Managed a variety of Provider Data Services (PDS) contracts, fee class, and fee schedules.• Communicate with Provider Relation Reps to load and understand facility, ancillary, and provider contracts.• Coordinate with Customer Service and Provider Relation areas on claim issues, provider issues, and payment issues.• Manage the Southwest Medicare, Coventry Health Care (CHC) of Texas, CHC of Virginia, CHC of Delaware, CHC of West Virginia, and Health America plans within PSA• Provide weekly reports for provider data service team, customer service operations department, and provider relations to see the turnaround times (TAT), of all items sent into PDS.• Log contracts sent into PDS to be worked and loaded for facilities and providers.• Follow up on outstanding claims to get resolution with any issues or problems that may arise for a member or provider.• Manage TAT, loading, and problem solving any issues that arise with Aetna and Coventry Contracts.• Mentor new representatives to ensure they are properly trained on all policies and procedures. • Load contracts and providers into IDX for Coventry claims to process for providers and facilities.• Load providers into Enterprise Provider Database (EPDB) for Aetna claims to process for providers and facilities.• Assist departments with any payment or claim issues that were discovered. • Special Projects: Aid in other units’ backlogs such as Ambulatory Surgery Center Groupers (ASC) and Aetna Enhanced Groupers (AEG) updates, Narrow Network setups, Behavioral Health Credentialing, Enterprise Provider Database (EPDB) to Coventry Provider Database (CPD) Sync Fallout; other urgent projects or issues presented by upper management.• Remain proficient in Content Management System (CMS)/Medicare regulations, updates, laws, and contract loads.• Pull SQL inquiries on data requested from management or provider relations. Also use to verify data and eliminate duplicate providers.

Managed a variety of Provider Service Area (PSA) contracts, fee class, and fee schedules.• Communicate with Provider Relation Representatives to load and understand facility, ancillary, and provider contracts.• Coordinate with Customer Service and Provider Relation areas on claim issues, provider issues, and payment issues.• At Management’s request, participate in the startup team for the CHC of Texas plan within PSA.• Manage the Southwest Medicare, CHC of Texas, and Health America plans within PSA.• Provide weekly reports for provider data service team, customer service operations department, and provider relations to see the TAT of all items sent in to PDS.• Log contracts that have been sent into PDS to be worked and loaded for facilities and providers.

Managed a variety of Provider Service Area (PSA) contracts, fee class, and fee schedules.• Coordinate with Customer Service and Provider Relation areas on claim issues, provider issues, and payment issues.• Manage the Southwest Medicare and Health America plans within PSA.• Provide weekly reports for provider data service team, customer service operations department, and provider relations to see the TAT of all items sent in to PDS.• Log contracts that have been sent into PDS to be worked and loaded for facilities and providers.

Provide Customer Service in the Operations area by answering customer calls, and processing claims and processed appeals for members/providers.• Manage incoming calls from members, providers, and brokers for benefits, claims processing, and/or payments.• Mentor and train new representatives.• Handle supervisor calls and escalated callers.• Process medical claims from providers and members.• Process benefit, coverage, and/or payment appeals for members and providers.

Provide Customer Service in the Operations area.• Manage incoming calls from members, providers, and brokers for benefits, claims processing, and/or payments.• Mentor and train new representatives.• Handle supervisor calls and escalated callers.

Answered a variety of calls for the Customer Service Operations area.• Manage incoming calls from members, providers, and brokers for benefits, claims processing, and/or payments.

Provide Telephone Customer Service for the Pennsylvania Department of Transportation hotline.• Assist internal representatives with supervisor calls and questions.• Determine high priority calls to escalate issues to the PennDOT operation center.• Schedule new driver testing.• Respond to driver licensing and motor vehicle questions.• Mentor and train new representatives.

Provide Telephone Customer Service for the Pennsylvania Department of Transportation hotline.• Assist scheduling of new driver testing.• Answer incoming calls regarding driver licensing and motor vehicles questions.

Answer calls from customers, setting up loans, and setting up payment options.• Assist customers with loans.• Follow-up daily with customers regarding loan set-up/payments.• Process new customer loans.• Provide bank personnel with loan repayments and account information.

Assist the head teacher with daily activities and lesson planning.• Work with children from the age of 6 months to 6 years of age.• Communicate with parents in person during daily drop off/pick up and via telephone when needed.• Assist with parent/teacher conferences.• Complete daily sheets and journals, giving parents updates on their children’s learning and development. • Feed and change children; monitor inside and outside play, group time, and lessons.

Provide office support in Human Resources in a variety of functions.• Respond to calls on the Personnel hotline/call center.• File reviews, appraisals, and any corrective actions, and other confidential and personal information for company personnel files. • Provide file retrieval to Legal Department when needed.• Data entry on Resumix.