Arthur Lee
Virginia Beach,VA
Summary
Detail-oriented professional with over five years of experience in clinical documentation, documentation review, and organizational support, complemented by a decade in a call center environment. Expertise includes healthcare operations, insurance verification, and HIPAA compliance, supported by strong communication skills developed through diverse roles in call centers and sales. Proficient in Microsoft PowerPoint and various word processing tools, offering a solid foundation in office administration along with a commitment to accuracy and efficiency. Thrives in fast-paced environments, fostering a continuous desire for learning and growth.
Overview
12
12
years of professional experience
Work History
Data Entry Specialist
Elevance Health
06.2019 - 04.2024
- Manage and maintain accurate provider network data, ensuring all information is up-to-date and compliant with internal standards and regulatory requirements.
- Collaborate with internal teams including credentialing, contracting, and analytics to support seamless provider onboarding and data integrity.
- Conduct thorough audits of network data using internal systems and Excel-based tools to identify discrepancies and implement corrective actions.
- Support data integration processes between systems (e.g., provider management systems, claims platforms, and third-party vendors) to improve operational efficiency.
- Monitor key performance metrics and generate reports for internal stakeholders to track network adequacy, provider demographics, and participation status.
- Ensure timely responses to data inquiries from health plans, providers, and regulators with a focus on accuracy and professionalism.
Customer Service Representative
Anthem, Inc.
06.2017 - 06.2019
- Acts as an advocate for customers by providing support and guidance of their anticipated needs, personal options and decisions.
- Demonstrates written and verbal communication skills, and the ability to properly tailor assistance to customers’ level of experience and knowledge.
Customer Service Representative
Aerotek @Anthem
10.2016 - 06.2017
- Acted as an advocate for customers by providing support and guidance of their anticipated needs, personal options and decisions.
- Demonstrated written and verbal communication skills, and the ability to properly tailor assistance to customers’ level of experience and knowledge.
Member Service Representative
Aerotek @Anthem
11.2015 - 07.2016
- Maintained enrollment database by verifying enrollment status, makes changes to records
- Researched and resolves enrollment system rejections
- Responsible for all billing and delinquency processes for assigned groups
- Ensured accuracy and timeliness of the membership and billing function
- Responded to inquiries concerning enrollment processes
- Performed error output resolution for electronic eligibility and processes error discrepancy list
- Maintained and reconciles premium bill, payments, self-bill and individual billed accounts
- Notified clients of premium discrepancies through payment adjustment notices and detailed audits
Database Research/Customer Service
Aerotek @IMS Health
10.2014 - 10.2015
- Researched location of medical staff and information such as Legal name, address, telephone numbers, state license information, etc. by searching the internet, state boards, and DEA website
- Followed proper procedures for quality assurance and met all performance management matrices including sites per hour and sites per day
- Obtained new names for new sites created on database file and open positions and titles at existing sites in database files
- Verified and update all existing database information for accuracy
- Performed Data entry for pharmaceutical companies into a database for all pharmaceutical clients
Customer Service Representative
GEICO
04.2012 - 10.2014
- Resolved customer inquiries by explaining insurance coverage and making changes to policies.
- Sold additional insurance products to fill gaps on customer's policies.
- Handled an average of 75 calls per day.
Education
High School Diploma -
Tabernacle of Prayer Christian School
Norfolk, VA06-2000
Skills
- Microsoft Powerpoint
- Clinical documentation (5 years)
- Insurance verification
- Call center experience
- Word processing
- Office experience
- Documentation review (5 years)
- HIPAA
- Organizational skills (5 years)
- Sales
- Medical terminology
- Risk management
- Analysis skills
- Clinical data entry (5 years)
- Outside sales
Additional Information
- Computer System Proficiency
- Input information for clients using Excel and Onekey
- Utilize Dual Monitors and MS Office for daily work responsibilities
- Retrieving documents from Cactus and Macess in order to verify disclosures of ownership
- Input information and make corrections in Facets
- WEM and ISG to research discrepancies in clients information and make corrections
- Utilize Outlook email system
Timeline
Data Entry Specialist
Elevance Health
06.2019 - 04.2024
Customer Service Representative
Anthem, Inc.
06.2017 - 06.2019
Customer Service Representative
Aerotek @Anthem
10.2016 - 06.2017
Member Service Representative
Aerotek @Anthem
11.2015 - 07.2016
Database Research/Customer Service
Aerotek @IMS Health
10.2014 - 10.2015
Customer Service Representative
GEICO
04.2012 - 10.2014
High School Diploma -
Tabernacle of Prayer Christian School
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