LaMeshia N. Owens
Fruitland Park,FL
Summary
An analytical and detail-oriented quality assurance professional with a wide array of experience in healthcare operations, QA auditing, enrollment/disenrollment, compliance, and billing. Proven aptitude for client relations, records management, workforce development, data entry, and auditing. A dedicated and performance-driven multi-tasker with an unwavering commitment to excellence who utilizes exceptional communication skills to successfully accomplish and exceed organizational goals.
Overview
19
19
years of professional experience
Work History
Workforce Management Real Time Analyst/ Planner
HEALTH PLAN ONE
08.2018 - Current
- Conduct capacity planning and gap staffing analysis during the onboarding of new accounts or staff reductions.
- Create internal forecasts based on historical data.
- Create schedules that satisfies the forecasted need based on interval level data.
- Maintaining a partnership with the client as the representative of Workforce Management.
- Communicate closely with Management regarding risks to Service Levels and guidance for recovery
- Retrieve intraday reporting data for root cause analyses and reporting
- Add/update agent accounts in IEX and set scheduling rules and availabilities for schedule generation
- Conduct agent schedule changes and trades in IEX
- Add agent skills and update skill level proficiencies
- Monitor Realtime Adherence
- Work well with team and individually
- Update and send Attendance Reporting to Management
- Create job aides on policies
- Share best practices with team members
- Complete Ad Hoc requests and Special Projects as assigned
Enrollment and Billing Specialist, Quality Assurance Auditor
Healthfirst
01.2013 - 06.2018
- Acted as subject matter expert (SME) on New York State rules and regulations concerning Medicaid, Family Health Plus, and Child Health Plus health insurance lines of business
- Reviewed, audited, and underwrote eligibility for enrollment applications to ensure accuracy and compliance with mandated rules and regulations for each line of business concerning citizenship, immigration status, income (including self-employed taxes), residency proof, and family size
- Maintained quality scores above 95% and production levels above minimum required
- Met personal and departmental goals and deadlines
- Trained for internal auditing of billing and transactional enrollment
- Prepared and submitted disenrollment requests to health reimbursement account (Maximus/HRA), within state regulated compliance, and disenrolled coverage in managed health services upon termination file confirmation from state
- Transitioned to insurance software team resolving member inquiries, demographic, and enrollment issues for Senior Health Partners (SHP), Complete Care, FIDA Absolute Care, North Shore, Montefiore, Child Health Plus (CHP) (on/off Marketplace Exchange), and Medicaid (on/off Marketplace Exchange)
- Conducted trainings on SHP, North Shore, Montefiore, and CHP Off Exchange products
- Transitioned into managed long-term care team, managed membership, enrollments, disenrollments, state audit reporting, billing, and resolved member inquiries/issues for FIDA Absolute Care Plan
- Special Projects as assigned
Financial Services Associate
Amscot
01.2012 - 01.2013
- Maintained knowledge of governmental rules and regulations concerning financial transactions concentrating on money laundering, fraud, currency transaction report limits, suspicious activity reporting, and account maintenance
- Processed various bill payments and cash advances
- Provided customer service in fast-paced environment
- Received excellent scores from Secret Shopper surveys
- Achieved highest revenue rating in all branches assigned
- Collaborated with branch managers on duties, including customer escalations
Workforce Analyst, Seasonal Supervisor
Connextions
01.2006 - 01.2012
- Oversaw daily procedures of national operations center (NOC) to ensure meeting of minimum requirements for optimal service level maintenance, including resource allocation
- Escalated issues regarding any potential factors impacting or creating breach of contract for client, including communication with major health insurance accounts
- Budgeted assigned accounts
- Identified and reported trending and forecasting for assigned accounts and call volume
- Monitored agent adherence
- Fostered positive work environment
Education
Biology/Pre-Med. -
Stetson University
Deland, Florida01.2002
Skills
- Microsoft Office Suite
- MHS
- EzR
- EPaces
- Macess
- Royal
- AX/DMS
- CMS (Marx)
- Market Prominence
- PEGA
- CCMS
- APOS
- Nice IEX
- In Contact
- Quick Base
- Share Point
- Calabrio
- Verint
- Amazon Web Services
- Genysis
Timeline
Workforce Management Real Time Analyst/ Planner
HEALTH PLAN ONE
08.2018 - Current
Enrollment and Billing Specialist, Quality Assurance Auditor
Healthfirst
01.2013 - 06.2018
Financial Services Associate
Amscot
01.2012 - 01.2013
Workforce Analyst, Seasonal Supervisor
Connextions
01.2006 - 01.2012
Biology/Pre-Med. -
Stetson University
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