1. Cheryl Spencer
3701 NW 21st Street # 110
Lauderdale Lakes, FL 33311
Email: chers2012@gmail.com
754-779-0104
OBJECTIVE
Toapplymyeducationandskillsina productiveworkingenvironment,inhopesto enhancemyabilityto makemy
work placeasuccessfulone.
SKILLS
Customerservice,QualityAssurance, Dataentry, Collections,Microsoftword,Excel,Access,Powerpoint,
Rimssystem, AS400, Proclaim,Benefitaccess,IDXsystem, MediSOFT andmedicalmanager,Peachtree,
SAP, GreatPlains, DirectNoble,Flash, PreQ, CAQH, Amisys, Npis,Sunbiz, MQA,PDM,Mednax
Experienceinmedicalbilling,Medicalrecords.MarketProminence,Esaws,Pega andPecos
EMPLOYMENTHISTORY
CahabaGovernmentBenefitAdministrations
ProviderEnrollmentAnalyst(Contract) Birmingham,AL 02/2015-03/2015
Responsibleforprocessingnewandestablishedproviderapplications,ensuringthatallproviders aregiven
a numberincompliancewithCMSregulations,prescreeningandfinalizingProviderEnrollmentapplications.
Responsibleforobtainingproviderprofileinformation;thisincludesverifying provider demographic,billing,
credentialing,etc.Enteringprovider enrollmentanddisenrollmentdataandmaintainingtheprovideraccess
database.ResponsibleforsendingW-9 forms, 1099letters, provider terminationnotificationlettersand
other dutiesas assignedby the Manager.
EmblemHealth Administrators Hollywood,FL 08/2014-01/2015
QualityAssuranceSpecialist
Actively confirm/validatesalesappointmentsand/orotherleadgenerationactivitiesin the departmentby
reviewingcallrecordingsanddocumentationinthedepartmenttrackingsystem,responsibleforappropriate
andtimelyactionwhenpoliciesorprocessesarenotmet. Communicatingwithprospects,sales
representatives andmanagementmaintainprofessionalism,confidentialityanddemonstratequalityvalues
in allrelationships.Understandallproductlines,allpoliciesandprocedures.Properlyassesthe quality of
an appointment,leadorother calldisposition,demonstratethoroughknowledgeofalldepartmentsystems
e.g. Market Prominence,ESAWS, Vprint Viewer. Review recordedtelephoneinteractionswhichhave
resultedin salesleads, or other specific activitiestoverify memberinformationandensurecompliancewith
allregulationsanddepartmentpolicies.At times,makeoutboundtelephonecallstoclarifyinformationor
rescheduleorcancelevents. Assist in handlingprospectivememberinboundphonecallsduringpeakcall
times.Participate insystem andproducttraining,productdevelopment,knowledgesessionsandother
departmentinitiatives.
Retrieve voicemailsfrom thedepartmentvoicemailboxesandappropriatelyfollowup.
Communicatetimelyto management;infractionswithregulations,processesand/ordepartmentpolicies,
appointmentchanges,etc.Performsotherduties as assignedor required.
2. Sunshine Health Sunrise, FL 11/2013- 08/2014
Provider Data Coordinator/Plan Enrollment
Perform day to day functionsto maintainappropriatedatabasesandcreatereportsto monitornetwork
compliancewithStaterequirements.Createandmaintainappropriatedatabases,including:contractnetwork,
authorization, thirdparty liability, provider set up corrections,checkrequests,amongothers,designand
generatereports to monitordepartmentactivityandState compliance,updatethedelegatedentityMedicareand
MedicaidAttachmentsonmonthlybasis. Provide appropriatereportsandstatisticaldata to other department
designeesfor the necessaryfollowup andresolution,generaladministrativesupportof assigneddepartment.
Conductinginsuranceverificationandinputtingaccuratedocumentationintoregistrationsystem.Enroll
PractitionerwithProvider in the system accordingtocontract,ProviderApplicationandSpecifiedplanattributes,
andInterfacingwith multiplepayerorganizations.Work withContractSupport andCredentialingtoassist in
maintainingtheaccuracyof the contractdatabase.
Arriva Medical Coral Springs, FL 08/2011- 11/2013
Plan Enrollment Rep/Order Entry Customer Service (Call Center)
Takecallsonclaimsinquiries,explainreasonfordenial,give claimsaddresswhereclaim needtobe resubmit,
explainEOBto patient,Assist Providers andmemberwithhealthplan.Explainand enrollpatientinto the Medicare
advantage plan.Processandfill diabetic ordersfor meter,strips, lancets,controlsolution,lancingdevice.update
patientinformationof testing frequency,and diagnoses,checkthedoctoraddressto makesure informationiscorrect
in the system, checkpatientIdnumberandprimaryId numbertomakesure thereis noduplicateaccountinthe
system, if so add accountto duplog, sendout meterto patientper their requestaccordingtodoctor’sapproval,
Complementarycookbooks,courtesyitemsetc. Updatepatientdemographicinformation,Reviewingdifferentkinds
of doctororder forms(DOF)suchas heatingpad,externalvacuum pump,backbrace,Updatesfilesby comparing
changes/informationaccordingtoDOF andpatientrequestsuchas frequencyincrease,physicianinformation
diagnosiscode,preferenceofmetertype etc. Ability to work different campaignsreorders,firstorders, acquisitions,
frequencyincreaseup-sells,specialty,andarchiving,
Operatingdifferentcomputerprograms:DirectNoble,DirectPreQ,Flash,Matrixsystem, Run/ view eligibilityfor
Medicarepatients,Checktoseeif private insurancehaveverificationnotes for currentmonth,if not placeoniv log
for verification, Assure all accountshaveproperpatientapproval notes. Utilizes allavailableresourcesto obtainand
enter insurancecoverageinformationfororderedservicesintopatient’s file. Completes afullMedicalVerificationfor
allmedications,administrationsuppliesandrelatedpharmacyservices, ManagesinboundcallsontheInsuranceline
from patients, clients,physicians,practitionersandclinicsregardinginquiriesaboutservicesprovided, financial
responsibilityandinsurancecoverage.Facilitatespharmacyand/ormajormedicalclaimswithinsurancecompanies
andpractitionerofficesandinvestigates andfacilitatespriorauthorizationany other insurancerejections,processand
post claimsinsystem.
