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yyyyyy x. yyyyyy

0000 xxxxxx xxxx , xxxx , xxxxx 00000

xxx-xxx-xxxx • abc@xyz.com

 

 

skilled professional eager to contribute provider education expertise as well as strong personnel instruction skills and communication talents toward actively supporting an organization in maximizing performance.

 

profile

 

  • accomplished provider educator offering solid and progressive expertise within management, personnel/beneficiary instruction and customer service capacities.
  • in depth experience in client-focused industries skilled in delivering world class customer service.
  • adept at blending strong decision-making abilities with outstanding organizational skills, solid leadership attributes, and successful interpersonal relationship-building techniques.
  • apply sharp problem-solving proficiencies, intelligent business acumen, and cost-effective strategies, along with exceptional written and verbal communication skills, to any professional environment.
  • capable of staying focused and maintaining a calm demeanor in high-pressure situations while exhibiting high quality, diplomatic customer / client services interaction both in person and via telephone.
  • technically proficient in microsoft office suite, including word, outlook, powerpoint, and excel.
  • available for positions that require more than 25% travel in support of overall company objectives.

 

selected accomplishments

 

recipient of commander s coin of excellence for contributions as tricare trainer and resource person.

awarded commander s coin of excellence from clinic commander for work as hipaa compliance assistant.

participated in executive council meetings with clinic commanders at laafb, vandenberg afb,

port hueneme, madigan, ft lewis and oak harbor.

 

professional experience

 

tricare field rep ii triwest healthcare alliance                                                                  2006-present

  • utilize extensive knowledge of tricare services, policies and procedures to education military healthcare providers and personnel through seminars, briefings and on-site visits.
  • responsible for tricare education operations across california and oregon, while assisting with seminars in arizona, wyoming, hawaii, and washington.
  • spearhead the investigation and resolution of customer complaints and congressional inquiries.
  • actively collaborate in the training of new tricare field representatives across the entire west region.
  • facilitate productive relationship and proactive communication with providers and facility administers.
  • consistently assist providers in innovative troubleshooting and resolution of complex claims issues.

 

hipaa compliance assistant force3 / acg systems, inc.                                                              2004-2006

  • serving as deputy privacy officer for 61 mds, actively supported over 100,000 services connected personnel across greater los angeles.
  • proficiently managed 100% of phi tracking and reporting functions for the 61st abg/space and missile systems center. 
  • consistently ensured delivery of quality customer service and issue analysis vital to sustaining and growing clientele base.
  • functioning as hippa compliance instructor, increased both staff and patient knowledge in support of the development, implementation, maintenance, and adherence to the military health system s (mhs) hipaa compliance regulations.
  • constantly updated healthcare personnel on new patient privacy laws, requirements and regulations.
  • succinctly briefed executive staff on innovative changes and trends in tracking hipaa compliance.
  • successfully compiled and submitted detailed reports recommending appropriate compliance action for hsi and jcaho reviews.

 

yyyyyy x. yyyyyy

0000 xxxxxx xxxx , xxxx , xxxxx 00000

xxx-xxx-xxxx • abc@xyz.com

 

professional experience

 

office manager/ benefit services rep ii triwest healthcare alliance                                2001-2004

  • hand-selected for promotion to office manager for exceptional on-the-job performance and proven managerial skills.
  • served as key member of personnel team during challenging transition of triwest central region to west region.
  • actively supervised 8 benefit service reps, 5 bsris and 1 clerical employee, assisting with difficult interviews, explaining program education strategies, providing procedural training, and preparing performance evaluations.
  • acted as point of contact for the mtf tricare flight, in the resolution of out-of-hospital referral problems and sensitive public relation issues. 
  • represented triwest at mtf executive council meetings, referral management planning meetings and on conference calls. 

 

beneficiary service rep triwest healthcare alliance                                                                   2001-2004

  • effectively focused all business operations on the provision of quality customer service, ensuring high customer satisfaction levels.
  • proficiently handled interviews with active duty and retired military and dependents, providing general healthcare program information, on-site counseling and enrollment support services.
  • responsible for processing pre-authorization requests for medical care coverage, while handling application denials.
  • successfully contributed in tricare for life briefings and informational sessions for beneficiaries about program benefits and requirements.

 

clerical to baltimore supervisor/claims rep social security administration                                          1969-2001

  • actively collaborated in human resource operation functions such as preparing statistical reports on workload and beneficiary access, evaluating performance and issuing awards/disciplinary action.
  • successfully interviewed applicants, beneficiaries, attorneys, personal representatives, and congressional aides on all aspects of filed claims.
  • consistently provided detailed explanations of laws, policies, programs, and procedures to potential clients.
  • ensured all clients were fully informed of rights and obligations under social security and supplemental security income programs.
  • drove the investigation, verification and documentation of program abuse and fraud; efficiently reconciled discrepancies between case allegations and evidence. 

 

director of labor assistance program american federation of government employees              1989-1994

  • spearheaded the establishment of labor assistance program, effectively identifying root problems with drugs, alcohol and life issues among personnel causing workplace difficulties.

 

professional education

 

associates of arts degree university of phoenix                                                                                 3/2010

       

training in microsoft excel long beach community college                                                                2005

 

legal training in hipaa and medical record security tricare management authority                       2004

 

benefit service representative training triwest healthcare alliance                                                  2004

 

courses on technology, customer service and leadership social security administration   2001

 

 

yyyyyy x. yyyyyy

0000 xxxxxx xxxx , xxxx , xxxxx 00000

xxx-xxx-xxxx • abc@xyz.com

 

professional references

 

 

 

 

 

 

 

valerie vigil

benefit service & education representative

triwest healthcare

las vegas, nv

702-523-8907

 

 

 

shenoa robinson

tricare field representative

triwest healthcare alliance

san diego, ca

xxx-xxx-xxxx

 

 

 

catherine windmiller

blue shield of california

senior field representative

city, state

xxx-xxx-xxxx

 

 

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