Victoria Gvinter
Cumming,GA
Summary
Results-driven Enrollment and Eligibility Supervisor with experience steering and directing all aspects of operations. Practiced in orchestrating multiple projects with competing priorities involving process improvements, safety initiatives and quality control. Recognized and commended for collaborating with upper management to achieve organizational objectives.
Overview
10
10
years of professional experience
Work History
Eligibility and Enrollment Supervisor
Brighton Health Plan Solutions LLC
02.2023 - Current
- Supervised Enrollment and Eligibility Department operations, ensuring optimal service to employers and caregivers by analyzing and overseeing production volumes, timeliness of data input, Employer portal workflow, staffing, and other variables.
- Guaranteed our team's success in meeting quality SLAs and TAT SLA rates of 97% and 98.8% respectively in 2023.
- Managed daily reports and deliverables, triaging them to ensure timely distribution and tracking in compliance with Service Level Agreements
- Worked on UseCases and Business Requirement Documents to deliver high-quality software solutions by ensuring clear understanding of client needs.
- Maintained qualitative and quantitative reports to track performance, employer compliance, and identify trends
- Conducted quality assurance monitoring, validations, and audits for the enrollment-eligibility document processes to map business process and workflows. Conducted gap analysis and documented requirements.
- Engaged in UAT testing
- Applied critical thinking skills to effectively solve complex problems and determine appropriate escalation paths.
- Maintained broad knowledge of client requirements, guidelines, procedures, and key contacts throughout employment.
- Demonstrated effective communication skills through both written and verbal methods, showcasing excellent interpersonal and organizational abilities.
- Interviewed applicants, recommended individuals for hiring and evaluated staff performance.
- Established and enforced clear goals to keep employees working collaboratively.
Eligibility and Enrollment Specialist
Brighton Health Plan Solutions LLC
06.2021 - 02.2023
- Created, audited, processed and updated member and eligible dependents’ profiles into the enrollment database
- Troubleshot Enrollment and Eligibility inquiries from Call Center Representatives and Employers
- Ensured accurate and timely completion of transactions to meet department TAT
- Ensured accuracy and completion of employer documents required for Federal government verification
- Involved in UAT testing participation
- Collaborated with IT Department to investigate and confirm member eligibility
- Reviewed and resolved premium issues in collaboration with Accounts Payable team
- Assisted with task/project completion across various departments.
- Handled new enrollments by entering customers' data and reviewing information.
Eligibility Services Representative
Brighton Health Plan Solutions LLC
10.2020 - 06.2021
- Handled and resolved inquiries from caregivers
- Reviewed and resolved eligibility, hours, and co-premium issues alongside the Enrollment team.
- Ensured high-quality and timely expediting of customer requests through effective communication with team members.
- Provided exceptional support via chat to enhance customer service.
- Answered phone calls and responded to questions and concerns.
- Documented and scoped actions taken to resolve issues after service calls.
- Contributed to business growth by confirming customer satisfaction with service and quality.
Billing Manager
Valley Stream Management Inc
01.2020 - 09.2020
- Oversee and streamline billing and collections processes
- Executed month-end closing procedures for the billing group information
- Maintained qualitative and quantitative reports for tracking performance, ensuring employer compliance, identifying trends, and discovering opportunities for improvement. Implemented quality initiatives to align with company goals.
- Led team of 4 staff members handling more than $300k in monthly charges.
- Ensured accurate posting and review of payments received on patient accounts.
- Resolved billing issues by applying knowledge and completing in-depth research.
- Managed billing calendar and scheduled claims for payments.
Billing Manager
Temana Associates Inc
03.2014 - 12.2017
- Ensured accuracy and completeness of claim preparation.
- Verified billing data for accuracy and made necessary revisions
- Communicated with insurance providers and advocated for claim approval
- Monitored and evaluated performance metrics, ensuring compliance with company standards and identifying areas for improvement
- Planned, organized and managed staff work to ensure successful completion.
- Led team of 5 staff members handling more than $500K in monthly charges.
- Resolved billing issues by applying knowledge and completing in-depth research.
- Managed billing calendar and scheduled claims for payments.
Education
MBA Financial Services -
METROPOLITAN COLLEGE OF NEW YORK
New York, NYBachelor of Economics -
KHABAROVSK STATE UNIVERSITY
Khabarovsk, RussiaSkills
- Proficient with Microsoft 365
- Visio
- Gantt Project
- Self-motivated
- Detail oriented
- Familiar with Waterfall and Agile Project Planning models
- Excellent attention to detail
- Proficiency in HIPAA
- COBRA
- FMLA
- LOAs
- QLE
- PTO regulations
- Strong analytical
- Investigative
- Time management skills
- Training and mentoring
- Team Building
- Policy and Procedure Development
Timeline
Eligibility and Enrollment Supervisor
Brighton Health Plan Solutions LLC
02.2023 - Current
Eligibility and Enrollment Specialist
Brighton Health Plan Solutions LLC
06.2021 - 02.2023
Eligibility Services Representative
Brighton Health Plan Solutions LLC
10.2020 - 06.2021
Billing Manager
Valley Stream Management Inc
01.2020 - 09.2020
Billing Manager
Temana Associates Inc
03.2014 - 12.2017
MBA Financial Services -
METROPOLITAN COLLEGE OF NEW YORK
Bachelor of Economics -
KHABAROVSK STATE UNIVERSITY
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