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Years Experience Customer Service

Location:
Chicago, Illinois, 60644, United States
Salary:
45000
Posted:
May 24, 2010

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Bobby Glover

**** * ********** #***

Chicago IL. 60644

nz5c58@r.postjobfree.com

312-***-****

SUMMARY

** ***** ********** ** ********** industry with Blue Cross Blue Shield of Illinois include system auditing, system performance, data quality analysis reporting

Classified Ventures 4/2010-5/2010 Chicago, Illinois

Title: Contractor (Contract Position)

Audit, track and analyze contracts, system data verification

Assist corporate finance team in various data entry processing

Create reports for account management team detailing customer perception of high-risk and performing accounts

Trouble shoots MS Internet Explorer browsers and other internet applications

Accomplishments in this role

• Audited, tracked and documented all customer inquiries, resolutions and contracts

• Data enter, processed and validated system contracts

• Diagnosed, trouble shooting and resolved email inquiries

• Provided first point of contact customer service

• Provided daily reports to technical support, project teams and upper management

• Provided prompt and accurate responses to customer inquiries

• Escalated necessary customer inquiries, data inaccuracies and issues to Tier 2 products and technical support teams

Blue Cross Blue Shield of Illinois 9/1993-11/2007 Chicago, Illinois

Title: Quality Control Coordinator

Responsible for processes of non recurring projects, meet or exceed stakeholder needs and expectations. Implement existing technology and/or new functionality through the application of recognized project management skills, QI tools (including Microsoft Project) and techniques. Develop a viable project plans, workflow charts and reports to satisfy the business requirements, management of cost, schedule, technical requirements, issues and actions.

Responsible for managing the ongoing relations, communications and education between Blue Cross Blue Shield and providers in relation to contract and program administration plus claim/billing and data system issues. This includes the collection and maintenance of provider data information (demographics), use of policies and procedures, identification of areas for process improvement, problem resolution including formulating resolution strategies, defining and recommending action items for the health plan and provider, evaluating outcomes, providing ongoing feedback to appropriate staff and report generation.

Primary duties may include, but are not limited to:

• Created and maintained databases to track operational performance.

• Analyzed data and summarizes performance using summary statistical procedures.

• Developed and analyzed operational performance reports (e.g., for processing claims data, provider data, utilization data, inventory, dept work flow) and provided notations of performance deviations and anomalies.

• Created and published reports for project teams, clients and department management.

• Devised best ways to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.

Accomplishments in this role

• Achieved high audit scores for the Blue Cross Blue Shield of Illinois Plan in which increased from 57% to 84% within a 3 year time frame due to my appeal and QI process

• Served as lead contact and liaison with assigned collaborators and communicated/consulted with them on a regular basis to assist with their interventions related to established goals, objectives, and measures, and to provide technical assistance and recommendations as needed.

• Provided consultations to project teams and management data of data quality improvement processes

• Lead projects with the implementation for Ernest & Young, Sox, SAS and Accenture audit projects to help identify provider data inaccuracies in the Premier/Pfmn/CICS/ mainframe system.

• Audited, resolved and reduced data defects and determine areas for improvement of over 542,000 provider data files.

• Identified and reported complex health care, technical, audit issues during face-to-face meetings, teleconferences, and through written correspondence with providers and stakeholders, and refer questions to appropriate staff, providers and the , Blue Cross Association as needed.

• Implemented policies and procedures, best practices, developing action plans, analysis for provider data quality and accuracy management and improved overall productivity through process improvements

EDUCATION

• First Business College from 6/1989-6/1991(Downtown) Chicago, Illinois 60601

(Accounting/Finance) (Certification/Diploma) GPA of 3.5

• Colorado Tech University From 2006-2008 Denver, Colorado

(Majoring in Healthcare Management) (Bachelor) GPA of 4.0

• Continuing Education (Certification) (2006) (Downtown) Chicago, Illinois 60601

• SAS CPE (Certification) 6/2006 Chicago, IL. 60601

• CCC Physician Cultural Competent Care (Certification) (11/2008)

SKILLS

• 6 years experience: Project Management – Conducted, assisted and implemented internal and external audits provider data, provider claims, contract processing, membership data, claims and other projects for Blue Cross Blue Shield of Illinois.

• 3 year experience: NPI (National Provider Identifier Processing)

Over 16 years experience: Microsoft Word- Conducted written business communications, memos, proposals, policy and procedures internally and externally.

Over 10 years experience: Microsoft Excel- Created analysis report due to tracking employee and departmental performance, provider data accuracy, CQI and business financials etc.

Over 10 years experience: PowerPoint- Created presentations to the necessity of communications, Provider Data Management Performance, business finance review and structure, employee and departmental performance, Inventory and education.

Over 7 years experience: Microsoft Outlook, PeopleSoft, Lotus-Use email communication tool used on a daily basis to communicate with staff and clients internally and externally.

Over 10 years experience: Microsoft Access- Monitor and track departmental inventory for reporting and analysis.

Over 10 years experience: CICS Mainframe Applications, Provider Data Management, Premier System, DB1, DB2, PPO, membership systems, Pricing, COBOL - Use system/software packages on a daily basis to process, CQI, maintain provider data, members and stakeholders information.

Reference available upon request



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