Customer Service Professional with Healthcare & Analytics Expertise
Resume:
Randallstown, Maryland *****
*********@*****.***
TRACEY L. JOHNSON
ACCOMPLISHMENTS
I have a vast understanding and experience of two highly respected professions. I was a Certified Medical Assistant and Phlebotomist. In addition, I’ve also acquired over One-Hundred and Fifty accredited course credits in Criminal Justice with a minor in Crime Scene Investigations from Kaplan University. I was accepted into Stevenson University into their Masters in Criminal Justice program. I have been employed by very reputable corporations, including a Government Private Sector, full-time employment with CMS- (Centers for Medicare and Medicaid) and Pfizer Pharmaceuticals to which my transcribed verbatim inbound-calls were used as evidence for the Food & Drug Administration (FDA). Experience in assisting Frederick and Washington Counties in Crime mapping, Matrix, Forecasting as a Criminal Analyst. Additionally, I’ve serviced the American workforce by assisting the population receiving Covid-19 grants monies through their Unemployment Insurance via EDD (Employment Development Department). Most recently, it was my pleasure to have assisted Baltimoreans and Maryland surrounding Counties residents and commercial accounts with their Baltimore Gas & Electric services agreements. Most recently, I enjoyed assisting Mississippi’s HMO Dual Special Needs Population with health, vision, 4n1 Card, prescription and pharmaceutical coverage and Prior Authorization assistance.
Over 15 years in Customer Service abilities, typing 45wpm, expert level proficiency in Microsoft Office applications- including Internet and electronic mail systems. LexisNexis, Beeline, Power BI, CC&B, Cx Wrapper, Teams, and a host of additional industry specific IT Systems.
Completed extensive training programs averaging 90% or more.
Medical Terminology, Fluency in Accounts Receivables & Payables, customer service inclined, knowledgeable of several IT specific programs, reimbursements.
Efficiently, effectively, and promptly performs tasks.
Answered Inbound Calls with necessary Outbound follow-ups
PROFESSIONAL EXPERIENCE
SHARED HEALTH OF MISSISSIPPI DSNP PLAN (SHMS)
October 2022 to July 2024
Remote Customer Service Representative (CSR)
My duties consist of being the front-line for Shared Health of Mississippi beneficiaries by assisting them with of their health coverage, prescription drug plan, supplemental benefits and 4-in-1 Card allowances. In being an additional advocate for Shared Health of Mississippi’s members, triaging skills are effective demonstrated on each call. Members, Providers, and Non-Member’s who call into SHMS Customer Service Line will always receive the highest level of professionalism for they deserve that. Shared Health of Mississippi assist a special population of people with two or more comorbidities. I possess the ability to keenly listen to members care/concerns without judgment, only seeking to assist and be an empathic ear. I assist Shared Health of Mississippi members with their balance to their 4-IN-1 Card or to a request for Coverage Determination for a Prior Authorization for a rejected processed claim via CVS/CareMark, every member receives optimal customer service and the most modern Information Technology used in daily operations of Dual Special Needs Plans mandated by the Centers of Medicare and Medicaid.
Inbound Calls: Managed between 50-100 calls per day of SHMS Members claims concerns.
Prior Authorizations: Reviewed, deciphered and assisted the retrieving or issuance of needed Prior Authorizations for medications and medical procedures.
Facets: stores documentation, demographics, used for routing to individuals and/or departments, and system to input Notes.
MARx: CCMS maintenance by Medicare: it provides beneficiary address verifications, enrollment and eligibility for Part D (PDP) Plans, Medicare A, B, and Medicare Advantage Plans (MAP) beneficiary proof.
Microsoft Teams: 21st century virtual Switchboard Operator for Case Managers (CM’s), Personal Assistant Liaisons (PAL’s) Utilization Managers (UM’s) and other Customer Service Representatives (CSR’s), and chats between the team. Attend virtual meetings
OTC NETWORK system: Used as verification for 4-in-1 Card History, balance information for Utility, Over-The-Counter (OTC) Groceries and Shared Rewards, current/previous ticket information.
Agent Workspace (AWS): used for research and notation of beneficiary records, view processed Prior Authorizations (PA), Outreaches (correspondence), Previous Interactions, member’s demographics and Claims information.
