NEUZA BARROS
BROCKTON,MA
Summary
I am a seasoned Audit Specialist with years of hands-on experience within Blue Cross and Blue Shield of Massachusetts. I am eager to contribute to the Electronic Enrollment Teams success through hard work and dedication.
Overview
19
19
years of professional experience
Work History
Audit Specialist
Blue Cross And Blue Shield Of Massachusetts Inc.
Hingham, MA, MA
03.2014 - Current
- Perform compliance audits for Member Touch Point Measures (MTM) and Federal Employee Program (FEP)
- Conduct Performance Guarantee Audit reviews for specific accounts.
- Facilitate ASC financial and comprehensive claims audits.
- Acting liaison between internal business areas and external parties to execute and meet strict audit timelines.
- Monitor the external audit schedules to ensure all projects are on track.
- Produce audit summary reports to internal business leaders with audit results and corrective action suggestions to bring business areas in line with standards.
- Participate in routine conference calls with Operational areas, Sales, third party vendors and the PPMR team to support current audit protocols and provide corrective action feedback.
National Claims Processor III
Blue Cross And Blue Shield Of Massachusetts Inc.
Hingham, MA
02.2012 - 02.2014
- Process a large volume of managed care claims using Nasco, B2, TPS, RTMS and Data entry.
- Identify and Investigate system discrepancies for resolution.
- Followed up with internal business areas on unresolved issues.
Quality Assurance Coach
Blue Cross And Blue Shield Of Massachusetts Inc.
Hingham, MA
03.2008 - 02.2011
- Scheduled and hosted quality review meetings with associates to review effectiveness and accuracy of claims and service sample processing.
- Created and distributed monthly reports to capture individual and team performance.
- Applied coaching techniques and tools to support managers and team members in improving performance and quality results.
Interplan Service-Claims Associate
Blue Cross And Blue Shield Of Massachusetts Inc.
Hingham , MA
03.2004 - 02.2007
- Acted as the primary point of contact for associates to resolve claims and benefits inquiries with other Blue Cross and Blue Shield plans.
- Processed complex claims inquiries from the team, internal business areas and other Blue Cross and Blue Shield plans using Nasco and ITS Systems.
- Modified, updated and processed existing policies.
FEP Member Service Representative II
Blue Cross And Blue Shield Of Massachusetts Inc.
Hingham, MA
03.2001 - 03.2004
- Quickly and accurately answered customer questions, suggested effective solutions and resolved issues to increase customer satisfaction.
- Displayed excellent phone etiquette and ability to perform multiple tasks and meet high production requirements.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
Education
No Degree - Liberal Arts And General Studies
Bridgewater State University
Bridgewater, MASkills
- Strong knowledge of BCBSMA functions
- Critical Thinking and Analysis
- Audit Preparation
- Effective and Professional Communication
- Manage multiple deadlines
Timeline
Audit Specialist
Blue Cross And Blue Shield Of Massachusetts Inc.
03.2014 - Current
National Claims Processor III
Blue Cross And Blue Shield Of Massachusetts Inc.
02.2012 - 02.2014
Quality Assurance Coach
Blue Cross And Blue Shield Of Massachusetts Inc.
03.2008 - 02.2011
Interplan Service-Claims Associate
Blue Cross And Blue Shield Of Massachusetts Inc.
03.2004 - 02.2007
FEP Member Service Representative II
Blue Cross And Blue Shield Of Massachusetts Inc.
03.2001 - 03.2004
No Degree - Liberal Arts And General Studies
Bridgewater State University
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