Customer Service Manager

**** ***** **** **** *******, GA *****•404-***-**** •*************@*****.***

Shenita Daniel

Experience

****- ******* ******** & Company Atlanta, GA

SR. Administrative II/Claims

• Prepare/handle daily documents including: Insurance billing invoices, reports, memos and letters.

• Creates/maintains presentation materials, monthly/quarterly reporting and other documents, using word processing, spreadsheet, database, or presentation software.

• Develops standard and ad-hoc reports; analyzes and summarizes data for management use.

• Performs general office duties such as: responding to customer inquires via telephone; opening, sorting, and distributing incoming mail; ordering office supplies; photocopying; and making travel arrangements.

• Assist adjusters daily with set up of claims and system issues.

• Coordinators meeting set-up including securing rooms, catering, dinner reservations, equipment (audio/video), etc.

• Perform exceptional administrative duties as assigned via Branch Manager.

• Input claim documents into CMS2, Xactanalysis and all other Programs.

• Promoted to Risk Tech Super User based on expertise in the system.

• Train adjusters on different systems to perform their job duties.

• Perform direct contact with US Property & Casualty Adjusters.

• Perform exceptional data entry skills daily.

• Promoted to assist GTS Department with Billing & Interim Invoicing.

• Experienced & knowledgeable in different systems daily: Risk Tech, CBS, AS400/AMS/ CMS, XactAnalysis ,Lotus Notes, Microsoft Applications, Ledes, Allegients and more.

Perform A+ Customer Service and use of Code of Business Conduct.

2008-2009 ( Lay-Off) United Health Group Atlanta, GA

Non-Clinical Admin Support Cord/Scheduler

• Work with Clinical Manager with daily Queues.

• Assign daily cases to DM/ CM Nurses as part of their daily assignments.

• Responsible for scrubbing cases, eligibility checks and working in information tools to assist patients with benefits.

• Introduce different programs to patients as part of benefit package.

• Verify corrections that have been entered into the systems.

• Communicating with clinical staff to resolve issues, obtain information and training.

• Work in Care Coordination System,ICD-9 Codes, CCF, Impact Pro ,CMS system, Knowledge Base and billing system.

• Responsible for providing expertise and customer service support to members, and/or providers. Direct phone-based customer interaction to answer and resolve a wide variety of inquiries.

• Provides non- clinical support to help its clients provide cost effective, quality-driven results.

• Scheduled accurate time and date on the clinical staff calendar to complete assessments with the patients daily.

• Receive and enter data for new and current patients documentation for referral source.

• Ensure adherence to Company policies associated with PHI and HIPAA.

• Updated schedules as changes occur and follow-up with any identified deficiencies.

2005-2009 Matria HealthCare Marietta, GA

Assessment Coordinator/Trainer

• Initiates high volume of outbound calls daily to prospective participants from insurance referrals to participate in the MaternaLink Program. Gives an overview of the program and responds to questions about the program enrollment, encourages immediate assessment of enrolled participants.

• Obtains all demographic information on new participants and inputs into computer to initiate medical record.

• Contacts participants to complete follow-up assessments between 26-28 weeks gestational age

• Refers any/all clinical issues including but not limited to Urgent Patient Notifications to the appropriate clinical staff member.

• Track productivity as assigned.

• Works closely with the Client Services and Clinical Operations Manager as necessary in the event of call-ins or emergencies.

• Develops/revises and follows administrative policies and procedures as assigned.

• Facilitates CQI process and is responsible for on going quality checks of administrative data as assigned.

• Handle all Insurance verifications/billing in regards to eligibility.

Preceptor:

• Precepted new Employees with the tools needed to succeed in the Maternalink Department.

• Demonstrated the process of enrolling participants and obtaining information using their medical history, previous pregnancies and the current pregnancy.

Trained new employees with the knowledge of using Trax (system) and checking eligibility of participants enrolling

2004-2005

2005-2006

2000-2003 Spherion Staffing/ Cingular Wireless Fullfillment Specialist/Collection

Adecco Staffing/ Home Depot Support Center Resolution Expeditor

Reponse Media Products

Jr. Accountant/Collection

Education

2010- Present

2008-2010

1997-2001 Georgia Perimeter College

(Business Administration)

University of Phoenix (Nursing)

American InterContinental University (Business Marketing)

Contact this candidate