Dynamic and highly motivated professional with 10+ year's business operations experience - administration, insurance sales, customer service agent, engineering, human resources, medical billing, and operations management. Driven to succeed on assigned projects with strong desire to improve existing procedures and implement cost-effective improvements. Focused team player who strives to work to the highest professional standards while keeping teams focused on timelines and milestones. Reliable individual who is capable of demonstrating effective leadership skills through project management and implementation. Confident in interactions with individuals at all levels while maintaining strict compliance with applicable laws and regulations as mandated by state and federal laws.
Relationship Development - Strong interpersonal communication skills and ability to collaborate and cultivate lasting relationships and leadership within diverse business communities. Work as an engaging facilitator skilled at written/verbal communication. Proven ability to communicate effectively within teams.
Information Administration - Highly experienced technical proficiencies. Knowledgeable of hospital coding and able to document medical procedures and diagnoses. Skilled in ICD-9-CM and CPT coding.
Project Oversight - Well-developed organizational aptitudes. Proven ability to analyze existing financial data and implement strategic planning for budget goals and forecasts. Success meeting and exceeding timelines, budgetary restrictions, and organizational goals within team-driven and self-guided tasks.
Key Strengths - Finely tuned analytical skills with a dedication to continually review and improve work processes. Known as a people -oriented, self-motivated, effective problem solver who is able to resolve both operational and staffing issues.
My Path (LMS), EZ Pay, Prolenium, FIM, CMMS, Maximo, Micro GADS, Nodal GAPS, and ADP PC Payroll
Accounts payable and receivable
ADP, Performance management
Schedule appointments, Processes
Articulate Sudio 13 software
Budgets, Strategic analysis
Customer service, Workflow
General ledger accounts
Multi-line phone systems knowledge
Organization, prioritizing, and multi-tasking
Company guidelines and procedures
Licensed Insurance Agent
2013Healthcare & Insurance Plans - Design and Management
2011Benefits Analyst Certification
Regulatory Environments for Benefits Programs
State Farm- Multi Lines Agent Bonham, TX10/2018 - Current
Develop leads, schedule appointments, identify customer needs, and market appropriate products and services.
Establish customer relationships and follow up with customers, as needed.
Discuss financial concerns and needs of customers as needed to address their concerns and identify
products to enhance and secure their life.
Work with the agent to establish and meet marketing goals.
Maintain a strong work ethic with a total commitment to success each and every day.
Licensed to sell Life, Health, HMO and Property and Casualty Insurance products.
Seek out leads and new clients.
Provide a high level of customer service to keep clients happy and secure retention.
Log, investigate, handle, resolve, track, and trend member and provider grievances and appeals including reporting and outcome resolution through consistent correspondence and follow-up.
Disseminate information regarding plans, benefit coverage, other member and/or plan information.
Provide organizational leadership for addressing member questions.
Responsible for member appeals and provider claim disputes, conducting investigations, and completion of responses within timeframes.
Comply with timely processing guidelines, policy, and standards of the state, such as grievance resolution and completion within (30) days of receipt.
Address quality of care complaints to quality management for resolution, and assist in investigations in conjunction with quality management medical reviews.
Investigate member issues as well as provider claims or billing discrepancies.
Regularly work with claims department in order to achieve corrective actions and resolutions.
Coordinate correspondence to members and providers regarding grievance and appeals/requests for hearing including, grievance forms, grievance acknowledgements, and resolution correspondence in the appropriate language.
Responsible for maintaining and reporting compliance, grievance, and appeal data, including: member files, logs, reports, documentation, and tracking information in a consistent and approved format.
Compile, prepare, and report compliance and grievance data monthly.
Formulate, implement, and execute processes, requests, workflow, or policies, including offering a proactive approach to suggestions and recommendations as well as working or cooperating with office associates or management effectively.
Act as a liaison to all company departments.
Accomplish duties and assignments with minimal supervision.
Maintain confidentiality of information.
Meet identified productivity and quality of work standards.