Quality Assurance Auditor Resume Example Currentaccessone Med Card

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 Auditor02/2014
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 Contractor10/2013 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.

Supervisor07/2012 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 Coordinator01/2010 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 Examiner10/2007 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 Healthcare01/2006 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 Representative03/2005 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 Representative10/2004 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 Administration2007Buffalo 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

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

Quality Assurance Auditor Resume Example

Resume Score: 90%

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