John McBride
Rock Hill,SC
Summary
Dynamic Quality Analyst with a proven track record at Cencora, excelling in claims processing and reimbursement optimization. Adept at cross-functional collaboration and quality auditing, I consistently enhance operational efficiency and customer satisfaction. Recognized for strategic thinking and attention to detail, I drive results through effective problem-solving and relationship management.
Overview
19
19
years of professional experience
Work History
Quality Analyst
Cencora
Conshohocken, Pennsylvania
10.2019 - Current
- Verify patient insurance eligibility and benefits to facilitate reimbursement
- Research and interpret insurance policies to identify coverage and restrictions
- Obtain prior authorizations and pre-certifications for services and procedures
- File appeals for denied medical claims and follow up to ensure resolution
- Resolve claim underpayments by identifying errors and working with providers/insurance
- Review explanation of benefits and remit reports to identify reimbursement issues
- Work with medical billers and coders to optimize reimbursement
- Track reimbursement delays and denials to identify trends
- Provide customer service to patients and providers regarding claims status
- Manage accounts receivable aging and collections
- Maintain compliance with regulations and payer policies
- Conducted quality audits to ensure compliance with industry standards.
- Developed and maintained quality documentation for process improvement.
- Conducted root cause analysis to investigate the source of problems in production process.
- Maintained records of inspection results, test data, and other relevant information.
- Trained team members on quality assurance protocols and best practices.
- Reviewed and approved product specifications for accuracy and completeness.
- Collaborated with cross-functional teams to address quality issues effectively.
- Implemented corrective actions to enhance product quality and safety.
- Collaborated with cross-functional teams to ensure that product specifications are met or exceeded.
- Wrote and updated manual test cases for team use, maintaining optimal organization for maximum productivity.
- Created and maintained database of common and known testing defects.
- Tested functionality, performance and compliance of each product against design specifications to maintain strong development standards and high customer satisfaction.
Assistant Manager
Walmart Inc.
09.2006 - 10.2019
- Assisted team members with delivering friendly, knowledgeable service to every customer by applying proactive monitoring and corrective action strategies.
- Reduced company expenditures and met budget targets by closely monitoring, tracking and controlling expenses.
- Assessed job applications and made hiring recommendations to bring in top candidates for key vacancies.
- Applied performance data to evaluate and improve operations, targeted to current business conditions and forecasted needs.
- Met or surpassed business targets on regular basis through strategic employee engagement and forward-thinking planning.
- Reconciled daily sales transactions to balance and long day-to-day finances with Point OF Sale software.
Collections Specialist
Conduent
Charlotte, NC
02.2017 - 07.2018
- Negotiated to collect balance in full.
- Discussed options with delinquent clients in terms of proposed solutions or foreclosure.
- Delivered exceptional customer service on all calls while maintaining calm and professional demeanor in challenging circumstances.
- Counseled debtors on payment options and arranged installment agreements.
- Set up drafts and processed immediate payments after conducting thorough research and analysis of account.
- Worked in call center environment handling and automatically dialed outbound calls.
- Achieved performance goals on consistent basis.
Call Center Customer Service Representative
Iqor Inc.
Pineville, NC
05.2016 - 02.2018
- Enhanced productivity by staying on top of call scripts and maintaining control over direction of conversations.
- Educated customers how to use company systems, complete forms and obtain desired services.
- Contributed to company achieving and holding industry-leading customer service ratings.
- Adhered to company policies and scripts to consistently achieve call-time and quality standards.
- Entered customer interaction details in company software to track requests, document problems and record solutions offered.
- Quickly and accurately answered Customer questions, suggested effective solutions and resolved issues to increase customer satisfaction 100%.
- Sought out training opportunities to enhance customer relationship management abilities and further boost satisfaction scores.
Education
Associate of Arts - business administration and management
Florence Darlington Technical College
12.2005
High school Diploma -
Dillon High School
Dillon, SC05.2003
Skills
- Goal-oriented
- Database Management
- Strategic Thinker
- Goals and performance
- Financial operations management
- Cash handling
- Team leadership and coaching
- Relationship building and management
- Quality auditing
- Claims processing
- Medical coding
- Customer relationship management
- Compliance management
- Data analysis
- Team leadership
- Problem solving
- Cross-functional collaboration
- Reimbursement optimization
- Attention to detail
Timeline
Quality Analyst
Cencora
10.2019 - Current
Collections Specialist
Conduent
02.2017 - 07.2018
Call Center Customer Service Representative
Iqor Inc.
05.2016 - 02.2018
Assistant Manager
Walmart Inc.
09.2006 - 10.2019
Associate of Arts - business administration and management
Florence Darlington Technical College
High school Diploma -
Dillon High School