Victoria Menefee
Queen Creek,AZ
Summary
Dynamic and detail-oriented professional with a proven track record at United Healthcare Group, excelling in problem resolution and critical thinking. Adept at fostering teamwork and delivering exceptional customer service, I thrive in fast-paced environments, ensuring timely and effective outcomes while maintaining a friendly and positive attitude. Committed to continuous improvement and organizational excellence.
Thorough team contributor with strong organizational capabilities. Experienced in handling numerous projects at once while ensuring accuracy. Effective at prioritizing tasks and meeting deadlines.
Overview
11
11
years of professional experience
Work History
Senior Resolving Provider Analysist
United Healthcare Group
Remote/Arizona
06.2022 - Current
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Excellent communication skills, both verbal and written.
- Worked well in a team setting, providing support and guidance.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Passionate about learning and committed to continual improvement.
- Organized and detail-oriented with a strong work ethic.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Managed time efficiently in order to complete all tasks within deadlines.
- Proved successful working within tight deadlines and a fast-paced environment.
- Learned and adapted quickly to new technology and software applications.
- Responsible for providing expertise or general support to teams in reviewing, researching, investigating, analyzing, negotiating, and resolving all types of Medicaid appeals and grievances.
- Research and resolve written complaints submitted by consumers and physicians/providers/facilities.
- Utilize appropriate claims processing systems to ensure that claims are processed appropriately.
- Make appropriate non-clinical complaints using sound, fact-based decision making.
- Complete necessary documentation of final appeals or grievance determination using appropriate templates.
- Communicate appeal or grievance information to providers and internal/external parties within the required time frames assigned by the state(s).
- Back up Subject Matter Expert the state of New Mexico Provider Appeals and Grievance Team.
Lead Patient Service Specialist
Banner Physical Therapy
Queen Creek
11.2019 - 06.2022
- Developed strong relationships with patients by actively listening to their needs and coordinating appropriate services accordingly.
- Assisted in the implementation of an electronic records management system, facilitating a seamless transition from paper-based records.
- Maintained strict adherence to HIPAA regulations while handling sensitive patient information, safeguarding privacy and confidentiality.
- Provided exceptional support to clinical staff during high-stress situations, ensuring efficient management of resources and optimal patient care.
- Increased revenue by accurately collecting copayments at the time of service, reducing outstanding balances owed by patients.
- Trained new Patient Service Representatives, contributing to a smooth onboarding process and fostering team cohesion.
- Conducted insurance verifications and pre-authorizations to expedite patient care and reduce billing errors.
- Streamlined appointment scheduling for increased efficiency and reduced patient wait times.
- Participated in continuous professional development opportunities to stay abreast of industry changes and maintain expertise in the field of patient services.
- Collaborated with medical staff to ensure accurate record keeping and proper documentation of patient information.
- Managed front desk operations, maintaining organization and ensuring all necessary paperwork was completed prior to appointments.
- Provided support during high-volume periods, effectively managing multiple tasks simultaneously while maintaining composure under pressure.
- Ensured compliance with organizational policies and procedures through thorough monitoring of daily operations at the front desk area.
Dispatcher
Plumbing and AZ Medic
Mesa, AZ
10.2018 - 11.2019
- Managed high-stress situations calmly and effectively, ensuring timely assistance to those in need.
- Communicated with drivers and personnel to coordinate timely delivery of goods and materials.
- Directed dispatching, routing, and tracking of plumbing technicians, drain technicians, and HVAC technician fleet vehicles.
- Collaborated with fellow dispatchers to maintain a seamless workflow during shift changes.
- Managed conflict resolutions with customers, drivers and other personnel to encourage professional relationships and promote respect.
- Provided exceptional customer service to callers, remaining empathetic and patient during emergencies.
- Promoted teamwork among colleagues by proactively assisting others when needed.
- Maintained updated and detailed records of calls in physical and electronic database.
- Facilitated smooth transitions between shifts by properly documenting unresolved calls and ongoing incidents.
- Analyzed customer feedback and provided solutions to improve customer service.
- Streamlined communication between dispatch and field units, reducing misunderstandings and errors.
- Managed high-stress situations to ensure caller calmness, using effective communication and problem-solving skills.
Asset Protection Manager
Wal-Mart Supercenter
Mesa, AZ
03.2014 - 03.2018
- Managed a team of security personnel, providing guidance and support to ensure consistent performance across all shifts.
- Maintained detailed records of all incidents involving theft or loss, using this information to inform future decision-making around risk mitigation strategies.
- Developed comprehensive training programs for new hires, ensuring they were well-equipped to handle various asset protection scenarios.
- Coordinated with other managers across the organization to ensure alignment of asset protection priorities and integration of security measures into daily operations.
- Implemented access control systems to safeguard sensitive areas of the business from unauthorized entry or tampering.
- Collaborated with store management to develop and enforce policies for maintaining a safe and secure environment for employees and customers.
- Established clear performance metrics for asset protection personnel, fostering an environment of accountability and continuous improvement among team members.
- Improved inventory accuracy by overseeing regular cycle counts and addressing discrepancies in a timely manner.
- Evaluated existing security infrastructure, recommending upgrades or enhancements as necessary to maintain a robust defense against potential threats.
- Partnered with local law enforcement agencies to share information about potential threats or suspicious activity in the area.
- Leveraged data analysis tools to identify trends in theft or loss, enabling targeted interventions that yielded significant improvements in asset protection outcomes.
- Controlled reduction of loss inventory by protecting company assets.
- Enhanced overall asset protection by implementing effective security measures and loss prevention strategies.
- Conducted thorough investigations into suspected cases of internal theft, resulting in the identification and remediation of vulnerabilities within the organization.
- Worked closely with law enforcement in investigating and solving theft and fraud cases.
- Collaborated with law enforcement to report crime and suspicious activity.
- Performed thorough cash audits and deposit investigations.
- Monitored paperwork procedures to prevent error-related losses.
- Supervised surveillance, detection and criminal processing related to theft and criminal cases.
- Reviewed and updated store security policies and procedures.
- Installed and maintained covert security equipment.
- Monitored store surveillance cameras to detect suspicious behavior.
Education
High School Diploma -
Sacramento High School
Sacramento, CA05-2003
Skills
- Friendly, positive attitude
- Teamwork and collaboration
- Customer service
- Problem-solving
- Time management
- Flexible and adaptable
- Attention to detail
- Excellent communication
- Dependable and responsible
- Multitasking Abilities
- Critical thinking
- Organizational skills
- Calm under pressure
- Decision-making
- Problem resolution
- Organization and time management
- Active listening
Timeline
Senior Resolving Provider Analysist
United Healthcare Group
06.2022 - Current
Lead Patient Service Specialist
Banner Physical Therapy
11.2019 - 06.2022
Dispatcher
Plumbing and AZ Medic
10.2018 - 11.2019
Asset Protection Manager
Wal-Mart Supercenter
03.2014 - 03.2018
High School Diploma -
Sacramento High School