1. Ronald
Washington Sr 39434 Gainsborough Dr, Palmdale , CA 93551
amealus@yahoo.com
Cell: 661-816-2031 Home: 661-480-5453
Experience High Desert Medical Group, Lancaster, CA June 2010 – Present
Benefits Lead Coordinator / Outsource Auditor
Insurance providers and policies. Claims and authorization
knowledge and adjustments. Member EOB, provider contracts,
guidelines and member services. Developed and maintained accurate
logs and procedural manuals of health plan benefit information. In
addition, have successfully provided support services contact with
health plan providers to obtain benefit information.
Proactively maintain health plan benefits ensuring that health care
member benefits and utilization can be tracked and documented.
Assist in disseminating benefit information to all internal department.
Ensure benefit options have accurate descriptions and correct copays
are reflected. Complete overview of manuals bi-yearly or whenever
new manuals are introduced. Conduct audits to ensure the information
accurately reflects information as provided by the health plan,
Contact contracted health plan provider services to obtain benefit
information. Knowledge of medical terminology. ICD9 and CPT 10
coding. Auditing and training instructor over outsourced departments.
Ensures compliance with established internal control procedures by
examining records, reports, operating practices, and documentation.
Verifies assets and liabilities by comparing items to documentation.
Completes audit work papers by documenting audit tests and
findings. Maintains internal control systems by updating audit
programs and questionnaires; recommending new policies and
procedures. Communicates audit findings by preparing a final report;
discussing findings with auditees.
Shield Health Care, Valencia, CA August 2008 – January 2010
Customer Service Agent/Call Center Rep
Customer service and sales of durable medical equipment. ICD
nine and CPT coding and billing. Adjudications and examination
procedures. Medicare and Medical coverage and authorizations.
Claims and approvals Private insurance, PPO/HMO coverage and
authorizations. Interacting with Dr offices and processing
prescriptions. Working with case workers, nurses and boarding
care facilities. Customer service skills in engaging with customers,
communications with Sales representatives, and working in teams
in a call center environment to expedite processing of cases.
AS400 and Onyx programs. Strong computer skills including
Microsoft Word and Excel.

2. Absolute Bonding Corp, Palmdale,
CA
September 2004 - August
2008
Assistant Office Manager/Customer service
Office assistant manager, customer service call center. Call center
training and performance enhancement. Computer program
training. Moderate installation of software and hardware. Repair
and trouble shooting. Work with management on sales stats
quotas. Analyze and report call volume. Obtain goals and
objectives for overall department. Sales strategies and bonuses.
Monthly tracking and sales. Data entry, inside sales and
dispatching to field agents. Banking and accounts payable.
Purchasing and payroll. Scheduling work days and hours. Word
perfect, excel, lotus and spreadsheet.
Countrywide Financial Corporation,
Lancaster, CA
May 2003 - September
2004
Customer Service/Call Center Rep/Collections/Loan
Counselor
Inbound/Out-bond customer service call center nationwide.
Serviced default loans and foreclosures. Collected monthly
mortgage payments. Debt counseling and repayment plans.
Mortgage financial information. Automated bank drafts and
mortgage pay by phone. Cross sales and refinances. Escrow
accounts and billing. AS400 program and Onyx program.
Education Northeast Louisiana University, Monroe, LA
Other - Business Management
Objective Manager and or Supervisor, Customer Service and
or Human Resources. Cash Handling and Banking.
A position where proven technical skills would be
utilized.
Computer Knowledge (Word, Excel, Power Point and basic desk
top)
ICD-10CM certificate
Salary Expectation: I am seeking a salary between 40K – 50K. An
hourly rate of $17 – 18.50 an hour