Healthcare Industry Professional specializing in Case and Account Management, Customer Service and Regulatory Compliance operations eager to contribute talents toward supporting the employer in optimizing bottom-line operational and financial performance

 

 

Ø  Offering over a decade of experience in delivering world-class customer service, account maintenance and case management, specializing in the healthcare/insurance industry

Ø  Excel in strategically prioritizing, coordinating and managing projects/workflow to optimize efficiency, maximize level of services and meet critical deadlines in fast-paced, time-sensitive environments

Ø  Proficient in complex record keeping, information gathering/compilation, database administration, spreadsheet development, and report production

Ø  Expertise in detailed analysis, quality assurance, troubleshooting, and problem solving, with knack for proactively identifying and mitigating potential issues

Ø  Dynamic communication, consultation, presentation, and interpersonal relation skills; talent for building and maintaining productive client relationships across broad populations

 

 

Aetna Healthcare-Chicago, IL                                                                                                   2007-2010

Network Representative

Optimized provider network performance across varied markets through efficient coordination and management of diverse reports and contract mailings

Effectively communicated healthcare plans, contracts and policy parameters supporting providers credentialing/re-credentialing

Expertly analyzed, identified and mitigated risks to company across broad-scope legal, financial, negligence, liability, economic, governmental, and public perception issues

 

Bank of America-Chicago, IL                                                                                                     2006-2007

Global Client Services Advisor

Delivered dynamic client services in efficiently managing 200+ lockbox accounts, with responsibility for daily maintenance as well as all financial adjustments; spearheaded client meetings to promptly address, troubleshoot and resolve issues

Drove business growth by actively consulting with multi-level Fortune 500 management decision makers in order to assess and define needs and provide customized banking solutions

Humana Healthcare-Chicago, IL                                                                                               2000-2006

Compliance Specialist; 2003-2006

Thoroughly reviewed provider credentialing applications for quality assurance and compliance as well as facilitated initial and re-credentialing primary source verifications; additionally in charge of maintaining monthly production of provider files

Assistant Provider Relations Representative; 2000-2003

Adeptly compiled and produced detailed spreadsheets vital to productively tracking claim payments for varied providers and medical groups; updated/uploaded 100+ provider contracts to database monthly

Ensured delivery of quality servicing in efficiently receiving, screening and directing high-volume of provider inbound calls related to claims and contracting issues

 

 

Paralegal Certificate, DePaul University-Chicago, IL; in progress-expected completion February 2011

B.S. Criminal Justice, Illinois State University-Normal, IL