CCMS: to view the member’s Personal Assistant Liaison (PAL), the member’s Case Manager (CM), if assigned one. CCMS is the place where Health Risk Assessments (HRA’s) and Physician Assessment Care Physician Assessment Care Forms (PACF’s). I possess knowledge of and have conducted both assessments temporarily to assist the PAL’s during AEP (Annual Enrollment Period 2022). CCMS is where SHMS Fulfillment/Forms are requested and ordered. (POA forms, formulary, etc.)
CA (CareAdvance): system used to store member’s care plan’s pertaining to their ailments. Broker completed HRA’s are stored.
Knowledge Center (KC): Shared Health Mississippi’s (SHMS) computerized encyclopedia/directory. Any topic pertaining to SHMS processes and procedures is in there. Documents necessary to daily operations are stored for retrieval i.e. (PT Intake Form, Coverage Determination form (CD), DME info, OTC Tracker).
Outlook: Is used as a daily communications vessel for all BCBST employees and SHMS contractors to stay abreast of current events, submit Upper Management request. It’s a place to receive and store one’s Educational Alerts and to access Outlook Calendar: to view attendance and to request Time-Off.
P8/Imaging: IT System to view received SHMS members signed documents, view CMS-1500 and UB-04 Claim Forms.
CVS/CareMark: System to view member’s processed/Quantity Limits (QL) and/or Transition Fill submitted prescriptions, the Provider who wrote the prescription, Member’s Medicare info (LIS co-pay levels), and the Rejections including which code.
NovoLogix: Used to view Prior Authorizations on file, any pending, rejections and their upload supporting documentation.
BALTIMORE GAS & ELECTRIC/ LANCESOFT
February 2022- June 2022
Customer Service Representative/Collections- Remote
Assisted Baltimore’s and its surrounding Maryland Counties residents with their needed gas and electric services pertaining to their Billing, Financial Assistance Programs, in addition to implementing Payment Arrangements, Extensions, and Restoral of disconnected services.
Verified and accurately calculated customers Energy Assistance grants committed to Restore Services.
Maintained Daily Switchboard Operations to transfer to correct departments to assist the customer with their residential or commercial account needs.
Expert-level usage of Microsoft Teams and Notes.
ACCENTURE, DEPARTMENT OF TENNESSEE LABOR AND WORKFORCE DEVELOPEMENT
June 2021- August 2021
RAPID RESPONDERS/Customer Service Representative (REMOTE)
Assisted Tennesseans with questions pertaining to the status of their claims, input Weekly Certifications, and operated JOBS4TN, Zendesk, and Microsoft Teams for updates per Unemployment.
Verified Work and Employer History.
BANK OF AMERICA- FRAUD DEPTMENT, TTEC
April 2020-November 2020
Remote Customer Service Representative (CSR)
Provided Bank of America cardholders with remote customer service in operating and understanding the parameters of their debit card usages and funds obtained through their Unemployment Insurance.
Assisted cardholders with online capabilities and navigations for password resets, electronic funds transfers and submitting claims.
FRAUD DEPARTMENT:
Processed knowledge and navigational skills to maneuver through two systems while adhering to Bank of America’s and Federal Government policies of monetary practices.
Assist Bank of America’s EDD (Employment Development Department) clients after Unemployment Insurance and Child Support funds Denial Codes #102 or 104. After researching accounts, if no fraud was present, a Suppression was performed, completed, and card usage reinstated.
Operated LexisNexis and FALCON on an expert level of comprehension and navigation.
REMOTE CUSTOMER SERVICE REPRESENTATIVE- SYKES- INTUIT
April 2019-January 2020
To provide customer service for incoming calls for Intuit clients. The client’s remote calls are handled by way of webcam; therefore, the communications process is the next best thing to in-person. Maintained strict confidentially and excellent customer service is my main objective.
CUSTOMER SERVICE REPRESENTATIVE, CSC -COMPUTER SCIENCES CORPORATION, CCRX- MEDICARE PART D
August 2007- October 2008
Provided beneficiaries with claims and policies information provided by CMS.
Expeditiously provided Beneficiaries and/or Power of Attorney’s with requested forms, pertinent coverage information, referrals via CMS guidelines while accurately navigating throughout NGD (Next Generation Database).
Assisted in Call Monitors, Call flow-chart grading, one-on-one counseling, and maintaining records of monitoring results.
MEDICAL CUSTOMER SERVICE REPRESENTATIVE, CSC-COMPUTER SCIENCES CORPORATION, 800-MEDICARE
JUNE 2006-AUGUST 2007
Provided timely assistance in providing CCRx beneficiaries with coverage specifications according to enrollments in their Gold, Basic, or Choice Plans.
