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Medicare Part B Representative Resume Example

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MEDICARE PART B REPRESENTATIVE
Professional Summary
Skills
  • Microsoft Office
  • Data Entry
  • CMS
  • Customer Service
  • Management
  • Research
  • Adaptability
  • Interpersonal Skills
  • Active Listening
  • Financial Services
  • HIPPA
  • Process Streamlining
  • Spreadsheets
  • Analysis
  • Team Building
  • Flexibility
  • Collaboration
  • Prioritization
  • Technology Literacy
  • Team Work
  • Organization
  • Administrative, Managing
  • Administrative support, Meetings
  • Benefits, Mail
  • Billing, Money
  • CMS, Microsoft Office
  • Interpersonal Skills, Problem Solving
  • Client, Processes
  • Clients, Product and service information
  • Customer Service, Quality
  • Data Entry, Research
  • Databases, Scientific
  • Direction, Spreadsheets
  • Fax, Team Work
  • Financial, Phone
  • General office, Troubleshoot
  • Government, Type
  • Insurance, Valuation
  • Team Building
  • Listening
  • Medicare eligibility
  • Data Entry
Work History
Medicare Part B Representative10/2019 to Current
Amerihealth Caritas Health Plan – Toledo , OH
  • Answer incoming phone calls from providers to identify the type of assistance needed (i.e.
  • Benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs).
  • Secures medical necessity checks/verification in accordance to Centers for Medicare & Medicaid services, verifies insurance, benefits, coverage and eligibility.
  • Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues.
  • Performs research to respond to inquiries and interprets policy provisions to determine the extent of company's liability and/or provider's/beneficiaries' entitlement.
  • Research complex issues across multiple databases and work with support resources to resolve customer issues and / or partner with others to resolve escalated issues.
  • Maintain accurate enrollment for assigned clients, troubleshoot and resolve issues as they arise.
  • Conduct all work in accordance with the confidentiality requirements mandated by HIPAA for member information.
  • Maintain and understand of all internal and external computer systems and reports that impact the enrollment process.
Senior Financial Customer Consultant Specialist09/2016 to 04/2019
Voya – City , STATE
  • Support of Custom Money-Out processing for participant plans.
  • Responsible for manual transactions issued through the contact center as well as: Distribution Sweeps, Excess Contributions, Installments, Non-Qualified Transactions, RMD, Roth Rollovers, etc.
  • Support of internal compliance monitoring aggregation system and automated contribution file processing for plan sponsors.
  • Process includes plan set-up, plan maintenance, and file processing.
  • Quality review of financial and non-financial transactions processed by the various processing teams.
  • Responds to client requests for information.
  • Resolves client administrative or service problems.
  • Ensures that all transactions are processed according to the company's and the client's standards.
  • Processes transactions to complete plan valuation such as contributions, loans, withdrawals, and earnings allocations.
  • Formats and loads data.
  • Review distribution request documents and process transaction per the request of plan participants based on plan rules and/or direction of sponsor or TPA.
  • Provides product and service information to agents and customers.
  • Resolve product and service problems by clarifying customer's complaints.
  • Maintains customer records by updating account information.
  • Maintains financial accounts by processing customer adjustments.
  • Verify security of callers to eliminate possibility of fraud.
  • Facilitate team huddles and Root Cause Problem Solving meetings.
Provider Enrollment Specialist04/2013 to 05/2014
First Coast Service Options – City , STATE
  • Accomplish daily enrollment/ disenrollment operations, including application review, entering applications into system and submissions in CMS.
  • Obtain missing information for enrollment completion.
  • Maintain accurate enrollment for assigned clients, troubleshoot and resolve issues as they arise.
  • Analyze multiple report from various sources to determine and implement appropriate action to reconcile enrollment discrepancies.
  • Conduct research as necessary to effectively resolve client's issues and respond to inquiries in a timely manner.
  • Courteously provide client with information and education concerning government program enrollment processes and requirements.
  • Utilized state enrollment systems and managed care enrollment systems.
  • Conduct all work in accordance with the confidentiality requirements mandated by HIPAA for member information.
  • Completed credentialing applications for providers.
  • Maintain and understand of all internal and external computer systems and reports that impact the enrollment process.
Administrative Assistant/Head Counselor/Supervisor01/1999 to 06/2012
Saint Francis Xavier Youth Program – City , STATE
  • Manage, Instruct, and Supervise 6+ employees.
  • Provide administrative support including answering phone, recordkeeping, managing incoming or outgoing mail and fax.
  • Managed the day-to-day calendar for all program services.
  • Drafted and Transcribed letter to various corporations and programs.
  • Setup community service activities for participants of Youth Program.
  • Provide appropriate direction of children/youth in their daily routine.
  • Construct daily and long-term schedules of activities that promote intellectual and physical development.
  • Improve children/youth language development, social skills, and understanding of scientific and mathematical concepts by using children's play, such as story telling and games.
  • Serve as Supply Officer for General office and Program needs.
  • Reputation for dependability, honesty, dedication and enthusiasm.
Education
Murry Bergtraum High School For Business Careers- City, State
Some College (No Degree): Arts, Early Childhood EducationFlorida State College At Jacksonville- City, State
Accomplishments
  • ACTIVE SERIES 6 - OCTOBER 2016 TO PRESENT.
Additional Information
  • DIPLOMA
Certifications

Series 6 Licencse

Build Your Own Now

DISCLAIMER

Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

How this resume score could be improved?

Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:

65Fair
Resume Strength
  • Completeness
  • Word choice
  • Length
  • Measurable results
  • Strong summary
  • Typos

Resume Overview

School Attended

  • Murry Bergtraum High School For Business Careers
  • Florida State College At Jacksonville

Job Titles Held:

  • Medicare Part B Representative
  • Senior Financial Customer Consultant Specialist
  • Provider Enrollment Specialist
  • Administrative Assistant/Head Counselor/Supervisor

Degrees

  • Some College (No Degree) : Arts, Early Childhood Education

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