Data Entry Customer Service

Mark S. Wise

** ******** *****

West Seneca, NY *4224

Cell: 716-***-****

Email: *******@*****.***

Valuable Skills:

● Thorough organizational skills and data entry experience

● Dedicated with a cheerful outlook; willingness to learn new processes and procedures.

● Excellent customer service, communication, and people skills

● Dependable and highly responsible and will be available to come in early or stay late.

● Ability to travel if necessary.

● Enjoy working in a challenging work environment.

● Analytical and problem-solving skill

● Ability and knowledge to research clinical documents for information to help in getting authorizations approved from insurance companies.

● CPT, ICD-10 and oncology medical terminology knowledge

● PC skills in Microsoft Excel and Word; knowledge of CRM, EHR, HealtheNet, Connex, ePaces, Availity, Magellan and NCCN with the ability to utilize these programs together daily and the understanding of how to apply each program for day-to-day use to complete work in a high volume, time sensitive work environment.

Employment History:

Pathology Service Coordinator - Roswell Park Comprehensive Cancer Center Buffalo, NY

August 2024 - March 2025

● Representative for the on-boarding and support of internal or external clients requesting Pathology services.

● Provides direct support and tracking of internal or external requests utilizing worksheets, dashboards, and various communication/tracking tools.

● Processes requests for the intake and release of Pathology material for internal or external review or testing.

● Handles correspondence requests for the tracking and status of material requests via phone, mail, fax, and Teams messaging.

Central Access Associate – Roswell Park Comprehensive Cancer Center Buffalo, NY

July 2022 – August 2024

● Receives between 100 – 160 incoming phone calls per day as a lead for the on-boarding/support of internal/external patients requesting services for Roswell Park using one or more technological touchpoints, including CRM system, email, web, Teams chat and phone.

● Answers requests from patients, caregivers, and community healthcare providers from incoming phone calls to Roswell Park call center.

● Maintains knowledge and provides information related to Roswell Park services including cancer care, supportive services, clinical research trials and pathology; also, any relevant community services or resources to optimize positive experience.

● Initiates patients care path by collaborating with new patient scheduling team, patient access coordinators, patient access representatives and concierge services according to Roswell Park guidelines.

● Collaborates and communicates between patients or their caregivers, hospitals, clinics, doctors’ offices, investigators, care teams, insurance companies, hospital pathology departments, Roswell Park’s clinical and supportive staff to get the patient the care and treatment they are seeking.

● Investigates patient inquiries or complaints and triages them to appropriate resource to assure research regulatory documentation is complete.

● Uses analytical, creative, and multi-tasking skills to problem solve efficiently and promptly.

● Serves as primary contact for all communication with community and referring physicians.

● Collects data and documents each patient or physician interaction according to Roswell Park guidelines and gets the info to nurse triage or proper department in a timely fashion.

● Works with department supervisor / management to identify and address systemic issues that may affect patient care of satisfaction.

Senior Pharmacy Authorization Representative - Roswell Park Comprehensive Cancer Center Buffalo, NY

January 2022 – July 2022

● With this promotion to Senior Representative, I will have the same job duties as in previous position but will also be taking on the responsibilities of reviewing and researching the IV auth denials. I will be in contact with our clinical staff and insurance companies by phone, Teams chat, e-mail, or fax to get the denial overturned so we can have the claim paid. I was also reviewing correspondence requests for the tracking/status of any authorization requests that have not been reviewed in a timely manner.

Patient Access Representative for Authorizations - Roswell Park Comprehensive Cancer Center Buffalo, NY

January 2020 – January 2022

● Verifies patient insurance and works the authorization dashboard and worklist while processing requests for the intake and release of all IV infusion authorization requests.

● Coordinates and makes arrangements for all access-related activities and pharmacy authorization requests by phone, teams chat, e-mail, fax, or stamped mail.

● Gathers data, triage, communicates with physicians, clinical staff Pharmacists, payors, and all necessary stakeholders in relation to all IV medication access requests in an administrative role.

● Does amendments or modifications on authorization requests if and when needed per updated clinical data provided.

● Responsible for working on IV infusion medication access issues (Prior Authorizations, Patient Assistance Programs, working on denials, following up on pending authorization and acting as a liaison between Roswell Park and payors) in a timely manner for assigned service line.

● Helped to coordinate the Early Phase Clinical Trial authorization requests with the clinical trial staff to ensure all documents were available for proper authorization.

● Works on off-label requests, appeals, clinical trials with our Clinical Research Services (CRS) department, sets up peer to peers with clinicians and insurance companies.

