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| Desired Industry: Healthcare |
SpiderID: 6945 |
| Desired Job Location: Rochester, New York |
Date Posted: 5/15/2006 |
| Type of Position: Full-Time Permanent |
Availability Date: 06/20/06 |
| Desired Wage: $675/week |
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U.S. Work Authorization: Yes |
| Job Level: Experienced with over 2 years experience |
Willing to Travel: Yes, Less Than 25% |
| Highest Degree Attained: High School/Equivalent |
Willing to Relocate: Yes |
Objective:
PROFESSIONAL STRENGTHS
Progressive Health Plan operations expertise and experience in the areas of Customer Service/Call Center, Claims and Marketing. Vast knowledge of Excellus Books of business. Familiarity with healthcare legislative mandates. Collaborative spirit. Competitive business intelligence and analysis.
Experience:
Excellus BlueCross BlueShield Rochester, NY 2001-Present
Other Party Administrator Jan 2005-Present
Conduct pre- and post-payment review of claims to determine claim payment liability when more than one heath care plan exists.
Act as a resource for the Corporation and external Customers with regard to Coordination of Benefits, Workers Compensation, Motor Vehicle no fault and Medicare Secondary Payer and provide support to those activities for all lines of business.
Responsible for achieving and surpassing 3% COB savings annually for the Corporation and meeting servicing objectives.
Consistently utilize all online resources and software.
Expertise in LRSP, TOPPS, ERISCO, FLRX, Microsoft Excel, and Word,,
Possess excellent communication skills with demonstrated ability in dealing effectively with all levels of internal and external customers while working independently keeping a 99-100% accuracy per quarter.
Safety Net Inside Sales and Service Representative April 2003 January 2005
Contributed to meeting and exceeding the sales and retention goals for the Safety Net division throughout all regions. Exceeded sales and service goals for the division earning a $1000 commission for 2005.
Strong sales skills promoting the sale of Safety Net and Government Programs, including Direct Pay policies.
Adhered consistently to call unit, divisional, and plan-wide policies with regard to customer service and patient confidentiality while developing sharp probative skills.
Facilitated and developed work plans for internal process improvement to enhance staff productivity and quality.
Assisted in training of new Safety Net representatives and provided additional training to current representatives, as needed.
Participated in all Health Fairs and outreach iniatives in order to enhance membership
Managed Care/Indemnity Member Service Representative Apr 2001 April 2003
Ensured compliance with Corporate strategy, MTM, DOH, NYSID, NCQA legislative mandates when addressing member inquiries.
Researched data and wrote summary of results to effectively address operational challenges.
Maintained high productivity by handling an average of 100 inquiries per day, while being recognized by OET for 100% accuracy
Responsible for claims research, reprocess and resolution through direct problem ownership
DONNA-MARIE FARQUHARSON
P.O Box 20894, Rochester, NY 14602 (585) 576-1189 Donna.Farquharson@excellus.com ________________________________________________________________________________________________________________________
PROFESSIONAL EXPERIENCE (continued)
East house Corporation Rochester, NY
Overnight Relief Counselor, Crossroads CD Program 2004-Present
Responsible for communicating and consulting with program staff regarding clients condition and functioning.
Respond to all crisis and emergencies.
Provide counseling and support, including supervision of medication to clients; provide residential, rehabilitation and support services to adults recovering from chemical dependency, ensuring security and safety of clients and facility.
Oversee all clients in 12 bed halfway house independently each shift.
Routinely perform random and routine observed urine screens and testing of client specimens in order to monitor client compliance and continued stay in facility.
Hillside Childrens Center Rochester, NY
Youth and Family Development Specialist 2000-2001
Interfaced with all levels of treatment team to enact therapeutic strategy for clients
Responsible for maintaining Behavior Management System through extensive use of computer software.
Served as lead in charge of work group shifts
Completed all UCR and mandated treatment reports per DSS and State and Federal regulatory requirements
Assisted in preparedness for JACHO audits and compliance.
Action for a Better Community, Inc. Rochester, NY 1999-2001
Head Start Case manager and Case Assistant
Redesigned enrollment process and file maintenance system.
Completed monthly bill and accounting functions
Facilitated meeting and performed supervisor functions in supervisors absence,
Developed process to track and quantify service quality.
Maintained appropriate staffing levels for facility in order to consistently meet State and Federal classroom ratios and guidelines.
Monroe County Department of Health and Social Services 1997-1998
Examiner
Conducted eligibility and recertification interviews with service recipients
Evaluated applications and conducted research for document integrity
Completed monthly reports
Executed State and Federal mandates
Determined clients monthly budget in food stamps, rent, utilities and cash
Eastman Kodak Company Rochester, NY
District Support Representative, New Service Business 1991-1993
Responsible for maintaining, updating and disseminating policies and procedures to staff. Team lead supervising ten staff
Trained representatives
Performed resource analyst functions on a rotating basis with other team leads
Journalist for the division newsletter
Education:
Rochester Institute of Technology, Rochester, NY 2003
Business Management, concentration in Accounting
State University of New York College at Brockport, Brockport, NY
Paralegal Certificate 1998
Andrews University, Berrien Springs, MI 1985- 1987
Business Management
Additional Information:
LEADERSHIP EXPERIENCE / ACCOMPLISHMENTS
Religious Activities Assistant Head, BSCF, Andrews University
Editor, Family Life Newsletter, Jefferson Ave. S.da Church
Board of Directors, Friendship Daycare and Nursery
Data Analyst, Crime stoppers Advisory Board
Writer, Frederick Douglass Voice newspaper
Candidate Contact Information:
| Name: Donna Farquharson |
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| Street: |
Phone: (585) 576-1189 |
| City: Rochester |
Fax: - |
| State: New York |
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| Zip: 14602 |
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| Web Site: |
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