Madeline Thomas
Faunsdale,AL
Summary
Highly motivated employee with a strong work ethic, adaptability, and exceptional interpersonal skills. Skilled at working effectively unsupervised and quickly mastering new skills. Brings years of experience and a willingness to take on any challenge. Organized, driven, and adaptable professional with a successful history managing high caseloads in fast-paced environments.
Overview
34
34
years of professional experience
Work History
HC & Insurance Operations Senior Representative
NTT DATA, Blue Cross Blue Shield Remote
09.2022 - Current
- Provided customer service to internal and external customers related to health insurance claims, billing issues, and policy questions.
- Reviewed and analyzed medical claims data for accuracy and compliance with established guidelines.
- Processed requests for new coverage or changes to existing policies, including reviewing applications, verifying eligibility information, and confirming enrollment details.
- Generated reports on claim processing activities, such as denials and appeals.
- Resolved escalated customer inquiries regarding billing discrepancies or policy disputes.
- Investigated complex customer complaints concerning HC and Insurance services.
- Responded to inquiries from regulatory agencies about HC and Insurance policies and procedures.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Examined claims, records and procedures to grant approval of coverage.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Collaborated with fellow team members to manage large volume of claims.
- Organized information by using spreadsheets, databases or word processing applications.
Tax Preparer
Happi Tax
09.2010 - Current
- Prepared and reviewed tax returns for individuals, partnerships, corporations and trusts.
- Compiled data from clients to accurately complete tax forms.
- Identified potential deductions to minimize clients' tax liabilities.
- Researched federal, state, and local laws to ensure compliance with regulations.
- Provided guidance on financial decisions related to taxes.
- Assisted clients in responding to IRS notices of deficiency or audit findings.
- Analyzed financial information such as income statements and balance sheets to calculate tax liability.
- Maintained accurate records of all client transactions and filings.
- Advised clients on the best strategies for filing their taxes efficiently and legally.
- Reviewed prior year's returns for accuracy and completeness before submitting them.
- Created spreadsheets detailing income sources, deductions, credits, estimated payments.
- Ensured that all applicable deadlines were met when submitting documents.
- Assisted customers with any questions they had about their taxes or filing status.
- Filed electronically through approved software programs.
Military Administrator
US Army
01.2017 - 12.2023
- Administered the ASVAB test to potential candidates
- Responsible for the security and accountability of all testing materials
- Utilize computer systems and software to administer computer -based enlistment and aptitude tests
- Assisted in the development of new administrative systems, procedures and policies.
- Maintained filing system for important documents such as contracts and invoices.
- Provided general administrative support to staff members.
- Supported departmental activities by providing clerical assistance as needed.
- Ensured that all paperwork was completed accurately before submission deadlines.
Healthcare Enrollment Specialist
Carenet
03.2019 - 04.2022
- Promote new insurance policies for existing customers and participate in continuing education program
- Knowledge of HIPAA and state regulations related to the release of Protected Health Information, preferred
- Following up with customers to finalize the enrollment process
- Utilize phones to enroll patients in various benefit packages suitable for their expressed needs
- Obtain referrals and pre-authorizations as required for procedures
- Answer all patient or insurance telephone inquiries pertaining to assigned accounts
- Reviewed and evaluated applicants' eligibility for programs based on their financial status, medical history, and other criteria.
- Followed up with applicants who had pending documents or outstanding issues related to their applications.
- Performed data entry into computer systems to update applicant files as needed.
- Reviewed applications and supporting documents to determine applicant's eligibility for Medicaid and Medicare benefits.
- Maintained up-to-date knowledge of state and federal regulations pertaining to Medicaid and Medicare eligibility.
Assistant Manager
Family Dollar
08.2015 - 08.2017
- Assisted in the development of operational strategies to ensure efficient and productive operations.
- Conducted regular performance reviews for employees to identify areas of improvement.
- Developed a system for tracking inventory and ordering supplies as needed.
- Monitored employee attendance records, timekeeping, and payroll information.
- Managed customer service inquiries and complaints in a timely manner.
- Resolved conflicts between team members in an effective manner.
- Maintained up-to-date knowledge of company products and services.
- Collaborated with management on developing strategic plans for achieving business goals.
- Organized training sessions for new hires to familiarize them with the workplace environment.
- Communicated regularly with customers to gain insights into their needs.
- Created reports on sales trends, inventory levels, and financial data.
Recruiting Specialist - Patient Administrator
U.S. Army
08.1990 - 08.2015
- Provide training for possible recruits joining the military
- Interviewing, recruiting, and testing possible candidates for the armed forces
- Preparing reports for the commanders that detailed the progress of their recruiting program
- Provide Administrative and Patient care services for the coordination of ongoing clinical trials
- Assist with outpatient care, treatment, as well as patient teaching
- Trained in all aspects of administration for patient care
- Managed emergent and routine patient care procedures
- Supervised and performed administrative duties in the patient administration division of an Army hospital as the supervisor of Outpatient Medical Records
- Directed Medical Records Department personnel in processing patient admission/discharge, auditing records for accuracy/completeness and updating patient medical records
- Initiate correspondence pertaining to medical records, line of duty investigation, and reports pertaining to patient administration
- Compile data and prepare required statistical reports; initiate correspondence pertaining to medical records and other required reports
- Identify patients by screening them for eligibility using electronic medical records, in person interviews and telephone screenings
- Knowledge of HIPAA and state regulations related to the release of Protected Health Information, preferred
- General office equipment including desktop computer, scanner, Microsoft Office Suite
Education
Bachelor of Interdisciplinary Studies -
Liberty University
Lynchburg, VA01.2022
Associate - Business Administration
Saint Mary College San Antonio
01.1992
High School Diploma -
Amelia Love Johnson High School
Thomaston, AL01.1989
Skills
- Eligibility Determination
- Customer Service
- Data Entry
- Medicaid and Medicare Knowledge
- Claims Processing
- Medical Terminology
- Insurance Plan Verification
- Microsoft Office : Word, Outlook, Excel
- Documentation Skills
- Insurance Terminology
- Teamwork and Collaboration
- Proficiency in CMS, Salesforce, Facets, Metvance, QNXT, IKA and many other systems
- HIPPA Compliance
- Attention to Detail
- Administrative Support
- Tax Preparation
Timeline
HC & Insurance Operations Senior Representative
NTT DATA, Blue Cross Blue Shield Remote
09.2022 - Current
Healthcare Enrollment Specialist
Carenet
03.2019 - 04.2022
Military Administrator
US Army
01.2017 - 12.2023
Assistant Manager
Family Dollar
08.2015 - 08.2017
Tax Preparer
Happi Tax
09.2010 - Current
Recruiting Specialist - Patient Administrator
U.S. Army
08.1990 - 08.2015
Bachelor of Interdisciplinary Studies -
Liberty University
Associate - Business Administration
Saint Mary College San Antonio
High School Diploma -
Amelia Love Johnson High School
Similar Profiles
Crystal BrownCrystal Brown
Business System Analyst at Blue Cross Blue Cross Blue Shield of Tennessee (Facets Billing)Business System Analyst at Blue Cross Blue Cross Blue Shield of Tennessee (Facets Billing)
Kristen BrackmannKristen Brackmann
Customer Service Advocate at Blue Cross Blue Shield of Florida, Florida BlueCustomer Service Advocate at Blue Cross Blue Shield of Florida, Florida Blue
Mercedes RaysorMercedes Raysor
Clinical Support IV at Florida Blue - Blue Cross Blue Shield Of FloridaClinical Support IV at Florida Blue - Blue Cross Blue Shield Of Florida