Account Manager Accounts Receivable

CHEKESHA WEST

Clifton, NJ *****

201-***-**** *********@*****.*** linkedin.com/in/chekeshawest

ACCOUNT MANAGER

Results-driven Account Manager with over 20 years of expertise in client relationship management, sales, operations, and strategic account planning. Adept at identifying client needs and delivering tailored solutions that drive business growth and enhance customer satisfaction. Demonstrates exceptional communication, negotiation, and problem-solving skills, with a proven track record of achieving revenue targets and fostering long-term partnerships. Proficient in utilizing CRM software and data analysis to optimize account performance and streamline operations. Committed to maintaining high standards of professionalism and integrity in all client interactions. SKILLS & PROFICIENCIES

Account Management Project Management Case Management Quality Audits Leadership Meeting Facilitation Benefits Review and Testing Renewal Change Management Relationships Building Strategic Thinking & Planning Complex Issue Resolution Customer Relations Client Retention Accounts Receivable HIPAA Diversity & Inclusion Medicare / Medicaid Coverage Zendesk Dial Pad Siebel SharePoint CPL BET HGI GEI NAEGS FACETS EMEVS MARX MEDXOOM TRIZETTO Premium Billing Support Ad Hoc Reporting Tools Reliability Ticket Management LMS Microsoft: Word, Excel, PowerPoint, Outlook Adobe AMT PROFESSIONAL EXPERIENCE

INDECS CORPORATION. Lyndhurst, NJ 02/2019 - 08/2024 Enrollment Analyst and Eligibility Administrator

Analyze gather, interpret, process, complex data & applications across multiple Enrollment platforms supporting clients with actionable steps, which improve population accuracy, processes & optimizes results.

● Identified vast opportunity for improvement in data exchange quality within transition operations & shared best practices and operational insights with internal & external departments, promoting client retention, while fulfilling all Managerial tasks associated with the Enrollment/Eligibility Department maintaining a direct report relationship with the Vice President of Operations.

● Managed, mentored & trained Enrollment Analysts introducing the INDECS portal processing & navigation for Members, Providers, Brokers, & Clients, PBM support, Implementation, Zen desk Resolution, Audit support, Quality Assurance, EDI reconciliation, Ad Hoc Reporting, Claims Support, Client Billing Reconciliation, and Correspondence Creation / Processing & adjudication(COB, ESRD, COC,DOI & COBRA).

● Discovered and raised awareness of consistent disparity between submitted requirements, printed Summary Plan Descriptions and full plan designs. Boosted reconciliation efforts by initiating interdepartmental discussions establishing impact and furthering client conversations resulting in new resources, personnel and streamlined processes.

● Inspired the transformation, improvement & re-launch of a new Client / Broker Enrollment, Eligibility platform, and training modules widely enhancing data quality adding ease of use resulting in decreased call assistance & quicker resolution.

● Guided employers, brokers, providers and members to successful portal submissions and/or benefit tool navigation providing review & approval, claims access, password reset, and unlocking on a daily basis. E-SOLUTIONS INC., San Jose, CA 10/2018 – 12/2018

Enrollment Analyst

HBCBS NJ contract: Analyze gather, interpret, process, complex data & applications across multiple Enrollment platforms supporting clients with actionable steps, which improve population accuracy, processes & optimizes results.

● Managed daily, weekly, and monthly CMS reporting, handling an average of 35 reviews daily to ensure accuracy and meet entry deadlines.

● Coordinated the use of computer skills, spreadsheets, applications, and functional databases ( I.E. MARX, OLI, Siebel, TPX, IKA, TRIZETTO) to research, document cases, and establish corrections to accounts.

● Interpreted and conveyed enrollment status to clients, including claims resolution partners, Medicare Beneficiaries, CMS and Medicaid utilizing customized organizational systems and communications to reconcile accounts.

CHEKESHA WEST 201-***-**** *********@*****.*** Page 2 ETEAM INC, South Plainfield, NJ 11/2016 –

05/2017

Medicare Analyst DSNP

HBCBS NJ contract: Analyze relevant legislation, statutes/regulations, and policies related to dual eligibles and adjudicate, process, summarize, resolve and identify impact for internal & external clients.

● Point of contact for strategic supervisory oversight to FACETS Management. Delegated assignments and compiled end of day reporting increasing capacity to evaluate problematic patterns and calculate precise resolutions as a result of being chosen as FACETS lead Admin for DSNP applications, daily quality audits, & subsequent corrections.

● Navigated reference guides, call center notes, SharePoint, supporting tools & databases, MARX (Medicare Database) & EMEVS (Medicaid Database) EAM, CENTRIX, & Rx Claims (AS400) adhering to regulations and policies associated with Federal Centers for Medicare and Medicaid Products and Services.

● Surveyed Rx claims error-out reports entering live eligibility fixes while coordinating with doctors’ offices and pharmacies for adjudications.

● Resolved investigations and supporting audits for Medicare Beneficiaries, Federal Regulators, subject matter experts and Executives while prioritizing urgent requests, deadlines, reconciling CMS reporting, and raising discussions to explore best practices delineating DSNP accounts. AXELON SERVICES CORPORATION, New York, NY 11/2014 - 8/2015 Pharmacy Benefits Specialist

HBCBS NJ contract: Master a comprehensive understanding of existing plans while creating new plans & implementing benefits for existing and newly obtained clients.

● Spearheaded interdepartmental collaboration unearthing systemic limitations that caused short falls in processes and communications while unifying and empowering departments, raising awareness and gaining buy-in to design workarounds which decreased duplication of effort, cancellations and delays for benefit builds.

● Formulated and installed new plan codes attaching, and managing quality for new and existing set ups categorizing error trends through peer review audits, claim declines, and systemic review,

● Performed liaison duties between Horizon Blue Cross Blue Shield NJ & Prime Therapeutics identifying original intent and historical submission for live coding.

EXPRESS SCRIPTS INC, Montvale, NJ 03/2006 – 09/2013 Associate Account Manager

Legacy MEDCO UHG DIVISION Build long – term positive relationships with clients and encourage new and repeat business through exceptional resolution, documentation and Account support.

● Investigated complaints and appeals for pharmacy denials auditing set up, authorization, and case management decisions. Composed chronologies detailing responses and resolution to NAEs, SMEs, CRMs, DOI, and Direct clients utilizing Siebel and SharePoint to document and assign cases.

● Hosted Renewal calls, collecting requirements and changes submitting electronically with Open Enrollment Structure and Town Meeting support. Coordinated efforts with the benefit build team by performing Quality Assurance with testing and implementation management, in accordance to deadlines.

● Identified, individual, Client, and BOB, errors (PDL, Set Up, Retroactive, IBAAG, and Systemic) to uncover over & underpayments. Managed impact and coordinated collaboration and corrections while reporting completion to Finance and Reliability Departments.

● Regularly exceeded performance objectives by 10% on an annual basis garnering high contributor status & glowing Managerial and Peer reviews in an Engagement Band setting. EDUCATION

Course Work, Business Management / Marketing, Saint Peter’s University, Jersey City, NJ AFFILIATION

Public Relations Committee, Coalition Impact,

Jersey City, NJ

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