Pasquale Mastroianni
Clifton Park,New York
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
11
11
years of professional experience
Work History
Performance Quality Auditor I
Elevance Health
Latham, NY
05.2023 - Current
- Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution
- Tracks and trends audit results, providing feedback to management
- Identifies and reports on systemic issues which create ongoing quality concerns
- Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested
- Produces other ad hoc reports as requested by internal and/or external clients
- Associates at this level conduct routine audits, generally related to a single function on a single systems for a single line of business.
Quality Assurance specialist
Magellan Medicaid Administration
Latham, NY
11.2020 - 05.2023
- Responsible for assessing the quality of the performance of the call center associates who deal with existing and potential customers
- Assisted in developing, creating, and implementing call center quality processes and procedures; as well as making recommendations for enhancements to training materials
- Provided feedback to call center team leaders, managers, and associates
- Support the quality program with the goal to meet customer requirements and performance guarantees; including monitoring and execution to meet timely deliverables
- Conducted quality control reviews and internal/external audits
- Administered analyses of data findings for quality and process improvement
- Supported work groups through project management by ensuring that documentation is accurate and timely.
Provider Outreach Specialist
Beacon Health Options
Latham, New York
09.2018 - 11.2020
- Successfully negotiated Single Case Agreements (SCAs) for out-of-network providers while ensuring the continuation & enhancement of services.
Worked with internal & external customers to understand requirements and provide exceptional service. - Worked with managers to resolve problems, improve operations and provide exceptional customer service.
- Flourished working in several systems simultaneously, handling work queues in the provider, clinical and customer service applications.
- Achieved and exceed in meeting productivity and quality standards.
- Communicated with internal departments and providers via event, inquiry, and in written correspondence.
- Successfully lead follow up protocols on SCA requests to conduct the proper provider/member checks, gather the appropriate provider documentation, negotiation rates while communicating with the clinical team to authorize the treatment, execute the SCA and assist with provider data entry and rate loading.
Monitored work queue to ensure cases are processed within expected turnaround time.
Claims Processor
Beacon Health Options
Latham, New York
02.2015 - 09.2018
- Successfully processed high dollar claims meeting department performance standards for production and quality & used client benefit and provider payment schedules.
- Reviewed outstanding requests and redirected workloads to ensure timely completion of projects.
- Accurately inputted all patient and insurance information into company's computer system using CAS Software.
- Corrected any data entry errors to prevent later issues such as duplication or data degradation.
- Proactively identified client service improvement opportunities by working collaboration with the unit supervisor(s) to resolve problems.
Customer Service Representative
Beacon Health Options
Latham, New York
10.2013 - 02.2015
- Successfully provided exemplary customer support to internal and external customers in fast-paced environment.
- Successfully Compiled customer feedback and recommended service delivery improvements to management.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Achieved and maintained productivity and quality performance expectations Quoted accurate benefit and policy information regarding inpatient and alternative levels of care.
Education
BBA - Business Administration
State University of New York At Cobleskill
12.2010
Associate of Science - Sports Management
State University of New York At Cobleskill
05.2010
Associate of Science - Liberal Arts And General Studies
Hudson Valley Community College
12.2007
Skills
- Compliance standards
- Attention to Detail
- Self Motivation
- Quality Assurance
- Customer Service
- Superior Organizational ability
- Time Management
- Problem-solving abilities
- Excellent Communication
- Professional Demeanor
References
Available Upon Request
Timeline
Performance Quality Auditor I
Elevance Health
05.2023 - Current
Quality Assurance specialist
Magellan Medicaid Administration
11.2020 - 05.2023
Provider Outreach Specialist
Beacon Health Options
09.2018 - 11.2020
Claims Processor
Beacon Health Options
02.2015 - 09.2018
Customer Service Representative
Beacon Health Options
10.2013 - 02.2015
BBA - Business Administration
State University of New York At Cobleskill
Associate of Science - Sports Management
State University of New York At Cobleskill
Associate of Science - Liberal Arts And General Studies
Hudson Valley Community College
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