Tutor/ Mentor Resume Example
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TUTOR/ MENTOR
Professional Summary
Over seven years of working in a managed care in a call-center environment. Excellent research and communication skills. Strong time management skills, multitasking as well as paying close attention to detail. Great team player while also possessing ability to work well independently. Comprehensive knowledge for meeting targets for staff and unit performances.
Education and Training
2002
Certified Massage Therapist: Massage TherapyEdutech School of Massage Therapy － City, State
1992
High School DiplomaVivian Gaither High School － City, State
Computer Skills
Claims billing & paired systems used: Diamond, Sidewinder, IKA, Facets, Maces, Amisys & Avality. Computer skills: Microsoft Word, Office 2010, Lync, WebEx, MS Word 2010, Excel, Power point and Internet. Computer systems: PeopleSoft, Vista, Windows & MAC Pro.
Professional Experience
03/2015
Tutor/ MentorMetropolitan State University Of Denver － Denver , CO
- Tutor students grades kindergarten through 5th grade.
- Help students build confidence in their academic skills, communication and critical thinking.
- Implement assetment to each student. Design tailored exercises to help each student reach on level status.
- Communicate with parents child's progress and areas of improvement needing focus. Build rapport with students.
- Serve as positive Role model and friend. Build self-esteem and motivation.
- Set goals and work towards accomplishing them.
- Attend trainings, and meetings for tutors.
- Completed trainings for:
- Identifying and Reporting Child Abuse & Neglect.
- Child Care Training
06/2014 to 03/2015
TutorLehigh Valley Hospital & Health － Trexlertown , PA
- Tutor grades K-5th assisting students in areas needed.
- Design and implement exercises and activities to facilitate the student's academic progress.
- Meet with student twice a week.
- Maintain all records required to document student's attendance and academic progress.
- Submit academic and behavior reports monthly.
- Have good rapport with students as well as parents.
01/2013 to 10/2014
Recovery Analyst IIUtah Retirement Systems － Salt Lake City , UT
- Research overpaid claims.
- Processed corrected & overpaid claims allocated to the assigned market consistent with company and departmental policies.
- Adhere to company and department procedures as well as HIPPA regulations and CMS guidelines.
- Cost containment unit is primarily responsible for overpayment adjustments and recoupments but not limited to researching duplicate payments, corrected claims, billed in error, incorrect provider paid, ASH claims & coordination of benefits.
- Billing system: Facets & Amisys; Other systems used: Maces, RNF, Overpayment database and Clue for PI (Processing Instructions) including market specific exceptions and rules.
- Assisted OHI (Other Health Insurance) team with member updates, enrollment/disenrollment period and benefit types.
- Main search engine: Availity.
09/2008 to 03/2012
Credentialing/Intake SpecialistU-Haul － Rochester Hills , MI
- Responsibilities consisted of credentialing/re-credentialing Medicare/Medicaid members for the following POS.
- America's 1st Choice, Freedom & Optimum Health Care.
- Maintain weekly production standard, abide by CMS policy and regulations while reviewing, researching and investigating each application.
- Manage time as deadlines and meetings for eligible providers and location have schedules each month.
- Access and pull DEA's, Medical Lic., Board Certs., Malpractice Summaries, CAQH applications, NPDB, CV, NPI, EPLS, CLIA, OIG, AHCA along with Hospital verifications to complete file requirements for committee meetings.
- Communicate regularly with PR reps to ensure requested information is collected to complete files by deadline.
- Claims Processor 08/2008 - 10/2010
- Responsible for processing professional claims. Reviewing and making adjustments to overpaid, corrected claims and coordinating benefits. Billing system: IKA
- Assist Managers with projects and project resolution received from the market.
- Follow policies and procedures for FL market when processing as well as follow HIPPA & CMS guidelines.
- Maintain daily production on excel spreadsheet.
- Answer provider and member correspondence submitted via mail. Respond back in timely fashion.
05/2007 to 05/2008
Provider Service RepWellCare － City , STATE
- Answer claims inquires, appeal and grievances submissions submitted by facilities and providers.
- Also submit appeals and grievances on behalf of providers and members.
- Review frontend claims for errors including: overpayment, billing errors, addresses, ICD9 codes and procedure codes.
- Responsible for servicing Medicare/Medicaid members in the following states: GA, FL, OH, NY & CT.
- Submitting OTC orders, answering benefit questions and claims inquiries from Providers as well as Members.
- Billing systems used: Diamond and Sidewinder.
01/2007 to 05/2007
Claims & Benefit Representative TPAHealth Plan Services － City , STATE
- Assist members, providers, brokers & employers with benefit and claim inquiry. Verify benefits as well as answer any pending claims inquiry.
- Answer incoming calls from over 10 different health care carriers following core for each company.
- Assisting management with processing corrected claims and provider correspondence received.
- Process claims within a timely manner while meeting production goals.
03/2006 to 01/2007
Disability Intake RepresentativeAetna Disability － City , STATE
- Take initial disability interview from Aetna members. Gather important information as well as fax out appropriate information to complete intake process.
- Assist TL & Management with coaching new hire and organizing activities to boost team moral. Responsible for assigning and tracking OT for team. Assist departments remain current with disability cases. (Long Term, Short Term, Intake Dept.)
- Maintain good communication with Disability Analyst & Nurse via email informing them of any changes that may affect members claim.
05/2005 to 03/2006
Medical Claims AdjusterOxford Insurance － City , STATE
- Process overpayment adjustments for all medical claim types and LOB.
- Reprocess corrected claims while staying within turnaround standards. Adhere to HIPPA and CMS guidelines.
- Ability to understand and apply plan concepts to include: Deductible, Coinsurance & Copay
- Attention to detail when reviewing, researching, investigating, processing and adjusting claims.
04/1996 to 03/2006
Reservation ManagerU-Haul Corp Office Of Central Fl － City , STATE
- Responsible for making reservations, and confirming rental with customers in Central Fl.
- Mentor and Train new employees.
- Resolve customer complaints. Issue reimbursements and credits when needed.
- Take notes and track time for all team meetings.
- Track and maintain stolen equipment report for Central Fl.
- Plan office activities to promote moral, team building skills and promote better work ethics.
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Resume Overview
School Attended
- Edutech School of Massage Therapy
- Vivian Gaither High School
Job Titles Held:
- Tutor/ Mentor
- Tutor
- Recovery Analyst II
- Credentialing/Intake Specialist
- Provider Service Rep
- Claims & Benefit Representative TPA
- Disability Intake Representative
- Medical Claims Adjuster
- Reservation Manager
Degrees
- Certified Massage Therapist : Massage Therapy
High School Diploma
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