Deborah Bernstein

adzt3o@r.postjobfree.com

602-***-****

Flagstaff, AZ.

Career Vision Statement

●To be a customer-centric claims processor who provides exceptional service to customers, ensuring their claims are processed accurately and efficiently.

Education

●Portland State University, Portland, OR.

●Bachelor of Arts in Sociology. Ongoing.

●Minor in Business Administration.

Experience

CVS CAREMARK. Scottsdale, AZ.

09/2017-11/2017

Enrollment Coordinator I

●Processed enrollment of Medicare Part D members including first-time enrollment and member modifications.

●Managed work activities from MedForce application key tool that drives work activity/tasks

●Interface with other applications for research and, where applicable, updating them with actions/outcomes of enrollment activity

●Logged work activity in Access database (task-start, type of activity, HIC number, task-stop, task-completion) and then proceed to next MedForce item in queue.

●Managed scanning of all member correspondence into Med Force application, which drives enrollment queue.

●Updated Excel spreadsheets to track workflow of various special assigned projects.

●Supported Outbound Enrollment Verification member calls.

Cigna. Phoenix, AZ.

07/2016-09/2017

Intake Specialist Group Insurance

●Received and entered information gathered via telephone, fax, or internet to create initial Short Term and Long Term Disability claims, Family Medical Leaves.

●As measured by QA reviews and call monitoring, fostered an effective customer service delivery.

●Ensured successful transmission of this information to the appropriate location within targeted time frames.

●Consistently met the following metrics, as evidenced by the CMS phone reports & Intake Reports.

●Capable of successfully completing 35-45 intake records per day.

●Average Inbound Productivity Rating of 83-85% or better. (ACD Time + Avail. = Productivity).

●Average hold time is less than 1 minute per call.

●Average Intake call time is 10 minutes or less.

●Average After Call Work time is less than 30 seconds per call.

Cigna. Phoenix, AZ. 12/2015-04/2016

Pharmacy Services Associate Claims Processing

●Managed and completed special projects whenever assigned for each assigned account toward appropriate reimbursement.

●Expedited the resolution of medical provider(s) problems/complaints.

●Professional interaction with customers and business partners both internal and external.

●Utilized information, facts, policies, procedures, resources and codes to ensure accurate and efficient responses.

●Flexibility to support extended hours as determined by business needs in order to meet customer expectations.

●Compliance with HIPAA regulations and CIGNA guidelines.

●Responded to phone, fax, and online inquiries primarily from healthcare professionals to assist them through the medication prior authorization process.

●Collection of structured clinical data for prior authorization and non-formulary exception requests. following the guidance provided in our online prior authorization tools and/or corresponding forms.

● Initial screening of requests was based on guidance given by online prior authorization tools.

●Approved prior authorization requests if the data collected meets the approval specifications.

●Referred prior authorization requests that do not meet the approval specifications to a Pharmacist for clinical review.

●Independently responded to contacts ranging from routine to moderate complexity.

●Performed other duties assigned.

●Performed research to respond to inquiries and interpret policy provisions to determine most effective response using established departmental procedures, HIPAA regulations, and corporate policies.

Phoenix Health Insurance. Phoenix, AZ. . 08/2014-11/2014

Commissions Specialist/Customer Service Representative

●Commissions Posting Data Entry and Accounting.

●Report Daily/Weekly on progress to Managing Agent.

●Track house sales as well as PHI Agents for overrides.

●Answer phones in a prompt warm and friendly tone with confidence and help direct client to their objective in a decisive manner.

Enterprise Consulting Solutions INC. Phoenix, AZ. . 08/2012-02/2013

Electronic Medical Records Processor

●Processed electronic medical records for health plans. Also, Medicare Advantage and Medicaid health plans for audit.

●Worked on a team with other coordinators, I was be responsible for the accurate and timely processing of Medicare Part D / Prescription Drug Benefit enrollment and disenrollment requests for new members.

●Retrieved medical charts remotely keeping private health information secure.

●HIPPA trained and tested.

●Handled entire release of information process from facilitating the medical records request, to fulfillment of the request, and invoicing the requestor.

●Proficient in Chartfinder and Epic Software.

Total Transit, Inc. . Glendale, AZ. . 01/2011 – 08/2012

Driver

●Influenced an established client base of over 50 clients in two years earning management respect and bonus rewards.

●Follow relevant safety regulations and state laws governing vehicle operation and ensure that passengers follow safety regulations.

●Test vehicle equipment such as lights, brakes, horns, or windshield wipers, to ensure proper operation.

●Arranged to pick up particular customers or groups on a regular schedule.

●Provided passengers with assistance entering and exiting vehicles, and help them with any luggage.

●Notified dispatchers or company mechanics of vehicle problems.

●Completed accident reports when necessary.

●Communicated with dispatchers by telephone or computer to exchange information and receive requests for passenger service.

●Drove taxicabs, limousines, company cars, or privately owned vehicles to transport passengers.

Michaelina’s Ristorante. Scottsdale, AZ. . 12/2005- 08/2009

Hostess

●Greeted guests and seat them at tables or in waiting areas.

●Assigned patrons to tables suitable for their needs and according to rotation so that servers receive an appropriate number of seating.

●Spoke with patrons to ensure satisfaction with food and service, to respond to complaints, or to make conversation.

●Answered telephone calls and respond to restaurant inquiries or transfer calls.

●Maintained contact with kitchen staff, management, serving staff, and customers to ensure that dining details are handled properly and customers' concerns are addressed.

●Inspected dining and serving areas to ensure cleanliness and proper setup.

●Received and recorded patron’s dining reservations.

Choice Hotels International Regional Headquarters 01/1995-06/1996

Customer Service Representative Reservations

●Provided a high level of customer service and client relations based on outstanding communication and interpersonal skills.

●Answered inquiries regarding information such as schedules, accommodations, procedures, and policies.

●Determined whether space is available on travel dates requested by customers, assigning requested spaces when available.

●Confer with customers to determine their service requirements and travel preferences and up-selling Choice Promotions and Choice Bonus Rewards.

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