ERIKA CODY
Crawfordville,FL
Summary
Resourceful Supervisor trained in resolution of critical issues within time-sensitive environment with successful track record of building and maintaining talented teams. Highly organized, energetic and versatile leader committed to continuous improvements. Proven history of motivating staff to work together to achieve targets.
Overview
10
10
years of professional experience
Work History
Call Center and Relations Supervisor for WY Medicaid
CNSI
04.2021 - Current
- Manage, coach and develop 10-20 staff members daily
- Conduct employee interviews, new hire on-boarding and terminations
- Analyze, Correct and Explain Medical Claim processing errors and payment methodologies to Staff, Medical Provider, Billing Agents and Clearinghouses
- Create Staff Development materials
- Analyze Call Center Service Level Agreement Metrics
- Create and Distribute project projection reports
- Organize and Conduct Leadership Meetings across departments
- Review, Revise and Create Medical Policy’s and Call Center Standard Operating Procedures
- Manage and Operate Call Center Tools such as CRM, IVR Genesys, Claims Processing Software (BMS), Jira, OKTA and SharePoint
- Assist with Provider and Member Medicaid Enrollment and Outreach Requests
- Provide Escalated Customer Services assistance and problem-solving solutions regarding Provider and Member complaints.
Resolutions and Adjustment Specialist (Claims Processor)
CNSI
06.2020 - 04.2021
- Analyze, Process and Resolve the following Claim Types: Durable Medical Equipment (DME), Professional, Medical, Outpatient, Inpatient, Dental, Tribal, IHS, RHS, FQHC, Hospice and Home Health Claims
- Train Staff on Claims Processing based on provided Resolution Text
- Analyze Claim Edits for accuracy
- Revised and Create Edit Logics
- Data Entry and Code review for CMS-1500, UB-04 and ADA Claims
- Adjust Medical Claims based on Provider’s written requests
- RTP Missing and Invalid Documents with proficient written explanations
- Organize and distribute Medical Claims inventory for Processing to met Service Level Agreements (SLAs).
Pharmacy Technician III/Trainer
Phoebe Putney Memorial Hospital
04.2017 - 04.2020
- Assist Pharmacists with completing physician orders on medication request by gathering medications, mixing medications, completing and processing orders and delivering these items to administrators such as Surgeons, Nurses, Respiratory Technicians, and other medical staff
- Assist Nurses with different medication issues by demonstrating how to properly use the medication dispensing machines, how to properly document medication waste and answered other medications questions
- Assist inpatients and outpatients on the proper use and administration of their medications by creating template tutorials
- Consult with Providers in making alternations to patient’s medications based on medical coverage
- Contact Patient’s insurance carries for verify and obtain coverage information
- Process claims for eligible patients on the Hospital’s “Indigent” Insurance program including Data Entry and Dispensing
- Manage, Process, Organize, and Distribute Narcotic Drug Inventory and corresponding invoices into dispensing machines and software
- Order Narcotic Drugs based on hospital use levels
- Manage and Train New and Current Pharmacy Technicians quarterly on Pharmacy polices and procedures.
Assistant Manager
Footlocker
11.2014 - 03.2017
- Supervisor 5-10 Staff Members Daily
- Manage and Distribute Store Tasks to 5-10 staff daily and demonstrate how each should be performed
- Perform store opening and closing tasks daily
- Perform evaluations and provide sales tips for improvement to staff members
- Conduct Inventory Audits
- Entered data and searched inventory through company software, utilized Microsoft Office Word & Excel
- Stock and Maintain inventory records of shipment and current stock
- File paperwork and Data Entry regarding invoices, receipts, orders, ect
- Daily
- Create and Set-Up Store Displays based on new product arrivals
- Assist with store budgets and profit margin reports
- Create Staff Schedules and Approve Timesheets
- Provide Escalated Customer Services assistance and problem-solving solutions regarding customer complaints
- Sale products to customers.
Education
Associate of Science - Pharmacy (Pre-Pharmacy)
Albany Technical College
Albany, GA05-2016
Associate of Science - Pharmacy (Pre-Pharmacy)
Darton State College
Albany, GA06-2014
High School Diploma -
Mitchell County High School
Camilla, GA05-2011
Skills
- Proficient verbal and written communication skills
- Proficient Team and Individual Work skill
- Self-Sufficient
- Excellent Problem-Solving skills and Critical Thinking skills
- Dependable
- Trust-worthy
- Generate excellent work in reporting with Exquisite Attention to Detail
- Driven to go above and beyond in any job position to improve a company’s overall quality of work
- Staff Management
- Business Development
- Process Improvement
- Operations Management
- Data Analytics
- Inventory Control
- Schedule development
- Training and mentoring
- Policy Enforcement
- Process Monitoring and Improvement
- Complex Problem-Solving
- Goal-Oriented
- Employee Motivation
- Inventory Oversight
- Processes and procedures
- Payments posting
- Claims review
- Transactions reconciliation
- Regulatory Compliance
- Accuracy and Precision
- Policy Interpretation
- Medical terminology knowledge
- Eligibility Determination
- Claim Amount Calculations
- Customer Service
- Data Entry
- Client Interviews
- Insurance Claim Forms Review
- Teamwork and Collaboration
- Data Entry Software
- Insurance terminology
- Medicaid knowledge
- Medical Terminology
- Information Verification
- Recordkeeping Organization
- Billing Software
- Written Communication
- Microsoft Office
- Decision-Making
- Application Review
- Insurance Coverage Verification
- Time management abilities
- Insurance plan verification
- Self Motivation
- Relationship Building
- Claims Processing
- Understanding of medical terms
License and Training
- Licensed Claims Adjuster, Florida, 2024
- Medicaid and TPL Insurance Trainer, 2021
- Medical Insurance Claims Processor, 2020
- Insurance Verification Specialist, 2017
- Licensed Pharmacy Technician, 2016
References
Available Upon Request
Timeline
Call Center and Relations Supervisor for WY Medicaid
CNSI
04.2021 - Current
Resolutions and Adjustment Specialist (Claims Processor)
CNSI
06.2020 - 04.2021
Pharmacy Technician III/Trainer
Phoebe Putney Memorial Hospital
04.2017 - 04.2020
Assistant Manager
Footlocker
11.2014 - 03.2017
Associate of Science - Pharmacy (Pre-Pharmacy)
Albany Technical College
Associate of Science - Pharmacy (Pre-Pharmacy)
Darton State College
High School Diploma -
Mitchell County High School
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