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
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