Adrian Price
Columbus,GA
Summary
Experienced with evaluating financial statements and internal controls to ensure compliance. Utilizes risk assessment techniques to identify discrepancies and recommend improvements. Strong understanding of regulatory standards and best practices in auditing.
Qualified Auditor with comprehensive background in auditing financial records and compliance processes. Expertly conducted audits that enhanced operational efficiency and identified discrepancies. Proficient in risk assessment and internal control evaluations, demonstrating accuracy and attention to detail.
Overview
2025
2025
years of professional experience
Work History
Auditor Credentialing Operator
NTT DATA/AMERI HEALTH CARITAS
01.2023 - 10.2024
- Responsible for research and analysis of projects maintaining provider data using NPI/NPPES as well as Visual Cactus and Excel software.
- Enrolled providers and practitioners into the Amerihealth Caritas Medicare database.
- Performed general administrative task pertaining to research and provider data.
- Research, review, and analyze provider data interpretation for setup and maintenance.
- Loads new provider into EZ-CAP. Verify W-9, NPI, Taxonomy codes and license.
- Enters new providers and maintain other production standards established within the unit for data entry and related projects.
- Assists in maintaining Data Integrity techniques to assure accuracy and consistency of provider information over its entire life-cycle.
- Assist with provider data clean ups and communicates process improvements to management
- Extracts data and reviews to interpret and identify any required validation activities and to detect issues and/or trends for further analysis. Conducts system audits and provides results for process improvement activities.
- Provider Data Management Record Building (5/2022- 1/2023)
- Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
- Maintained confidentiality, handling sensitive information discreetly throughout all stages of the audit process.
Claims Representative
NTT Data
05.2022 - 10.2024
- Worked productively in fast-moving work environment to process large volumes of claims.
- Followed up with customers on unresolved issues.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
- Developed strong relationships with clients, facilitating trust and open communication during the claims process.
- Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
- Collaborated with cross-functional teams to expedite complex claims investigations and resolutions.
- Minimized financial losses by identifying fraudulent claims through thorough analysis and investigation.
- Negotiated favorable settlements with claimants, resulting in cost savings for the company.
- Conducted detailed assessments of claims documents, ensuring accuracy and completeness before submission for approval.
- Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
Customer Service Representative
Hamilton Relay Svc Inc
01.2022 - 05.2022
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Responded to customer requests for products, services, and company information.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
- Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Assisted customers in navigating company website and placing online orders, improving overall user experience.
Remote, Customer Service Representative
Blue Cross Blue Shield Michigan
10.2021 - 01.2022
- (Remote)
- Collaborated with team members to develop best practices for consistent customer service delivery.
- Contributed to sales growth by upselling products and services based on individual customer requirements.
- Provided coaching and mentoring to new hires, contributing to their successful integration into the team.
- Exceeded performance metrics consistently, earning recognition as a top performer within the team.
- Coordinated with logistics department to expedite shipping for urgent customer orders.
- Resolved escalated customer issues, restoring confidence in company's commitment to service excellence.
- Customized support strategies for high-priority clients to ensure their specific needs were met.
- Negotiated solutions with dissatisfied customers, turning potential negative reviews into positive testimonials.
- Collaborated with product team to communicate customer feedback, resulting in product enhancements.
- Developed feedback system for customers to share their service experience, leading to actionable improvements.
- Enhanced customer loyalty by offering personalized solutions tailored to individual needs.
Certified Nurse Assistant (CNA)
Prattville Health and Rehabilitation
2018 - 2022
- Record patients' medical history, vital statistics, or information such as test results in medical records.
- Prepare treatment rooms for patient examinations, keeping the rooms neat and clean. Interview patients to obtain medical information and measure their vital signs, weight, and height.
- Clean and sterilize instruments and dispose of contaminated supplies. Prepare and administer medications as directed by a physician. Show patients to examination rooms and prepare them for the physician. Explain treatment procedures, medications, diets, or physicians' instructions to patients. Help physicians examine and treat patients, handing them instruments or materials or performing such tasks as giving injections or removing sutures.
- Collect blood, tissue, or other laboratory specimens, log the specimens, and prepare them for testing.
- Contact medical facilities or departments to schedule patients for tests or admission. Change dressings on wounds.
- Set up medical laboratory equipment.
- Perform general office duties, such as answering telephones, taking dictation, or completing insurance forms.
- Greet and log in patients arriving at office or clinic.
- Schedule appointments for patients.
- Inventory and order medical, lab, or office supplies or equipment.
- Improved patient satisfaction by providing compassionate and attentive care.
- Maintained detailed patient records to facilitate accurate documentation and timely communication among healthcare professionals.
