Customer Service Quality Review

THAMRA NGUYEN SHAFER

Sand Springs OK ***** * Cell: 918-***-**** * email: ******@*****.***

Experienced administrative professional with strong organizational and analytical problem-solving skills in an independent, multi-tasking, and fast-paced work environment; who is adaptable to changes and a great team player that can perform exceptional services creating valuable resource to the organization. Results driven professional with successfully implementation for positive changes. Consistent, persistent and functional. A great team player who is readily available to assist management and other team players effectively.

PROFESSIONAL EXPERIENCE

CommunityCare Managed Healthcare, Tulsa OK

Claims Review Analyst, Operation Support-Claims March 2022-Current

Perform quality review on claims, enrollment, and customer service personnel on select criteria determined by management. Audit personnel daily of randomly selected output and complete appropriate forms for manager/supervisor feedback. Will work closely with trainer on training needs identified through the quality review process.

Audit claims, enrollment and customer service personnel daily of randomly selected work and complete appropriate forms related to the audits.

Answer questions for claims, enrollment and customer service personnel.

Establish training needs for employees identified during the quality review process.

Examined Claims, records, and Procedures to grant approval of coverage

Followed specific security rules and guidelines to protect patient medical records and payment card information.

Liaised between physician, site of service and billing department to obtain appropriate documentation.

Navigated through multiple online systems to obtain documentation.

Retained strong medical terminology understanding in effort to better comprehend procedures.

Perform other duties as assigned.

CommunityCare Managed Healthcare, Tulsa OK

Hospital Verification Specialist, Provider Services December 2017 – March 2022

Ensures the accuracy of provider hospital privileges; accountability to facilitate the verification of hospital privileges by working with hospital medical staff, and when appropriate, facilitating an internal review process to waive privileges when there is an identified business need; enter documentation into PIMA and facilitate data accuracy activities as assigned.

Update over 1500 providers hospital privileges off a monthly report and verify privileges via webdesk ticket system.

Verify and Audit provider directory quarterly.

Audit and review Change Route tickets submitted by Provider Reps. Collaborate with Provider Reps to ensure provider credentialed status and privileges are current.

Determine and ensure Business Needs waivers are necessary and deliver to appropriate provider when needed.

Collaborate with Credentialing staff on Credentialed providers status. Research and obtain Credential files for provider demographics or other pertinent information as needed.

Ensure provider contact information is correct.

CommunityCare Managed Healthcare, Tulsa OK

Administrative Assistant, Medical Management April 2014 – December 2017

Overall general support for the department, managers and Medical Directors. Assist with general office administration, responsibilities included but not limited to budgeting, meeting arrangements and taking minutes, special projects and other duties as assign.

Managed the Senior VP & Chief Medical Officer’s calendar and provide meeting/training arrangements for department.

Organized and managed budget for events, meetings, and travel arrangements for CMO and Medical Director.

Input, analyzed, and prepared annual and monthly budget for the Medical Management Executives and Wellness departments.

Processed and mailed patient surveys, track and enter returned surveys on a excel worksheet, and provide monthly report of the results to manager.

Provided detail meeting minutes for the Quality Improvement Committee, Utilization Review owners meetings, Med Mgmt Staff meetings, and Med Mgmt Leadership meetings.

Maintained and updated Departmental Org Chart quarterly, Departmental Personnel Directory and credentialing, update and maintain any departmental documents/templates as requested by management.

Complete end of month procedures per protocol provided, track and complete Licensure renewals, purchase orders, Case Mgmt. invoices. Issue and mail Excelcare Medical Director review invoices.

Complete tickets to Information Services as needed. Notify Information Services for all computer or phone issues reported.

Maintained Work Orders: Reported all maintenance needs and submitted work order if repairs are, and follow up to confirm maintenance has been completed.

Maintained, compared, and provided up to date reporting of all Dialysis members, Notice of Medical None Coverage, transition to home surveys, and SNF surveys with DAR reports.

Acted as liaison for Corporate Action Committee, IS Contact, and Wellness committees.

H&H Landscaping, Inc., Swansboro NC

Business Systems Manager Aug 2012 – Nov 2013

Assisted with general office administration and served as a liaison for General Manager and consulting group. Other responsibilities included but not limited to bookkeeping, Accounts Payable, Accounts Receivable, Bank Accounts Reconciliation, Petty Cash, and Payroll processing.

