Customer Service Data Entry
Resume:
Paula Brown **** Grove Park Blvd
Charlotte, NC **215 ************@*****.***
Education:
1. MBA: Masters in Business Administration, Charlotte, NC, 11/2009 2. Bachelor's Degree: Business Management, Charlotte, NC, 10/2007 3. Associates Degree: Accounting, New York, NY, 06/1992 Computer Skills: Microsoft Word, Excel, Power Point, OutLook, Office Live, Access 2010, Salesforce, Smartsheet (project management), Transcription
(downstate hospital), CTI Answering system.
License/Certifications:
1. Diploma in Project Management (PM) 7/2014
2. NC Health, Accident, Medicare/Medicaid License-2019 Experience:
ACS Solution: IQVIA (Allcare Plus Pharmacy, Benefit Verification Specialist - 1/31/22 - 6/31/2022
As a Benefit Verification Specialist I conducted investigations for patients insurance coverage for Humira, RinVoq and Skyrizi injections for subcutaneous use (CIII), For patients site of care. I provided information on prior authorization and/or appeals requirements and confirmed product acquisitions from patients' insurance benefits. I gave a summary of benefits to the patient and healthcare provider (HCP) office, detailing the outcome of the benefit investigation. I advised the patient of benefit coverage information and the enrollment status in the Co-pay Assistance Program.
GoHealth Insurance, Charlotte, NC 28262 Senior Benefit Consultant, 8/15/2019 - 6/15/2020
Advocate for Medicare and medicaid insurance, Comply to Federal CMS and State standard of operations. Responsible for outbound and inbound calls to determine eligibility of callers for medicare. Process high quality information to complete the buying process. Adapte business priorities based on customers needs. Help through the decision making process of selecting the proper medicare plan. Lash group (AmerisourceBergen), Ft. Hill, SC 29715 Benefit Verification Specialist, 10/1/2018 - 03/29/2019
research, payer tracking (Medicare, Medicaid, Tricare, and various Private Payers). Clearing 40-70 cases per day using Fusion and Salesforce applications. Benefit verifications to ensure maximum reimbursements. Qualify patients for co-pay or patient assistance programs. Pre-determination and prior authorization processes regarding medical procedures using CTI phones. Assisting site Coordinator with benefit information, payer process Effective time management, organizational skills, medical billing, data entry, payer ses, and payer research to ensure timely processing of enrollments. Lash group (AmerisourceBergen), Ft. Hill, SC 29715 Benefit Verification Specialist, 10/2017 - 02/2018
Effective time management, organizational skills, medical billing, data entry, payer research, payer tracking (Medicare, Medicaid, Tricare, and various Private Payers). Clearing 40-70 cases per day using Fusion and Salesforce applications. Benefit verifications to ensure maximum reimbursements. Qualify patients for co-pay or patient assistance programs. Pre-determination and prior authorization processes regarding medical procedures using CTI phones. Assisting site Coordinator with benefit information, payer processes, and payer research to ensure timely processing of enrollments. Convergys (Nike sports), Charlotte, NC Customer Services Rep, 07/2017 - 9/2017 Provided excellent shopping experience to customers while maximizing business results. Greeted and obtained information on customers shopping range. Explained company policies on lost and tracking shipments. Gilded and recommended clothes and sneakers to customers matching their personality and budget. Setting up promo codes and gift cards. Assist with customer returns, exchanges and complaints. Convergys (Anthem blue Cross/Blue Shield) Affordable Care Act Patient care coordinator, 10/14 - 2/15 Charlotte, NC
Answered an average of 60 calls per day by addressing customer inquiries, solving problems and providing new product information. Developed reputation as an efficient service provider with high levels of accuracy. Scored in top 10% of employees in successful resolution of issues. Recipient of multiple positive reviews acknowledging dedication to excellent customer service. Licensed in 9 states to cross-sell insurance policies. Comply with private companies for Medicare insurance sales. Scripts were used to describe products and services. Navigating through multiple system applications to fulfill callers request, update caller information and research caller status inquiries. Obtain customer information such as name, address, and payment method, and enter orders into computers. Answer telephone calls from potential customers who have been solicited through advertisements.
IQOR (Sprint Project) Charlotte, NC Team Lead 11/08 - 4/14 I continue to advance to increasingly responsible roles in management. Developed, implemented and monitored programs of 10 day-to-day agents to maximize customer satisfaction. Train and assist agents with device programming and provisioning. Manage on-site customer service representatives and encourage the team to maintain performance objectives. Addressed escalated internal/external negative sentiments immediately. Brown Plastic Manufacturer, Inc. Rock Hill, SC Project Manager- 7/04 - 9/08 Facilitated business process review meetings with subject matter experts and refined the processes to maximize business efficiency. Manage project workflow by designing tools that track targeted value and project due dates. Steer and direct plastic manufacturing operations that generate $5M in annual revenue. Facilitated business process review meetings with subject matter experts and refined the processes to maximize business efficiency. Manage project workflow by designing tools that track targeted value and project due dates. Establish operational policies and implement process improvements to ensure superior quality and outstanding output of custom molded and extruded parts. Design and implement coaching and training programs to develop staff, facilitate efficiency, and improve performance. Manage operational and capital expense budgets exceeding $2M. Ensure adherence to strict quality control procedures. Documented/executed user-acceptance and performance test plans to ensure that the system changes are error-free and meet the approved requirements and designs.
Volunteer
Teacher Assistance - Devonshire Elementary School-CMS Assist teachers in classroom tutoring reading, writing, math,arts and crafts Program Assistance- Explorer Program-CMS- High School Division Planned and chaperon students on field trips
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