Customer Service Project Manager

DENISE R. SMITH

410-***-**** ***********@*****.***

Summary

** ***** ** ********** ******* for Fortune 500 companies in biotech, IT, health care and telecommunication sectors. Additional administrative experience in payroll, HR, A/P & A/R. Proven success in ensuring full compliance with contractual timelines and quality service levels. Demonstrated ability to handle confidential information with discretion. Received numerous awards and customer service commendations. Skills

Strong organizational skills

Mentoring and Coaching

Manage multiple work streams

Medicare Parts A/B/D

Streamline Work Processes

Data Capturing and Analytics

Claims Processing /Adjusting

Grievances and Appeals

01/2021 to 10/2022

Windsor Mill, MD

09/2018 to 01/2021

Windsor Mill, MD

08/2015 to 09/2018

Windsor Mill, MD

Experience

Senior Human Resources Generalist

Northrop Grumman/Peraton

Supported our Social Security Administration (SSA) customer under the Contract Management Team Worked closely with a Project Manager Support Lead in supporting project management activities as needed Interfaced with program and functional staff members Gathered staffing metric data to prepare reports and present to leads and/or management for analysis Performed various staffing functions: create, monitor, and update requisitions Tracked, monitored, and reported on candidates throughout the staffing process Partnered with hiring manager to determine staffing needs and coordinating interviews Maintained relationships with both internal and external clients to ensure staffing goals are achieved Entered data into SharePoint and various applications and databases Pre-screened all candidate resumes and verified all documentation and certifications prior to forwarding to the Hiring Manager

Scheduled interviews and ensured templates are being followed Assisted in the hiring and onboarding of all resources Implemented HIPAA policies and procedures for the program and ensure awareness of HIPAA breach policies. Management Resource Assistant

Peraton

Supported our Social Security Administration (SSA) customer under the Contract Management Team Worked closely with a Project Manager Support Lead in supporting project management activities as needed Interfaced with program and functional staff members Gathered staffing metric data to prepare reports and present to leads and/or management for analysis Performed various staffing functions: create, monitor, and update requisitions Tracked, monitored, and reported on candidates throughout the staffing process Partnered with hiring manager to determine staffing needs and coordinating interviews Maintained relationships with both internal and external clients to ensure staffing goals are achieved Entered data into SharePoint and various applications and databases Pre-screened all candidate resumes and verified all documentation and certifications prior to forwarding to the Hiring Manager

Scheduled interviews and ensured templates are being followed Assisted in the hiring and onboarding of all resources Implemented HIPAA policies and procedures for the program and ensure awareness of HIPAA breach policies. Support Systems Analyst Level II (BOSC

Northrop Grumman, MBOSC

Supported the Centers for Medicare and Medicaid Services (CMS) under the (BOSC/MBOSC) Program Analyzed and resolve issues submitted by Medicare Part D Plan Providers, Business Owners, and third- party 03/2014 to 03/2015

Windsor Mill, MD

03/2011 to 03/2014

Windsor Mill, MD

groups

Created and update Remedy and ServiceNow (SNOW) tickets, maintaining thorough notes to include status information, research analysis, resolution details, and other pertinent information Managed individual ticket queue and collaborate with team members to ensure successful routing of incoming issues to ensure timely ticket resolution

Assisted in answering Help Desk inquires, respond to electronic inquires and interact with Health Plans to provide accurate and quality responses while adhering to NG and CMS Security Policies Adhered to CMS and NGC requirements for handling of Protected Health Information (PHI) and Personally Identifiable Information (PII)

Utilized the MARX, TSO, HPMS, MBD, ELMO, REMEDY, SEVICENOW (SNOW), EIDM and SharePoint systems to perform research for complex MARX enrollment/payment issues Developed Training and Business Requirement documentation Interfaced with CMS stakeholders

Facilitated and train new hires on the onboarding process Created Power Point Presentations and facilitate between CMS and Team Members. Customer Service Analyst

Maricom, A CSC Company

Served as 2nd Level CSA for The Department of Health and Human Services (DHHS), Centers for Medicare & Medicaid Services (CMS) and the Patient Protection and Affordable Care Act (ACA). Responsible for notifying Plan Sponsors on outbound projects of program specifications and qualifications as it pertains to the guidelines of the program.

Responded to all initial calls received from Plan Sponsors, as well as questions/problems submitted electronically.

Validated callers in compliance with HIPAA guidelines and practices. Ensured all interactions with Plan Sponsors are immediately logged into the PEGA Workflow Manager interaction tracking system.

Provided resolution or response to the customer, within the specified service level timeframe, to communicate the status of the problem and the actions being taken or escalate to the proper department.

Conformed to policies and procedures established by CMS under the Department of Health and Human Services

(HHS) as they are made available.

Managed workload to ensure that each interaction is resolved in a timely manner and that the highest priority calls are promptly attended to.

Utilized Microsoft desktop products such as Outlook, Word and Excel to perform research, documentation and resolution, in addition to the Entry Tracking System (ETS). Responded to or provided resolutions via email utilizing a knowledge-based system. Customer Service Analyst

MARICOM, A CSC Company

Served as 2nd Level CSA for The Department of Health and Human Services (DHHS), Centers for Medicare & Medicaid Services (CMS) and the Patient Protection and Affordable Care Act (ACA). Responsible for notifying Plan Sponsors on outbound projects of program specifications and qualifications as it pertains to the guidelines of the program.

Responded to all initial calls received from Plan Sponsors, as well as questions/problems submitted electronically.

Validated callers in compliance with HIPAA guidelines and practices. Ensured all interactions with Plan Sponsors are immediately logged into the PEGA Workflow Manager interaction tracking system.

Provided resolution or response to the customer, within the specified service level timeframe, to communicate the status of the problem and the actions being taken or escalate to the proper department.

Conformed to policies and procedures established by CMS under the Department of Health and Human Services

(HHS) as they are made available.

Managed workload to ensure that each interaction is resolved in a timely manner and that the highest priority calls are promptly attended to.

Utilized Microsoft desktop products such as Outlook, Word and Excel to perform research, documentation and resolution, in addition to the Entry Tracking System (ETS). Responded to or provided resolutions via email utilizing a knowledge-based system. 06/2017

01/2017

02/2016

Baltimore, Maryland

Education and Training

HDI Support Center Analyst Certification

NGC Agile Engineering 101 Workshop January 18-19

Public Trust Clearance ITIL Certification

Northwestern Senior High School

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