Maintained precisely swift operations within their operational systems via SXC, FACETS, InfoCrossing, MARx, CITRIX, AS400, MMC, FILENET- imaging system, NGD, TRR Reports, Witness, Pega, and AVAYA telephonic system. Assisted Supervisor and Lead with employee performance ratings. Conducted, assisted, and coached per QA (Quality Analysis) monitoring’s and Call Flow charts. Organized and participated in assisting Team Lead with interoffice daily operations. Applied mathematical calculations in claims transactions and billing, EOB’s (Explanations of Benefits).
MEDICAL SERVICE REPRESENTATIVE, MAGELLAN BEHAVIORAL HEALTH
March 2003-January 2006
Demonstrated empathic listening skills while acquiring pertinent patient information such as demographics, insurance coverage, and assisting with plan of action. Processed Prior Authorizations for IOP (In/Out patient) services. Offered and provided referrals unto physicians, family members, and/or beneficiaries with Inpatient (IP), Outpatient (OP), and SHIP facilities to further treatment plans. Triage calls for staffed Healthcare professionals (HCP’s).
RESERVATIONS SALES AGENT, NORTHWEST AIRLINES
May 2001-March 2003
Daily operations of scheduling itineraries for customers traveling within domestic flights. Provided accurate calculations for new, and revalidated tickets for customers, active military, the bereaved, pets, and unaccompanied manors guardians. Maneuvered swiftly and effectively throughout numerous computer programs and multiple screens to assist travelers with their travel needs. Assisted an abundance of travelers with excellent customer service, listening skills, and empathy towards their traveling needs.
Geographical and airport codes knowledgeable.
MEDICAL SERVICE REPRESENTATIVE, PFIZER PHARMACEUTICALS & AMERICAN HONDA CONSUMER AFFAIRS- TELESPECTRUM WORLDWIDE
April 1997 to May 1999
Pfizer Pharmaceuticals
Rapidly acquired Inbound Calls and provided detailed product descriptions regarding side effects, allergies, diagnosis, and dosages for prescription medications. Adhering to customers concerns by carefully listening for ADR’s (Adverse Drug Reactions) for medications. Answered calls and provided formulary and support assistance for the Diabetes Control Network (DCN), TriAD (Aricept and Alzheimer’s), and Viagra (sildenafil) Transcribed all inbound calls for patients inquires as regulated by the FDA. Dictation fully monitored and regulated by the FDA (Food and Drug Administration) per consumer verbatim. Entered and forwarded proper fulfillment. Demonstrated excellent skills for empathizing and voicing compassion for the consumer.
May 1999 to October 1999
TeleSpectrum Worldwide
American Honda Consumer Affairs
Assisted Honda’s consumers with recall and/or warranty data with expirations. Informed vehicle owner’s current recalls and locations of Honda Certified repair shops.
Processed consumer refunds and calculations based on motor vehicle repairs paid, yet recalls honored the coverage.
Informed customers of coverage stipulations and guidelines.
Provided reference information and contacts to American Honda Consumer Affairs and additional departments in Torrance, California.
EDUCATION
KAPLAN UNIVERSITY—ONLINE—BACHELORS’ IN CRIMINAL JUSTICE, MINOR -CRIME SCENE INVESTIGATIONS
Four-times Dean’s List Awarded--- GPA 3.40- 3.95
Two-times Presidential List Awarded --- GPA 3.96 to 4.00
Alpha Phi Sigma nominee- Academic Excellence in Criminal Justice Program
Medix School- Towson, Maryland- Graduated 3.23 GPA
Total Accredited Hours: 767.95
American Association Medical Assistance- Certified Medical and Office Assistant & Phlebotomist, acquired on 1st attempt- June 27, 1997- certification #0073275
FBI Citizen Patrol – Spring 2009
800-MEDICARE CERTIFIED- JANUARY 1997- COMPLETION of CMS INTENSIVE TRAINING COURSE- MAINTAINED 95% or better on weekly basis
SALARY NEGOTIABLE: DEPENDE20071NT UPON FULL or PART-TIME EMPLOYMENT
LAPSE IN WORK HISTORY: July 2024 to present- Actively seeking employment opportunities.
In 2015, my daughter has Brain Surgery for Chiari Malformation at JHU, rehabilitation discontinued June 2019.
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