Highly motivated Sales Associate with extensive customer service and sales experience. Outgoing sales professional with track record of driving increased sales, improving buying experience and elevating company profile with target market.
Skills
Training Curriculum Development Design and Delivery
Classroom Facilitation Facets
One on One Coaching
Tutoring/Mentoring IMS - Information Management Systems FEPDirect - Federal Government Subscribers Information System
Windows MaxMc
Word BlueWeb
Excel Medical Review Edit Automation, Ultera
PowerPoint, Snagit
Customer Service Patient Management System
Organization Medicare/Medicaid Bayou Health Plans and associated systems
Detail Oriented Navinet Healthland Scheduler Training Development, Design and Delivery, Classroom Facilitation, 1/1 Coaching, Microsoft Word, Excel, PowerPoint, BCBS system applications including Facets, IMS, FEPDirect, MaxMc, BlueWeb, Medical Review Edit Automation, Ultera, Snagit
Work History
Admitting Clerk, 01/2011 - 01/2012 American Advanced Management, Inc – Riverbank, CA,
Greet patients upon arrival to hospital/physicians clinic Patient check-in to physicians clinic Patient admits to emergency room Patient admits to hospital Answer multiline phone system for hospital, ER and physicians clinic Schedule appointments for both hospital/physicians clinic (7 physicians offices, radiology, pathology, MRI Van, etc) Courtesy call to remind patients of scheduled appointment for next day Responsible for all cash-flow (patient payments/copayments, cafeteria monies, hospital inpatient bank, payments received by mail, etc.) Run daily reports for review and processing.
Reports include: Cash-flow Report, Patient Admits, Patient Discharges, Physicians Clinic Schedule, MRI Schedule, Pet Scans, Stress tests, Medicare Patients Swing Bed etc.) Processing of reports include: verify insurance coverage for all patients, verify/request referrals when required, verify/request authorizations when required, communicate with physicians/insurance provider by phone to obtain correct information such as CPT4, ICD9, ICD10 codes, dates of service, policy dates, etc.
Then submit results to upper management Prepare bank deposits Prepare bank deposits for morning pickup Maintain extensive filing system.
Operations Trainer, 01/2007 - 01/2011 Aptive Pest Control – Wilmington, NC,
Provide training to new hires and/or promoted Blue Cross Blue Shield associates on all functions required to perform job duities/assigned tasks successfully in the form of which is most convenient for the client (classroom facilitation, computer based training, 1 on 1 training, on-the-job training, etc.) Provide remedial training as identified through monthly error reports as well as Action Requests submitted by management Track client satisfaction throughout each course and address all issues related to training utilizing the most convenient method for the client (on-the job training, classroom facilitation, computer based training, 1 on 1 training, etc.) and reporting the results to leadership following each training initiative Maintain knowledge of the Federal Administration Manual, benefits and processing procedures Partner with client departments to develop performance improvement strategies Advise my management on front line issues and concerns, as needed Participate in Release Testing for benefit/system changes as needed in order to maintain knowledge of changes implemented with each Release Conduct departmental meetings/sessions as needed to communicate benefit/system changes to staff Participate in bi-weekly Federal Employee Program Express Town Hall Conference calls in order to maintain knowledge of upcoming benefit/system changes Travel to attend annual Blue Cross Blue Shield conferences in order to maintain up to date knowledge of FEP Operations and Systems Conduct annual benefit training for all Federal Employee Program depts prior to implementation Demonstrate the American Society for Training and Development Trainer Competencies in classroom facilitation develop and maintain departmental manuals and reference tools for each training initiative Apply adult learning principles to all curriculum and assess achievement of learning objectives 100% of the time Document methodology selections in Lesson Plans that are appropriate to the learning style and needs of the adult learner in training Develop and implement an evaluation plan for all training initiatives.
Adjustment/COB Processor, 01/2002 - 01/2007 Blue Cross Blue Shield Of LA – City, STATE,
Ensure accurate delivery of the Federal Eemployee Health Benefits contract through daily review, research, and adjustment of claims received through Action Requests, memo, reconsiderations, audit, or changes in coverage including recalculation of benefits to previously processed professional, major medical, Medicare, dental, AIE, CIE and PIE claims submitted with incorrect codes or processed incorrectly in the claims area for FEP contracts.
Review and research other coverage/Medicare information, manually generate and process Other Coverage Questionnaires, add, revise and delete COB information and Medicare records, determine the order of benefits for other coverage and Medicare.
Identify and resolve edits to complete claim for payment, recalculation of benefits to previously processed COB/Medicare claims to add, revise or delete other coverage information.
Determine if an overpayment has occurred, request refunds, and/or utilize procedures for requesting refunds on processed claims.
Claims Processor/Special Claims Processor, 01/1998 - 01/2002 Blue Cross Blue Shield Of LA – City, STATE,
Ensured accurate delivery of the Federal Employee Health Benefits contract through processing of professional, major medical, Medicare, dental, AIE, CIE and PIE claims received through Claims Control.
Resolve edits to ensure correct contractual benefits are ultimately provided for the subscriber/provider, contact subscriber/provider to obtain additional or missing information.
Set up Action Requests with information obtained by phone contacts, generate send back letters to subscriber/provider to obtain additional or missing information.
Utilized all actions necessary to ensure contractual benefits.
Verification Clerk, 01/1997 - 01/1998 Regular Coding, Blue Cross Blue Shield Of LA – City, STATE,
Accurately reviewed all information submitted on each claim received through Claims Control in a timely manner.
Correct, add or delete information/mistakes as detected by system automation.
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