent judgment and decision-making skills in dealing with complaints and sensitive requests
●Provide claim status, check/remit inquiries, and provide member eligibility and benefits
●Responded in a timely, professional, and courteous manner to member inquiries and complaints, as well as referring inquiries to appropriate sources for resolution and following issues through to completion.
●Function as interface and facilitator between members and providers
●Effective telephone skills to manage inbound calls for triage and resolution
●Effective outbound skills to deliver educational messages, collect health data, and critical thinking required to assess, triage, and offer solutions.
●Conduct research to locate members phone numbers, addresses, determine member’s PCP
●Schedule and coordinate Level 1 Assessment, Integrated Care Team Meetings, Care Plan updates
●Close Care Gaps for members
●Arrange transportation for members to get to and from appointments
●Mail Unable to Reach and Integrated Care Team letters
●Assist with members in locating a PCP
United Health Group, Southfield, MI
Sr. Provider Service Rep 06/2012 – 05/2015
●Maintain confidentiality and comply with HIPAA
●Engages with high volume, high visibility providers to ensure Provider Satisfaction.
●Assisted providers with eligibility and benefits, PCP assignments, and payment inquiries.
●Educated providers in medical billing and claims processing using Facets and the provider database.
●Established and maintained positive and effective work relationships with providers and members.
●Accomplished daily operational excellence by ensuring compliance requirements were met.
●Completed the documentation necessary to track provider issues and facilitate the reporting of overall trends
●Proficient in Plan claim adjudication system
●Proficient in provider relations, addressing problems and issues experienced by providers to prevent complaints
●Plan knowledge of policies and procedures related to provider contracting, billing and payment
Bank of America, Detroit, MI
Teller Supervisor 04/2003-01/2011
●Effectively supervised tellers through operations, conducted vault, ATM, and teller audits as well as performance management.
●Succeeded in tracking productivity and sales of tellers, analyze, and resolves non routine and or moderately complex operational problems often requiring research
●Provided a positive customer experience that leads to improved satisfaction and sales
●Accurately and efficiently processed transactions such as customer deposits and cashing checks
●Assisted customers with inquiries and/or problem resolution in a professional manner
●Developed and maintained rapport with customers to provide outstanding, personalized service
Education:
Cleary University:
Pursuing bachelor’s degree in Business Adminstration
Penn Foster Career School: Diploma 2016 Medical Billing/Coding
Michigan Business & Technical Institute: Medical Office Certification
2010 Business Management & Communication
Chadsey High School
1996 Diploma
SPECIAL SKILLS:
System knowledge: Facets, Macess, Portico, Microsoft Office, JIVA, G Suite, CHAMPS, MaRx (Medicare), Patient3D, Patient Ping, Trucare, WSA, P3D, Kronos, Arbor and CareConnect.
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