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Quality Assurance Auditor Resume Example

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QUALITY ASSURANCE AUDITOR
Professional Summary
To pursue a position that is both challenging and rewarding while offering stability, potential for growthand utilizes my skills and experience to their maximum potentital. Skills Computer proficientCollaborativeExcellent communicator both verbal andAdaptablewrittenStrong work ethicAnalytical thinkerExercises good judgment Quality improvement competencyStrategic planning capabilityPromotes positive behaviorEffective trainer
Skills
  • Computer proficient
  • Excellent communicator both verbal and written
  • Analytical thinker
  • Quality improvement competency
  • Promotes positive behavior
     
  • Collaborative
  • Adaptable
  • Strong work ethic
  • Exercises good judgment
  • Strategic planning capability
  • effective trainer

 
Work History
Quality Assurance Auditor 02/2014
CurrentAccessOne Med Card – Fort Mill, SC
  • Routinely collaborated with department managers to correct problems and improve processes.Run and review reports for various departments.Conduct comprehensive monthly compliance audits to identify trending errors.Identify trending errors and make suggestions for corrective action.
  • Tracked complaints and other customer inquiries.Routinely make corrections or suggestions for updating manuals and ensuring that informationalchanges are properly presented to the appropriate staff.Participated with committee that strives to keep staff engaged and involved with the company.Often take on new tasks within other departments to expand my current knowledge of processes.
  • within the company.
Medicare Contractor 10/2013 to 12/2013
Univera Health Care – Concord, NC
  • Review member account to determine accuracy and possible revisions to financial standing withcompany.
  • Update system to reflect next year insurance changes.Work with all areas within department to ensure identified issues are resolved timely and staff has been properly educated on problems.
  • Multitasking work by helping out with any area within department which is seeking assistance.
  • Prioritizing projects as they are assigned.
Supervisor 07/2012 to 10/2013
Medicare Operations Univera Healthcare – Williamsville, NY
  • Supervise 9-20 team members.Responsible for managing inventory and workflow.
  • Interviewing & hiring potential job candidates as well as temporary staff during open enrollment period.
  • Identifying training gaps for staff and work with training department on developing training programsthat would be most beneficial to staff and the corporation.Maintaining clear communication between departments for optimal flow of information.
  • Perform annual performance assessment of staff.Continuously work toward identifying and removing barriers to increased productivity, quality, costeffectiveness, timeliness of operations, and customer satisfaction.
  • Worked on personal development for staff.
  • Skillfully developed departmental goals, objectives, standards of performance, policies and procedures.Consistently complied with applicable laws and regulations and ensured department adhered to Medicare regulations.
  • Encouraged creative thinking, problem solving, and empowerment as part of the managements goals to improve morale and teamwork.
Medicare Credit & Collections Coordinator 01/2010 to 07/2012
Univera Healthcare – Williamsville, NY
  • Planned and executed Credit and collection program in accordance with Medicare guidelines.Created daily reports using multiple databases to track and send out letters to delinquent members.
  • Managed member records so information is complete and accurate.
  • Developed training to assist with implementing new program.
Resolution Examiner 10/2007 to 01/2010
M&B Univera Healthcare – Williamsville, NY
  • Solved complex billing issues and helped resolve system issues.
  • Maintained monthly records for programs that work in conjunction with Social Security, EPIC,Medicare and Medicaid.
  • Prepared monthly, quarterly and yearly reports of reconciliation activity including financial impact to.
  • the Plan.
M&B Processor Univera Healthcare 01/2006 to 10/2007
Univera Healthcare – Williamsville, NY
  • Responsible for processing applications Researched and resolved billing issues.Provided customer support for members.
  • Worked with other departments in order to improve quality of work.Used Medicare guidelines for adjustments of member accounts.
Call Center Representative 03/2005 to 07/2006
Lifetime Health – Amherst, NY
  • Responsible for providing customer service and support to all Lifetime Heath Centers.
  • Answered telephones & routed information to appropriate areas.
  • Knowledge of referrals and department responsibilities as well as HIPPA regulations.
Patient Service Representative 10/2004 to 03/2008
Lifetime Health – Amherst, NY
  • Responsible for direct patient contact.Scheduling of appointments and streamlining information to other providers and departments.Ordering supplies.
  • Maintained communication between staff.
Education
BBA: Business Administration 2007 Buffalo State College - Buffalo

     

  • Coursework in Business Administration
Skills
billing, creative thinking, Credit, customer satisfaction, customer service, customer support, databases, financial, hiring, insurance, inventory, letters, managing, Multitasking, next, policies, problem solving, processes, quality, Scheduling, teamwork, telephones, training programs, workflow
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Resume Overview

Companies Worked For:

  • CurrentAccessOne Med Card
  • Univera Health Care
  • Medicare Operations Univera Healthcare
  • Univera Healthcare
  • M&B Univera Healthcare
  • Lifetime Health

School Attended

  • Buffalo State College

Job Titles Held:

  • Quality Assurance Auditor
  • Medicare Contractor
  • Supervisor
  • Medicare Credit & Collections Coordinator
  • Resolution Examiner
  • M&B Processor Univera Healthcare
  • Call Center Representative
  • Patient Service Representative

Degrees

  • BBA : Business Administration 2007

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