Nichole Gordon
Raleigh,NC
Summary
Health Care Administrative II professional with over twenty years of progressive experience in customer service call center, insurance, hospitality and telecommunications industries. Hardworking and focused Administrative professional offering excellent communication, planning and prioritization skills demonstrated through 20 years of performance. Skilled at drafting reports and business correspondence, managing mail and updating tracking spreadsheets. Exceptional leadership skills with expertise in streamlining workflow to optimize personnel strengths.
Overview
24
24
years of professional experience
Work History
Healthcare Claims Assistant II
GDIT
04.2012 - Current
- Verifying operational audits and operational procedures are followed correctly for provider Enrollment
- Processing provider enrollment applications to ensure new and currently providers are within compliance within NC State regulations
- Validated the qualifications of licensed professionals, organizational members or organizations meet requirements and standards outlined in State business rules/desk procedures
- Perform and assess background check through LexisNexis, AAR, OIG and PPTD
Healthcare Claims Assistant II
CSRA
04.2012 - Current
- Perform source verification of licensure, certification, endorsements and accreditations through Lexis Nexis and State Licensure Board
- Deny provider that do not meet requirements
- Initiate inquiry on Provider Penalty Tracking (PPT), Office of Inspector General (OIG), and System for Award Management (SAM) and (MCSIS)
- Meet performance quality and quantity standards on a daily basis.
Credentialing Coordinator
CSC
04.2012 - Current
- Re-enroll an organization or provider based on business rules/desk procedures for specific entity or provider
- Initiate Intellicorp background check
- Initiate inquiry on Provider Penalty Tracking (PPT), Office of Inspector General (OIG), System for Award Management (SAM) and (MCSIS)
- Update and Complete Verification indicators within the NCTracks system in a timely fashion.
Customer Service Advocate
04.2012 - Current
- Answering incoming phone calls on behalf of client; provides accurate and appropriate information to callers
- Providing strong expertise in general claims support, reviewing, researching and resolving provider claim issues
- Providing strong expertise in general prior approval, recipient eligibility, enrollment verification, and pharmacy
- Adheres to Service Level Agreements, knowledge with MMIS Fiscal, Operation; Performs clerical or administrative duties as assigned
- Completes call guides; gathers and verify required information; Adheres to contact center scheduling, ensures telephone coverage during call center hours
Data Entry/Credentialing
CSC
12.2011 - 04.2012
- Compared data entered with source documents, or re-enters data in verification format on screen to detect errors
- Deletes incorrectly entered data and re-enters correct data, sort and verify accuracy of data entered
- Processed letters of intent to return/improve and reasonable assurance for providers
- Reviewed licensures, certifications, and other documents before sending application for background verifications.
Floor Supervisor / Team Lead
Grey Hound Bus Terminal
- Assisted associates with money transactions, customer assistants, and worked closely with terminal supervisor
- Announced bus schedules, for arrivals and departures
- Balanced and signed off on associates draws at end of shifts
- Assisted bus drivers with passengers, schedule changes, bus routes, delays, etc.
Customer Service/Sales Advocate
Kelly Service, All State Insurance
10.2010 - 01.2011
- Identified new advertising markets, and proposed products to serve them
- Prepared and delivered sales presentations to new and existing customers in order to sell new advertising programs, and to protect and increase existing advertising
- Obtained and studied information about clients' products, needs, problems, advertising history, and business practices in order to offer effective sales presentations and appropriate product assistance.
Floor Supervisor / Queue Monitor/Team Lead
AAA Auto Club
06.2007 - 09.2010
- Issued instructions and assigned duties to workers
- Communicated with other departments and management to resolve problems and expedite work
- Planned, prepared, and devised work schedules, according to budgets and workloads
- Reviewed and checked work of subordinates such as reports, records, and applications for accuracy and content and corrected errors.
Dispatcher
AAA Auto Club Group
07.2006 - 06.2007
- Dispatched tow truck or service truck to stranded vehicle
- Answered telephone and obtained and recorded on road service card information such as name of club member, location of disabled vehicle and nature of vehicle malfunction
- Relayed information to service station or tow truck in motorist's vicinity, using telephone or two-way radio.
Customer Service Agent & Sales
AAA Auto Club Group
01.2003 - 07.2006
- Obtained and examined all relevant information in order to assess validity of complaints and to determine possible causes, such as extreme weather conditions that could increase wait time on road service
- Kept records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken
- Completed contract forms, prepared change of address records, accepted payments, and issued service discontinuance orders, using computers.
Front Desk Associate and Concierge
Marriott Hotel (Plaza Towers Condominium)
09.2000 - 06.2003
- Transmitted and received messages, using telephones and telephone switchboards
- Contacted housekeeping and maintenance staff when guests reported problems
- Answered inquiries pertaining to condominium residents, registration of guests, and booked appointments for use of club house supervised four employees, scheduled work hours, resolved conflicts, determined responsibility duties, handled all resident's needs, worked closely with property managers, entertainment, and travel directions.
Education
Associate Degree/ Criminal Justice Degree -
Wake Technical Community College
Wake Technical Community College
Skills
- Good listening, oral and written communication skills
- Documentation, analytical & problem solving skills, Knowledge of NC Medicaid or Healthcare, Working with NCTracks
- Proficient with computers printer and associated peripherals devices, Proficient with Microsoft Office Suite programs to include Word, Excel
- Over 20 years of superior customer service skills
- Credentialing experience
Timeline
Healthcare Claims Assistant II
GDIT
04.2012 - Current
Healthcare Claims Assistant II
CSRA
04.2012 - Current
Credentialing Coordinator
CSC
04.2012 - Current
Customer Service Advocate
04.2012 - Current
Data Entry/Credentialing
CSC
12.2011 - 04.2012
Customer Service/Sales Advocate
Kelly Service, All State Insurance
10.2010 - 01.2011
Floor Supervisor / Queue Monitor/Team Lead
AAA Auto Club
06.2007 - 09.2010
Dispatcher
AAA Auto Club Group
07.2006 - 06.2007
Customer Service Agent & Sales
AAA Auto Club Group
01.2003 - 07.2006
Front Desk Associate and Concierge
Marriott Hotel (Plaza Towers Condominium)
09.2000 - 06.2003
Floor Supervisor / Team Lead
Grey Hound Bus Terminal
Associate Degree/ Criminal Justice Degree -
Wake Technical Community College
Wake Technical Community College
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