Cherteral Kincheon
Houston,Texas
Summary
Talented Self- Motivated Customer Service Professional with Administrative experience. Able to work in a fast pace environment with minimal supervision, while providing outstanding customer service in a timely manner to both internal and external customers. Experienced in scheduling, data entry, quality, and heavy documentation, and resolving complex issues. Dedicated to providing expertise in leadership customer service, analyzing, verbal/written skills, and office support.
Overview
9
9
years of professional experience
Work History
CRG Analyst
United Health Group
02.2024 - Current
- Perform high level research on complex member requests
- Maintaining accurate documentation in ORS/ Service forms
- Identifying and resolve anticipated member issues to prevent future calls
- Responsible for reviewing Claims and Resubmitting Claims to be paid
- Responsible for making PCP Changes, and sending proper documents to different departments within M&R
- Perform any follow-up work needed for resolving and close requests
- Ensure satisfaction by helping providers/members with timely and accurate status updates to their requests
- Extensive work experience, possibly in multiple functions
- Maintain proficiency in all technical applications (technical skills and system knowledge)
- Provide strong example of exemplarily leadership
- Meet Quality, Productivity and Attendance requirements
- Comply with all current policies, procedures and workflows
- Works Independently
AR Resolution Specialist- Claims
United Health Group/Optum Insight
04.2023 - 02.2024
- Work directly from main system which is Stockamp Reporting, Oasis Gold Client, and Cerner Solutions to review and resolve claims for accurate resolution
- Review and research denied claims by navigating multiple systems, to accurately capture data/information for accurate processing
- Interpret explanation of benefits for appropriate follow up action
- Responsible for writing appeals to different payors to resolve denied claims
- Communicate and collaborate with Patient Access or other back-end departments to ensure clear understanding on claims errors, issues, and trends
- Utilizes payer portals to verify eligibility, claim status and/or obtain better claim insight information
- Conduct data entry and re-work for adjudication of claims
- Work on multiple simultaneous projects as needed
- Meets performance goals in the areas of efficiency, accuracy, quality, client satisfaction and attendance
Service Account Manager
United Health Group C&S National Medicaid Growth Team
09.2020 - 04.2023
- Intake 80 to 90 calls per day from members, partners, and agents to assist with complex member renewal requests
- Update demographic information for various health plans
- Investigate member issues as identified and communicate resolution to customers in real time
- Create and develop training material for upcoming projects
- Facilitate trainings for several projects within various health plans to enhance employee skills in resolving customer issues, handling return calls, and navigating new systems
- Implemented successful action plans that improved the team’s overall performance with various projects for LA, NJ, and KS
- Analyzed data from multiple sources to ensure established numbers were met on a department level and prepared and presented reports to senior management
- Identify and resolve operational problems using defined processes, expertise, and judgement
- Provide coaching to team members regarding improvement opportunities
Member Advocate/CRG Intern
United HealthCare Services Inc.
11.2015 - 09.2020
- Respond to and resolve on the first call, member service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence for Medicaid/Medicare
- Help guide and educate members about the fundamentals and benefits of consumer-driven health care topics to include managing their health and well-being by selecting the best benefit plan options, maximizing the value of their health plan benefits and choosing a quality care provider
- Intervene with care providers (doctor's offices) on behalf of the member to assist with appointment scheduling or connections with internal specialists for assistance when needed
- Assist members in navigating myuhc.com and other UnitedHealth Group websites and encourage and reassure them to become self-sufficient
- Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member
- Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues
- Meet the performance goals established for the position in the areas of efficiency, call quality, member satisfaction, first call resolution and attendance
- Also selected to work Special Project for HARC Welcome Calls for the state of Iowa
- Selected to be part of Innovation Committee directed at finding ways to streamline processes, reduce cost, review SOP's for updates, find innovative solutions and communicating ideas while accomplishing all goals
CRG Intern
United Health Group
08.2016 - 08.2019
- Responsible for providing expertise and customer service support to members, customers, and/or providers
- Direct phone-based customer interaction to answer and resolve a wide variety of inquiries for both Medicaid and Medicare members
- Responsible for reviewing Claims and Resubmitting Claims to be paid
- Perform high level research on complex member request, accurately document ORS/SF Form, met all requirements in the proper TAT measured, work multiple functions within all states, and exemplify leadership
Education
Associate of Applied Science -
Houston Community College
Houston, TX05.1996
Skills
- Organized and detail-oriented
- Training skills
- Microsoft office proficiency
- Schedule management
- Knowledge of Medical Terminology
- Knowledge of ICD and ICD 10 Codes
- Cross-functional collaboration
- Customer relations
- Leadership Skills
- Excel in Facets
- Excel in AHCCS
- Excel in PSI & RX Claims
- Excel in Care One
- Excel in ICUE
- Excel in ISET
- Excel in Macess
- Excel in Sharepoint
- Excel in IEX
- Excel in Claims System
- Excel in Salesforce
- Excel in Community Care
- Excel in Maestro
- Excel in Genesys
- Excel in Epremis
- Excel in Availity
- Excel in FinThrive
- Excel in StockCamp
- Excel in Cerner
- Excel in OAS Gold Client
- Excel in GPS
- Excel in IR Tracker
- Excel in Agent Presence EWR Live
- Excel in CSP Claims Portal
- Excel in Echo UI
- Excel in B360UI
- Excel in Cosmos
Accomplishments
- Recognized as a Top Quality Performer
- Part of Innovation Team
Timeline
CRG Analyst
United Health Group
02.2024 - Current
AR Resolution Specialist- Claims
United Health Group/Optum Insight
04.2023 - 02.2024
Service Account Manager
United Health Group C&S National Medicaid Growth Team
09.2020 - 04.2023
CRG Intern
United Health Group
08.2016 - 08.2019
Member Advocate/CRG Intern
United HealthCare Services Inc.
11.2015 - 09.2020
Associate of Applied Science -
Houston Community College
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