Certified Nurse Assistant (CNA), Patient Care Technician (PCT)
Baptist Health
01.2018 - 01.2022
- Maintain records of patient care, condition, progress, or problems to report and discuss observations with supervisor or case manager.
- Administer prescribed oral medications, under the written direction of physician or as directed by home care nurse or aide, and ensure patients take their medicine. Check patients' pulse, temperature, and respiration.
- Provide patients with help moving in and out of beds, baths, wheelchairs, or automobiles and with dressing and grooming.
- Care for patients by changing bed linens, washing and ironing laundry, cleaning, or assisting with their personal care.
- Plan, purchase, prepare, or serve meals to patients or other family members, according to prescribed diets.
- Accompany clients to doctors' offices or on other trips outside the home, providing transportation, assistance, and companionship.
- Direct patients in simple prescribed exercises or in the use of braces or artificial limbs.
- Provide patients and families with emotional support and instruction in areas such as caring for infants, preparing healthy meals, living independently, or adapting to disability or illness.
Call Center Representative
Sykes Call Center, Bank of America
01.2019 - 01.2021
- Managed high call volumes while providing exceptional customer support and maintaining professional composure.
- Handled escalated calls professionally, effectively resolving complex issues and ensuring client satisfaction at all times.
- Mastered multiple software systems for seamless navigation during calls, improving efficiency and reducing hold times for customers.
- Enhanced customer satisfaction by efficiently addressing and resolving inquiries in a timely manner.
- Reduced average call handling time, ensuring prompt service to customers while maintaining quality interactions.
- Developed rapport with customers through empathetic listening skills, creating positive experiences even during difficult conversations.
- Maintained detailed records of customer interactions, streamlining communication efforts between various departments.
- Streamlined call flow processes for more efficient response times and increased productivity.
- Participated in ongoing training and development, staying current on company policies, products, and procedures to deliver accurate information to customers.
- Improved first-call resolution rates with thorough issue analysis and effective problem-solving techniques.
- Delivered consistent top-notch performance under pressure during peak calling hours or challenging situations.
Customer Service Agent
Piedmont Airlines
01.2014 - 01.2019
- Demonstrated empathy in handling difficult situations, fostering trust and loyalty among customers.
- Effectively managed escalations from dissatisfied customers, working closely with management to ensure timely resolutions that maintained brand reputation.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Demonstrated high attention to detail, organization and management of multiple tasks and projects simultaneously.
- Clearly communicated product features and benefits, helping customers make informed decisions about their purchases.
- Addressed customer account discrepancies and concerns.
- Contributed to achieving company goals by consistently meeting or exceeding performance metrics.
- Assisted in training new hires, sharing best practices for effective customer service delivery.
- Streamlined communication processes for improved information exchange between customers and team members.
- Responded proactively and positively to rapid change.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Investigated and resolved customer inquiries and complaints quickly.
Education
Bachelor of Science - Forensic Psychology
Southern New Hampshire University
Hooksett, NH05-2028
Business Administration - undefined
Javelin Technical College
01.2012
High School Diploma - undefined
Marietta High School
01.2006
Skills
- Microsoft: Outlook, Teams, Word, Excel
- Customer Service/Call Center (15 YRS EXPERIENCE)
- Health Plan/Payor & Provider experience
- Certified Nurse Assistant (CNA)
- Medical Data Entry/Data Management
- Attention to detail
- Team collaboration
- Audit reporting
- Decision-making
- Bookkeeping
- Clear communication
- Compliance standards
- Audit planning
- Process evaluations
- External auditing
- Internal auditing
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Resolved product issue through consumer testing.
- Achieved excellent results by completing Auditing tasks with accuracy and efficiency.
Timeline
Auditor Credentialing Operator
NTT DATA/AMERI HEALTH CARITAS
01.2023 - 10.2024
Claims Representative
NTT Data
05.2022 - 10.2024
Customer Service Representative
Hamilton Relay Svc Inc
01.2022 - 05.2022
Remote, Customer Service Representative
Blue Cross Blue Shield Michigan
10.2021 - 01.2022
Call Center Representative
Sykes Call Center, Bank of America
01.2019 - 01.2021
Certified Nurse Assistant (CNA), Patient Care Technician (PCT)
Baptist Health
01.2018 - 01.2022
Customer Service Agent
Piedmont Airlines
01.2014 - 01.2019
Business Administration - undefined
Javelin Technical College
High School Diploma - undefined
Marietta High School
Certified Nurse Assistant (CNA)
Prattville Health and Rehabilitation
2018 - 2022
Bachelor of Science - Forensic Psychology
Southern New Hampshire University
National Honors Society
Inducted in to National Honor Society while currently attending college for my BA in Forensic Psychology
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