SWANZETTA LARRY
Jonesboro,GA
Summary
To obtain a position where can maximize multilayer of management skills, quality assurance, program development, training experience, management and customer service. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Dedicated Intake Specialist skilled in claim eligibility analysis and records management. Excellent communication and interpersonal skills. Familiar with industry standards and requirements. Managing duties to facilitate smooth workflow and operational efficiency. Dependable Coordinator provides excellent office management and administrative support. Possesses strong communication and interpersonal skills with demonstrated ability to manage competing priorities and meet deadlines. Creative problem solver with strong analytical and critical thinking skills.
Overview
14
14
years of professional experience
Work History
APPEAL COORDINATOR
CareCore National
01.2012 - Current
- Fax or email appeal related documentation to health plans.
- Track appeal related data in electronic data base.
- Prepare appeal files for physician review.
- Manage documents related to appeal process and notifications to members and providers.
- Prepare reports of appeal activities
- Support complaint turnaround times in appeal processing
- Process and tracking of Criteria Release
- Process letters in response to Medical Records Requests
- Managed assigned appeal plan and follow thru till appeal is processed.
- Organized and detail-oriented with strong work ethic.
- Passionate about learning and committed to continual improvement.
PHYSICIAN LINE SPECIALIST
- Answer telephone calls with physician line queue, meeting departmental standards for speed of 5 seconds to answer and call volume of over 50 calls day, in professional and respectful manner.
- Educate callers about health Plan requirements for pre-authorizations, reconsiderations, and appeals.
- Work with sites, patients, and physician’s offices to investigate and resolve any pre-certification issues and know where to transfer calls when appropriate.
- Maintain working knowledge of all process and procedure changes, current procedural terminology coding and updated training materials and use these changes and processes accordingly.
- Assist with scheduling peer to peer calls.
- Support medical directors with level of review
- Worked effectively in fast-paced environments.
- Gained strong leadership skills by managing projects from start to finish.
ELIGIBILITY REPRESENTATIVE
- Perform investigations on eligibility cases to ensure best care for patients.
- Maintains working knowledge of CPT coding, updated training materials, processes and procedure changes.
- Prepares program correspondence as needed.
- Collect and apply appropriate data to ensure most cost-effective route for members.
- Devised and implemented strategies to streamline eligibility verification processes.
- Established databases to track, analyze and automate eligibility application processes.
- Used computer-aided guidance packages such as skills assessment tools, career planners, psychometric tests and personal inventories to assist clients in determining strengths and weaknesses.
- Engaged wider departments in accurate, timely paperwork completion
CUSTOMER SERVICE REPRESENTATIVE/TECHNICAL SUPPORT
ACS
01.2009 - 01.2011
- Interact with over 100 callers per day to provide and process information in response to inquiries, concerns and requests about products and services.
- Offer alternative solutions where appropriate with objective of retaining customers and client business.
- Maintain sales goal on monthly basis.
- Ensured reliable quality service to all customers.
- Ensured adherence to standard policies and procedures.
- In charge of handling all customer complaints tactfully and ensuring are resolved amicably
- Answering support tickets
- Bolstered customer retention by creating and offering unique discount options and inspiring interest in new product lines
- Participated in team meetings and training sessions to stay informed about product updates and changes
DATA INTAKE COORDINATOR /SENIOR AGENT
- Provide mentoring/ training to over 15 new agents.
- Maintain proper call flow and processing in timely manner.
- Utilize skills in customer service to provide excellent service to all members.
- Performs various clerical functions and projects as needed.
- Provided daily operational review/quality control of education accountability as it relates to imposed government regulatory.
- Maintained and documented work completed on daily basis; presented report to management.
- Resolved caller issues quickly and thoroughly.
- Verified and improved quality standards by analyzing customer service metrics.
- Informed clients of policies and procedures
- Presented feedback to management on customer service trends and improvement areas.
- Established strong customer relationships, building recommendations and loyalty.
- Established strong customer relationships, building recommendations and loyalty.
- Prepared and presented contracts and other legal documents to clients
- Maintained comprehensive product and service knowledge for accurate, informative customer advice
Education
MBA - Business Administration
University of Phoenix
Tempe, AZ11.2010
Bachelor of Science - Business Management
University of Phoenix
Tempe, AZ02.2009
Associate of Science - Accounting
Savannah Technical College
Savannah06.2004
Skills
- Excellent communication
- Attention to detail
- Encompass Basics
- Scheduled Maintenance
- Incident Management
- Root Cause Analysis
- Strategy Management
Timeline
APPEAL COORDINATOR
CareCore National
01.2012 - Current
CUSTOMER SERVICE REPRESENTATIVE/TECHNICAL SUPPORT
ACS
01.2009 - 01.2011
PHYSICIAN LINE SPECIALIST
ELIGIBILITY REPRESENTATIVE
DATA INTAKE COORDINATOR /SENIOR AGENT
MBA - Business Administration
University of Phoenix
Bachelor of Science - Business Management
University of Phoenix
Associate of Science - Accounting
Savannah Technical College
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