Data Entry Customer Support

TN: 913-***-****

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

Patricia L. Robinson

PROFESSIONAL SUMMARY

Experienced Software QA Associate, Benefit Configuration Analyst, Quality Tester and Customer Support with two PBM’s, including benefit and drug configuration, claim testing, user acceptance testing for implementation and Data Mining. Project Management included budgeting, timelines, milestones and problem resolution thru out the project life cycle while exceeding customer expectations. With strong customer-centric focus and the ability to deliver excellent results. Ability to plan and oversee operations initiatives, and effectively troubleshoots and solves problems. Detailed, organized, and analytical. Prioritizes and multi-tasks efficiently and works well under pressure. Strong communication skills.

SKILLS & CORE COMPETENCIES

Analytical Problem Resolution Utilize Billing Database Systems

Benefits Configuration Setup Worked with Medical Providers

Knowledge of SQL and JIRA MS Office Skills (Excel, Power point, Access)

Data Entry Analysis and Validation Upload Data Spreadsheets

Prioritize Work to meet Deadlines Pharmacy Claim Research

Data Entry Experience Communications Skills/Written/Verbal

Team Building Remote Working Experience

Experience with Buy and Bill Knowledge of SQL

Customer / Client Focus Processing Account Receivable Claim Knowledge

Claim Verification Data Quality Audits

PBM Experience SalesForce

PROFESSIONAL EXPERIENCE

Cigna/ Express Scripts TN 9/2022 – current

Enrollment Billing Representative

Prepare and review Account Receivable claims to ensure accuracy copay billing.

Work with internal/external customers to resolve payment issues.

Audit accounts for compliance.

Good knowledge and understand of Enrollment/Copay Billing process and procedures.

Works to clearly defined procedures under minimum supervision.

Reviews claims to ensure billing accuracy.

•Pursues collection activities to obtain reimbursement from payers and/or patients.

•Frequent follow up with payers and/or patients on outstanding accounts.

•Effective analytical and effective communication skills.

SS&C/DST KCMO 4/2017 - 6/22/2022

Software QA Associate/Pharmacy Configuration Analyst

Analyze data, identify defects in database uploads. Process and modify and set up benefits based on requirements provided by the customer. Process customer claims including Cigna, Humana, Preform Rx and Clear script. Medicaid and Medicare Part D Knowledge.

Quality Review new and updated Benefits. Perform quality testing procedures, testing and reports to confirm the benefits are set up correctly.

Research and Analysis Claims

Modify and set up Benefits based on customer requirements.

Research and validate client benefit customer requests.

Process Clinical/Customer Request – Pull Ad Hoc reports, updating and building Drug list, NDC files to ensure the Drugs are processing correctly. Verification of NDC’s. Data Entry.

Involves analyzing and researching the situation to find resolution of the complex claims processing issues or customer inquiries. Work with cross-functional teams for Formulary and Prior Authorization Updates.

Perform Testing and Validation for accurate client Benefit set ups. .

Provide support to Clients as needed for SS&C services.

Update Databases, Spreadsheets Data Mining and perform testing and validation with Quality Assurance Team regarding UAT Testing, Jira Tickets and Mass Testing.

Execute customer request in a timely matter.

Perform validation and Implementations of Customer request.

United Health Group/Optum Rx, OVP, KS 9/2016 - 4/2017

Subject Matter Expert/Sr Customer Service Representative

Resolve issues of lost/damage specialty medications scheduled for delivery to clients.

Involves analyzing and research the situation to find resolution to ensure the best outcome for the client and company while provide superior service.

Experience with Buy and Bill.

Work with Logistics Vendors UPS. FedEx and Dawson Logistics to ensure on-time delivery of the patient medication and quick thinking to resolve any road block issues.

Pharmacy Medical Billing, UnitedHealth/Optum Rx, OVP, KS 7/2015- 8/2016

Point of contact when patient’s calls for prescription refill status inquiries in ScriptMed and IRIS. Medical Terminology and Prior Authorization

Work with Dr. Offices, Hospitals to process new/refill specialty prescription orders work with ICD9/10 and J Codes.

Run Test Claims for Benefit Eligibility information, determine copays, and verify ICD-9, ICD-10 and J Codes.

Quest Diagnostics, Lenexa, KS 12/2014-6/2015

Client Svcs Rep II/Clinical Specimen Technician

Communicated employer/court inquiries reporting drug result status.

Order Supplies for Healthcare Events

Responsible for Client’s system password changes and pulled various reports for Clients.

Responsible for functions of Specimen Processing thru completion in the Lab.

Identify problems with specimen types and find resolutions.

***Held various other Management/Leadership positions within my AT&T career

AT&T, Kansas City, MO 1/2007 – 12/2013

Sr. Technical Project Manager

Managed Large Volume of Multi-Million Wireless and Fiber projects thru completion and Overseen Provisioned and project managed the Network project through implementation

Execute, Plan and conduct Conference calls with Sales and Network Teams.

Created timelines, identified and resolved issues to ensure on time completion.

Supported the Marketing Account Teams to assist Business clients with finding Network Resolutions and any service issues with the customer.

Sr. Project Manager/Service Manager

AT&T, Kansas City, MO 5/2000 - 12/2006

Supported, Prepared and distributed the daily weekly and monthly project reports for the Wireless and Other Wireless Teams.

Scheduled conference calls with Sales and Network Team (Planning Managers, Outside Plant Engineering, Special Services, etc) to create timelines for various projects to implement the infrastructure and circuits through completion.

Attend meeting with Account Managers and Business Clients Supported the Marketing Account Teams to assist Business clients with finding Network Resolutions and products.

Education

Completion of Sig Sigma Yellow Belt Training

Master of Business Administration (MBA) – Baker University, Baldwin City, KS

BS – St. Mary’s University, Leavenworth, KS

Pharmacy Tech License (need to renew)

References

Available upon request.

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