Customer Service Data Entry

Melissa Roy

East Haven, CT ***** adz7k3@r.postjobfree.com 203-***-****

Summary

Professional Experience

Highly motivated and accomplished customer service professional with demonstrated expertise in fast paced retail and healthcare settings. Extensive background in auditing, coding, data entry, training, and Center for Medicare & Medicare (CMS) regulations. Dynamic leader, recognized for outstanding team-building and managing diverse projects simultaneously.

Clinical Administrator Coordinator Senior New England Region

2015 to present United Healthcare Trumbull CT

Responsible for federal and state compliance with regards to CMS Medicare & Medicaid process and procedures of approved services. Tasked with managing team through complex administrative process.

Successfully plans, prioritizes, and organizes to complete work in a timely fashion and establish objectives.

Supervisors workflow for team members and develops new policy.

Responsible for in-depth knowledge of different XXXX (SOP) to complete multiple requirements of state and plan requirements

Liaison for providers, members and other outside stakeholders to answer Medicaid benefit questions.

Exceeds daily metrics by XXX percent

Clinical Administrator Coordinator New England Region

2013-2015 United Healthcare Trumbull, CT

Responsible for the administration of authorizations for behavioral clinical services and benefits. Managed electronic communications for member and providers to ensure the appropriate responses documented in the correct systems.

Served as primary point of contact for providers or members regarding medical, behavioral clinical services or benefits.

Managed all electronic referral for prior authorization of medical behavioral services. (can you give me volume)

Responsible for maintain communications with clinic team to ensure policies were followed per CMS compliance guidelines.

Audited submitted documentation and responses in systems to certify administrative policies were being met.

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Data Entry II-

2007-2013 Quest Diagnostics - Wallingford, CT

Responsible for coding daily requisitions of patient information for submission to over 50 medical carriers for payment.

Managed over 1,000 daily requisitions for patient services

Exceeding daily coding of 700 requisitions by 30%.

Completed reports in multiples software system to identify and resolve patient and provider missing data to complete insurance payments.

Responsible for outreach to providers, medical offices and patients to confirm the correct codes were submitted.

Facilitated patient intake?

Maintained Quest coding requirements

Assisted Supervisor to address questions and resolve employee issues.

Territory Manager-

2005-2007 Premier Concepts - Bentonville, AR

Responsible for correct pricing and product location for fifteen stores in Florida, promoted to New England territory with over twenty-one stores. Developed relationships with store managers to provide additional products and increase overall revenue.

Improved relationship with all stores and was able to secure additional increasing revenue by ? percent

Customer Service Manager

2001-2005 Kash-N-Karry Supermarket Clermont Florida Clermont, FL

Responsible for managing front end and cash office employees.

Managed all hiring and termination of employees.

Completed on boarding I-9, training, employee files, and processed terminations.

Performed internal customer service functions by assisting in answering multiple employee requests and questions.

Education & Licensing

Certificate of Achievement in Certificate of Leadership

Colby-Sawyer College

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