Resume

Sign in

Human Resources Manager

Location:
Riverview, Florida, 33569, United States
Salary:
50,000
Posted:
March 12, 2011

Contact this candidate

Yusminda Rutledge

Dynamic and Results-Oriented Professional

q5a0s0@r.postjobfree.com

CELL PHONE (813) ***-**** HOME PHONE (813) ***-****

CURRENT ADDRESS

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

Riverview, FL 33569

To obtain a position that will enable me to use my strong organizational skills, educational background and ability to work well with people

Education

MBA in Business Administration in health-care administration, 2010.

B.S. in Forensic Psychology, 2000

A.A in Liberal Arts, 1998

Argosy University, Tampa, Fl.

John Jay College of Criminal Justice, New York, NY

Borough of Manhattan Community College, New York, NY

Experience

Amerigroup Corporation 4200 W. Cypress Street Tampa, FL 33607 04/2007 to Present

Claims Analyst

• Evaluate claims to determine the type and payment reimbursement.

• Process provider referrals, primary care encounter information and fee for service claims.

• Interpret Medicaid contracts and fee schedules.

• Reviews and responds to quality audit assessments and action grams in a timely manner.

• Work with other departments to resolve issues.

• Prepare correspondence, responds to phone logs & contact logs, generates action grams, and completes projects for all markets.

• Adheres to company and departmental policies and procedures, as well as HIPAA regulations.

• Understand and implement appropriate claims processes and courses of action when adjudicating

¬

Department Of Health, Office of Disability Determination P.O. Box 15550 Tampa, FL 33684 10/2003 to 05/2006

Investigator, Claims Adjuster

• Evaluated and received medical documents to determine their evidentiary of sufficiency for decision making purposes.

• Authorized purchase of medical/psychological diagnostics services to document on impairment.

• Developed and established documentation through telephone interviewing.

• Knowledge of Social Security Administration Policies and SSA disability program.

¬

Human Resources Administration/BFI 250 W. Church Street, New York, NY 10008 09/2000 to 03/2003

Fraud Investigator/ Assistant to Deputy Director

• Interacted in an Administrative and Investigation capacity with other government agencies to determine staffing eligibility, conveying information, providing feedback in order to facilitate cooperation.

• Conducted investigations of companies, agencies, employee’s, and clients and complaints.

• Personal Assistant to the Deputy Director, duties included: felony warrant matches, screening of applicants, oversaw all confidential files of employees, liaison for human resources, time and leave issues.

• Supervised and handled special warrant projects and other projects that dealt with law enforcement.

• Provided analysis, reviewed and recommended concerning performance reviews, compensation changes/adjustments, merit increases and promotional increases for consistency and compliance with company policy and legal considerations.

• Maintained and recorded data for reports, summaries to include chronological development.

• Delegated and coordinated multiple regulatory projects under aggressive deadlines.

• Conduct timely investigations into complaints of EEO, Workplace Harassment, and other associate concerns.

• Assisted the HRA in ensuring a Healthy Work Environment. Conducted employee relations assessments; developed effective employee relations.

• Provided guidance and consultation to employees and leaders to improve employee performance and maximized organizational effectiveness

• Provided guidance and consultation to employees and leaders to improve employee performance and maximize organizational effectiveness.

• Developed effective employee relation strategies and interventions as appropriate; Consult with leaders and employees to improve employee voice, engagement, and recognition; Reviews and recommends disciplinary actions; Conducts investigations and responds to employee Grievances.

• Ensured ongoing compliance with all legal and regulatory standards. Consults with leaders on employment, regulatory, and policy & procedure compliance.

¬

Skills / Strengths

• Successful leader, equally effective as member of a team.

• Highly organized able to multi-task and accomplish multiple objectives.

• Professional demeanor and attentive to detail.

• Interviewing Techniques, EBT (Electric Benefit Transfers)

• Budgeting, IPV (Intentional Program Violation), and Civil Litigation

• HIPPA/ PHI (Protected Health Information)

• AFIS System

• Pharmaceutical Drug Division Management

• Levy 400, EDIB system & PCOM, SAR, Brio, Lexis Nexis, Factiva System, World Check, Mantas 4 and 1&2, AIIRS, Facets, Macess, People Soft

¬

Professional Memberships

SHRM-Society for Human Resource Management 09/2010 to Present

PHR Certification (In Progress)

References

References and Transcripts Available By Request



Contact this candidate