Prepared, interpreted, and issued reports of financial position (income and expense, and other appropriate accounting, cost information) and other analytical reports while maintaining general and cost accounting records.

Improved financial status by analyzing results; monitoring variances; identifying trends; recommending actions to management.

Issued confidential payrolls and provided on demand check processing.

Managed company’s Payables and Receivables; entered invoice and bills, bill customers, and generate reports from QuickBooks. Monitored all billing to assured maximum cash flow.

Reconciled transactions by comparing and correcting data.

Supervised administrative policy including analyzing, revising, and implementing company policies and procedures.

Increased productivity by developing automated accounting applications; coordinating information requirements.

Developed, updated, and maintained annual operating budget, marketing plan, and office manual.

Assisted with marketing campaign initiatives.

Vanderbilt University Medical Center, Nashville TN Apr 2007 – Jan 2012

Budget/Accounting Analyst, Administrative Assistant III and II, Department of Medicine

Provided general administrative support to the department and review financial submissions, and other responsibilities include:

Completed business correspondence (composes, edits and sends letters and memos); created spreadsheets, graphs, reports, and templates using MS Office, Excel, and PowerPoint.

Maintained database by entering, verifying, and backing up data.

Administered group SharePoint accounts and upload documents, maintained department website

Prepared Monthly Expense reports, invoice processing, and other statistical reports as needed.

Assisted staff with travel arrangements and processing

Gathered and distributed periodic communication reports and meeting minutes; Gathered requests for office supplies, submitted orders and distributed supplies when received.

Reviewed and analyzed Budget Submissions, Journal Entries, Travel Expense Reports, Check Requests, Purchase Requisitions, ePAC submissions, Procurement Orders, and Payroll.

Developed and maintained eFile system, monitored scanning and renaming of daily paperwork.

Maintained Office Manual updates, Travel & Telecommunication Monthly Reports preparation, and Petty Cash Management.

Performed internal budget auditing function for department; reviewed data periodically to analyze trends affecting budget/accounting needs.

Maintained technical knowledge by attending educational workshops.

University of Utah, Dept of Orthopedic, Jan 2001 – Feb 2007

Administrative Assistant, VAMC Bone & Joint Research Lab, Institutional Review Board

Provided general administrative support to the department and review financial submissions, and other responsibilities include:

Completed business correspondence (composes, edits and sends letters and memos)

Maintained database by entering, verifying, and backing up data for IRB.

Prepared Monthly Expense reports, invoice processing, and other statistical reports as needed.

Assisted Director and Managers with travel arrangements and reimbursements

Gathered and distributed periodic communication reports and meeting minutes

Gathered requests for office supplies, submitted orders and distributed supplies when received.

Reviewed and analyzed Budget Submissions, Journal Entries, Travel Expense Reports, Check Requests, Purchase Requisitions, Procurement Orders, and Payroll.

Internal budget auditing function and review with Director

SKILLS HIGHLIGHTS

Flexible and highly adaptable, capacity to learn new skills and acquiescent to new challenges, team orientated, used to working on tight deadlines to meet objective.

Accustomed to working under great pressure, is ambitious and highly motivated having demonstrated the ability to work within a team, liaising with colleagues up to senior management levels.

Ability to manage multiple tasks simultaneously, work independently with minimal supervision and meet stringent deadlines.

Highly proficient in office software (Microsoft Office) and adjustable to new systems to enhance work environment.

EDUCATION

University of Phoenix, Jan 2010 – Jan 2012, Masters Bus. Admin.

University of Utah, Salt Lake City, UT Mar 2002 - Dec 2003, B.S., Bus. Management

Salt Lake Community College, Salt Lake City, UT Jun 1999 - Dec 2000, A.S., General Business

Recreation

iNails Nail Technician (2007-current)-manicure, pedicure, dip powder, shellec/gel, and nail art

Hands On Nashville Volunteer (2009-2011) – multiple volunteer projects from painting school play yards to helping bag goods for giving away.

Habitat for Humanity (2008-2010) – help build foundation to complete home for a family in need.

LifePath Hospice Volunteer (2004-2007) - serve both patients and their caregivers by providing much-needed time, empathy and companionship during the end of life process.

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