● Ability to multitask and have the skills and knowledge to problem solve efficiently and in a timely matter.

● Helps with the training of new co-workers and updates latest information from insurance companies when it becomes available.

Utilization Management Assistant- Independent Health Association Williamsville, NY

March 2016 – January 2020

● Provides administrative support to the Utilization Management department.

● Provides direct support and tracking of internal/external authorization requests utilizing worklists, dashboards, and communication/tracking tools.

● Obtains clinical authorization requests and build case for clinical review. First line of review in the eligibility and benefit authorization process

● Responsible for intake of clinical information, data entry of requests, preparation of the documents for clinical and/or administrative review

● Accountable for maintaining departmental productivity and quality metrics and completing assigned tasks in compliance with regulatory and departmental requirements in a high volume, fast paced, time sensitive work environment.

● Registers new physicians into computer system so authorizations can be reviewed.

● Works within network and out of network physicians

● Familiar with coordination of benefits

● Daily communication with members, referring physicians and Independent Health customer service with authorization information or questions.

● Demonstrates ability to work independently under strict deadlines to stay with turnaround time guidelines for building authorization cases for clinical review.

● Understanding of CPT and ICD-10 codes

● Maintains daily Excel spreadsheets for authorization approvals for select providers.

● Analyzed departmental documents for appropriate distribution and filing.

● Helps to train and develop new Utilization Management Assistants in the department to provide the co-worker knowledge of how systems are configured so they can be able to work in a high-volume work environment.

● Reviews provider relations service requests and ODAG’s (Organizational Determinations and Grievances) to build cases or investigate claims that are not pulling to the authorization.

● Reviews benefit grid to see if authorization is required and if product/services are covered. Claims Analyst- Nova Healthcare Administrators

Williamsville, NY

January 2015 – March 2016

● Reviewing and adjudicating claims from group buckets in the Health Rules system

● Reviewing provider correspondence and correcting claims

● Review service requests: correct the claim or forward it to the proper department for review.

● Maintaining a level of productivity for number of claims per hour as well as financial and process accuracy in a high volume, fast paced, time sensitive work environment.

● Maintains quality and compliance accuracy scores to reach department goals.

● Completing the daily Health Rules reports on a rotating basis with co-workers. Pre-Appointment Coordinator- Ross Eye Institute

Buffalo, NY

Full-time: August 2014- January 2015 - Part-time: January 2015- December 2015

● As coordinator in the outpatient clinic, responsibilities include insurance verification, existing and new patient scheduling and referral requests.

● Assisted with day-to-day billing and receivables when needed.

● Scheduling patients visits, calling patient to make aware of appointment time, copay, patient registration, any specific information regarding appointment as well as informing patient of any previous balance due on account.

● Entry of billed charges into CGM software

Patient Account Representative- Rural Metro Medical Services Buffalo, NY

December 2012 – August 2014

● Creating invoices by reviewing the Patient Care Reports as written by ambulance crew in a high volume, time sensitive review.

● Determine if a Physician Certificate Statement is needed for transport.

● Check demographic information of patient.

● Determine medical necessity of ambulance trips and decide if trip is billed to insurance, facility, or patient.

● Check signatures of all parties involved in transport.

● Code invoice with appropriate ICD-9 codes at time of transport by knowing the system configuration and how to apply each program.

Medicare Enrollment & Service Representative (AP

Professionals)- Univera Healthcare Williamsville, NY October 2012 - December 2012

Hired as a temporary employee for the Medicare Open Enrollment Period

● Analyzing applications in accordance with the Centers for Medicare & Medicaid Services requirements and procedures to determine eligibility.

● Processes eligible applications and/or communicates missing information or documentation to the member or their legal representative by phone or correspondence.

● Learned the system configurations in a brief period to be able to complete work in a high volume, time sensitive enrollment application process.

Shift Supervisor - Ball Maintenance & Janitorial Service Cheektowaga, NY

March 2008 – September 2011

● Duties include supervising and coordinating work activities of janitorial staff in commercial and industrial facilities to keep proper workflow to maintain that work is completed correctly and in a timely manner.

● Delegate duties, inspect the work, investigate any complaints regarding services and act to correct the situation.

● Inventory janitorial supplies and equipment and order supplies for each job site.

● Screen new applications, train new employees, and take any disciplinary actions when needed.

● Collects and reviews hours of employees and reports to owner of company.

● Make phone calls and visit businesses to inquire about getting new work for the company. Education:

Medical Administrative Assistant- Bryant & Stratton College Amherst, NY

Graduated with AAS in August 2012

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