yyyyyy x. yyyyyy                                                          0000 xxxxxx xxxx , xxxx , xxxxx 00000

xxx-xxx-xxxx • abc@xyz.com

 

details-focused information systems auditor specializing in driving organizational efficiency; managing high-volumes of data; performing diverse billing, coding, and accounts management; and providing world-class client relations eager to offer 13+ years of experience toward maximizing an employer s success.

 

profile of qualifications

 

         integral leader who demonstrates a record of progression to roles of higher-level responsibility and authority.

         top performer who excels at managing health care administrative support processes and creating goals to meet key objectives, along with overseeing customer services initiatives in coordination with multiple parties.

         excellent communicator who seamlessly interfaces with all levels of business representatives and clientele.

         ambitious self-starter who contributes superior attention-to-detail and sharp analytical abilities.

core competencies

 

information systems support                           policy / procedure development                     client / provider relations

staff recruitment / training                             quality monitoring systems                              key beneficiaries support

personnel performance                                       health care programs                                         process improvement

professional synopsis

 

 

customer service supervisor (2005 c 2009)

         applied dynamic leadership talents toward monitoring a high-volume of personnel performance, identifying training needs, and initiating comprehensive recommendations for improvement to boost efficiency.

         drove business growth by recruiting, training, and managing a top-performing staff, including conducting group meetings and individual reviews to facilitate valuable team building and improve communication.

         planned and prioritized team member schedules to maximize use of resources and meet all service goals.

         ensured high-quality customer service levels and staff performance excellence by objectively drafting and developing plans and performance evaluations for hr manager review, evaluating quality monitoring system records for csr activities, and identifying need for internal standards and guidelines.

 

customer care representative (2002 c 2004)

         contributed strong communication and interpersonal relations skills toward responding to inquiries from beneficiaries regarding all health care programs, including informing and assisting clients with enrollment, eligibility, benefits, referrals, authorizations, claims, collections, and network / certified providers.

         led complete resolution of service issues by interfacing with enrollment, claims, and health care services departments, along with documenting all communication involving beneficiary and provider contacts.

         developed various knowledge of required measures to protect the privacy of health information when using or disclosing data, and attained key proficiencies in understanding grievance and appeals processes.

 

benefits service representative ii (1997 c 2004)

         utilized broad scope of industry and healthcare services knowledge toward providing efficient individualized, single-visit resolutions of customer encounters for walk-in beneficiaries and military treatment staff.

         performed consult tracking activities, including inputting data, making outbound calls, assisting beneficiaries with grievance and appeals processes, and maintaining solid relationships with public- and private-sector staff.

         documented beneficiary and provider contacts, and ensured data was completed for each type of contact.

         researched referral status, authorization, and consult tracking reports when past due from specialty provider.

         supported tricare service center with clerical activities, including ordering marketing materials, forms, and supplies; preparing correspondence and reports; and routing in-person briefing to specific beneficiaries.

 

additional insurance, accounts receivable, data processing, & nursing aide roles held prior to 1997

education & technical summary

 

bachelor of science in health care management                                                                  national american university

certificate in health care                                                                                                                                     blair junior college

 

microsoft office suite • maxmc medical management system • electronic billing • icd-9 / cpt • data entry