3. Sodexo Vending Services,FortLauderdale,FL
AccountsPayableRep 11/2007-08/2011
Inputted invoicesintoa spreadsheet,print invoicesfrom e-mail,fax invoicesfor approval from locationmanager,
postingcustomerpaymentsby recordingcash,checks,andcreditcardtransactions,processandcutchecks,
preparebalancesheetforend of the monthbilling,
Answered the phonesandtake problem calls,resolvethe issue that the customerarehaving, updatingreceivables
by totalingunpaidinvoices,resolvingvalid or authorized deductionsbyenteringadjustingentries,verifying vendor
accountsbyreconcilingmonthlystatementsandrelatedtransactions,prepareinvoiceandbilltheclient.Contactthe
vendor for serviceson the machine.
AAANorthern California(Call Center) FortLauderdale,FL 06/2003-11/2007
CustomerService/Dispatcher(WorkAT Home)
Handledhighvolumeof inboundcallsfrom customersthatwerestranded onthe road andwere inneed of:
battery services, ran out of gas, flat tire or needto be towed, dispatchservicetruckwith the specific road
servicesthat the customerwasrequesting,give the servicecenterthe locationofthe customer,andprovided
customerswithanestimatedtimeof arrival, placeallhighwaycallsashighpriority, callCHPand give the
locationofall highwaycalls.
ConductedFollowupqualitycallswiththe customersandserviceshopsto ensurethat the customerwasservice
baseon the properETAand metqualitystandards.
MedicareCall Center, Tamarac,FL 06/2005-06/2007
Prescription Drug CustomerServiceRep
Receiveinboundcallsfrom beneficiariesenrolledintothePart D program,EducatebeneficiariesonthePart D
planincludingbenefits,costsharing,andlevels of coverage.Assist beneficiarieswithupdatingaccount
information,providingplaninformation,andresolvingissueswith utilizationof the plan.Handledinquiries
regardingexplanationofpremiums, co-pays,deductiblesandprescriptiondrugbenefits. ProcessedHealth
Careand PrescriptionDrugplanenrollmentsaccordingto CMSregulatoryrequirementsandproceduresrelating
to processingtimeframesandlateenrollment,penaltyand disenrollment,maintainhighvolumeinterpersonal
relationshipsandhandleallotherinquiresas required.Lookup medicinesontheformularyto verify if they are
covered, the tier andcopaylevel. Comparetheamountof drugs, dosage,type of drugs andhowoften the drug
is beingtaken inorder to give membersthelowestprescriptiondrugplanthatfit their needs.
4. Magellan SpecialtyHealth, Plantation,FL 06/2004-06/2005
ProviderRelations/Medical Records/Credentialing
Handledcallsfrom providerandpatients, explainedtothem about their allowablecharges,pullprovidercontract,
explainwhya claim wasdenied,andgive mailingaddresswhereclaimneedstoberesubmitfor payment, give
informationofin andout of networkcoverage
Operateddataentry device to perform a variety of data entry andverification,detect andcorrectanyerrors.
Processinsuranceclaimswithprimaryandsecondarycarriers,post system transactions,processreturnmail,
file insuranceclaims,respondtodebtor andattorney correspondence,authorizations,telephonecommunication
with debtors, clients,attorneys and insurancecarriers.GettingInformation -Observing, receiving,andotherwise
obtaininginformationfrom allrelevantsources.Verifies the professionallicensing,training,practiceskillsand
certificationsofprofessionalstaff is currentandcomplete,Performsdocumentpreparation,scanningand
indexingof papermedicalrecorddocumentsintothe Electronic MedicalRecordandauditsresultsfor image
qualityand indexingaccuracy.Monitorsexpirationdatesof credentials,processingallapplications requesting
accesstoHCA facilities,commitsallcompletedfilestoImagingSystem, ensurethat all the necessarypaperwork
was donein orderto receive hospitalprivileges.EvaluatingInformationto DetermineCompliance,Usingrelevant
informationandindividualjudgmenttodeterminewhetherevents or processescomplywithlaws, regulations,or
standards. Verifies patientinsurance coverageof medications,administrationsuppliesandrelatedservices,
FacilitatesandcompletesthePriorAuthorization processwithinsurancecompaniesandpractitioneroffices.
Notifiespatients, physicians,practitionersand/orclinicsofany financialresponsibilityof servicesprovided and
requestedservicesthat are not providedby the facility.
EDUCATION
Weaver HighSchool
SouthernConnecticutState University
