KIMBERLY THOMAS

• Review incoming agreements and upload terms and conditions to the Rebates and Admin Fee system
• Prepare rebate verification form templates for customers to ensure timely data submissions
• Efficiently complete Microsoft Excel spreadsheets, conditional formatting
• Manage the shared email box, responding to internal and external customer inquiries and appropriately assigning email tasks to rebate analysts
• Complete check submissions and accompanying reports, ensuring the log is complete and up to date
• Operate independently within a varied and changing scope of responsibilities under some supervision
• Provide support for internal audits through the collection and submission of requested documents
• Conduct audits of provider information and escalate issues for resolution as appropriate
• Operate independently within a varied and changing scope of responsibilities under some supervision
• Compliance with internal policies.
• Collected, arranged, and input information into database system.
• Organize and input gathered information into a digital database. (SAP, RADB, Wizard)

• Provider support for baseline provider data transactions that cannot be administered automatically via provider database due to system limitations and/or data integrity issues
• Perform baseline demographic transaction updates utilizing provider system applications in support of claim adjudication and provider directory
• Resolve on-going department support using research and analysis essential to resolving concerns/issues raised by providers and internal/external customers
• Conduct audits of provider information and escalate issues for resolution as appropriate
• Modify and update existing policies and claims to reflect change in beneficiary, amount of coverage, or type of insurance.
• Processed 30 + transactions per day
• Evaluated customer needs and feedback to drive product and service improvements.

• Maintain provider enrollments in Medicare and Medicaid across various states
• Support members through navigation of enrollment process to facilitate optimal decisions
• Analyze information from interviews, educational and medical records, consultation with other professionals, and diagnostic evaluations to assess clients' abilities, needs, and eligibility for services
• Process benefits applications with an 100% accuracy rate
• Explain eligibility details and affordability options to patients with kindness and respect
• Follow up with insurance carriers to address and rectify denied claims.
• Developed and maintained courteous and effective working relationships.

• Assisted with configuration issues and loading of provider information as needed
• Maintained accurate and timely maintenance of critical provider information on all claims and provider databases
• Validated data housed on provider databases and ensured adherence to business and system requirements of customers respective to contracting, network management, and credentialing
• Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
• Strong system knowledge, problem solving skill
• Uploading 30 + Provider profiles per day.

• Oversaw regulatory and strategic initiatives to ensure accuracy of Medi-cal claims
• Responded to written claim inquiries professionally
• Increased member satisfaction rate by 48% via providing claim updates and corrections
• Acted as intermediary between insurance companies and customers, including researching and assessing information to determine validity of claims via QNXT data base
• Modified, updated, and processed existing policies and claims to reflect changes in beneficiary, amount of coverage, and type of insurance
• Improved profit margins by 62% with streamlining operations and workflow.
• Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
• Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
• Maintained confidentiality of patient finances, records, and health statuses.
• Checked documentation for accuracy and validity on updated systems.
• Maintained strong knowledge of basic medical terminology to better understand services and procedures.
• Verified client information by analyzing existing evidence on file.

Handled escalated calls for front-line associates to address complex issues and restore customer satisfaction

• Cultivated impactful relationships with customers and drove business development by delivering product knowledge for Medicare members
• Informed customers about billing procedures, processed payments, and provided payment option setup assistance
• Trained new employees on procedures and policies to maximize team performance
• Performed troubleshooting, mediation, and resolution to complex member issues
• Maintained legal protection and transparency via documenting transactions with comprehensive member forms and summarized actions taken for improved internal communication.
• Received and managed up to 30 calls from hospitals and PCP office

• Assisted Medi-cal customers by answering questions, addressing concerns, and providing current account information
• Educated customers about products, pricing, and policies to address and resolve issues
• Met and exceeded performance goals to support long-term company growth and market dominance
• Handled approximately 100 calls each day, including new sign-ups, service cancellations, and cross-selling opportunities
• Oversaw and guided team of 10 associates to handle customer call escalations, training, and mentoring new employees on customer service and order processing.