healthcare quality assurance specialist resume example with 9+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000
Cell:
resumesample@example.com
:
Objective
Responsible Healthcare Quality Assurance Specialist with excellent communication skills demonstrated by 6 years of experience in healthcare.
Skills
Knowledge of HMOs, Medicare and Medi-Cal
Skilled in Kronos and Clarity
Thorough in AS400/STEPP
Great Training Skills
HIPAA compliance
Strong work ethic
Team player with positive attitude
Proficient in Excel, Word, and Powerpoint
Deadline-driven
Good written communication
Exercises good judgment
High customer service standards
Dedicated to process improvement
Conflict resolution proficiency
Strong problem solving ability
Troubleshooting skills
Telecommunications knowledge
Experience
Healthcare Quality Assurance Specialist, 11/2015 to Current Kelsey Seybold Clinic – Katy, TX,
Responsible
for daily reconciliation of beneficiary’s membership
Processed
urgent requests from the client and other departments
Served
as a resource to other members of the Enrollment team
Processed
inquiries from Customer Service Department
Monitored
and maintained daily processing of the Transaction Reply Report (TRR) and
Monthly Membership Report (MMR) from the Centers for Medicare and Medicaid
Services (CMS)
Completed
retroactive enrollment and disenrollment process
Assisted
with special projects as needed
Reconciled
monthly claim reports
Enrollment Analyst, 08/2014 to 11/2015 International Bancshares Corp – Del Rio, TX,
Responsible
for daily reconciliation of beneficiary’s membership
Processed
urgent requests from the client and other departments
·
Served
as a resource to other members of the Enrollment team
Processed
inquiries from Customer Service Department
Monitored
and maintained daily processing of the Transaction Reply Report (TRR) and
Monthly Membership Report (MMR) from the Centers for Medicare and Medicaid
Services (CMS)
Completed
retroactive enrollment and disenrollment process
Assisted
with special projects as needed
Reconciled
monthly claim reports
Provided
accurate research
Customer Service Representative, 03/2012 to 08/2014 DST Health Solutions – City, STATE,
Answers about 65-120 calls per day from members of an insurance company who have questions about their premiums, deductibles, and Late Enrollment penalties through Medicare.
Assist clients with dis-enrolling from the insurance plan.
Process claims and provide processing information to pharmacies who call about customers.
Assist other representatives with questions that they may be unsure of the answer.
Always adhere to the schedule, very prompt and accurate with the calls.
Education and Training
: Criminal Justice, Expected in to Miles College - Fairfiled, AL GPA:
High School Diploma: , Expected in 2007 to Jess Lanier High School - Bessemer, AL GPA:
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