Halle L. Pierce

1217 Ella Grasso Boulevard Apt B

New Haven, CT06511

203-891-6109 (Home)

203-506-2084 (Cell)

SUMMARY: To obtain a challenging and rewarding position in a well rounded company

EDUCATION:

Stone Academy, Hamden, Connecticut, Certified Medical Assistant graduated June 2005 plus a supervised externship in the medical assisting program at Ann Skopek M.D. and Associates, 9 Washington Ave, Hamden, Connecticut 06514

Albertus Magnus College, 700 Prospect Street New Haven, Connecticut; March 2008 to May 2012 Received A.A Degree 2010 B.S Degree Health Care Management 2012

WORK EXPERIENCE:

September 2017-October 2017

Randstad Farmington, CT

Fosdick Wallingford, CT

Customer Service Representative

  • Answer all inbound calls in call center. Assist customers with entering and processing all merchandise orders, track location of orders that were processed with customer, resolve customer escalated issues over the phone, process customer payments, and explain products and services to customer over the phone.

August 2017-December 2017

Burlington Hamden, CT

Stock Flow Associate

  • Label and tag merchandise for all departments. Sort and stock merchandise on designated shelves in all departments.

September 2016-October 2016

Hamilton Connections Hamden, CT

Fosdick Wallingford, CT

Package Associate

  • Sort items, arrange items, label items, and assemble items for distribution. On occasion process items on conveyer line.

January 2014-May 2014

Aerotek Hamden, CT

Wellpoint (Anthem Blue Cross Blue Shield) Wallingford, CT

HEDIS Auditor

  • Responsible for providing administrative and telephonic support for department working on a HEDIS data collection project.
  • Communicate directly with provider offices in pursuit process by requesting medical record information and coordinating the exchange of files.
  • Responsible for booking on site appointments for chart audits, verify patient, provider, and demographic information, maintain department tracking log, and abstractor calendars.
  • Conduct research and assist abstractors by utilizing research within the company’s claims and medical record systems and locating where members receive care.
  • Responsible for making outbound calls and taking inbound calls to providers.
  • Assist supervisor with other HEDIS assignments and follow up calls to providers.

November 2013-January 2014

Kohls Hamden, CT

Sales Floor Associate

  • Handle merchandise recovery.
  • Sort, organize, and set up merchandise on designated shelve areas.
  • Determine price and incorrect prices on merchandise.
  • Cover and provide additional coverage in other departments as needed.
  • Greet customers and assist customers with price checks on merchandise and purchasing and location of specific merchandise.
  • Answer customer calls and other department staff calls.
  • Manage and recover merchandise from fitting room areas.

October 2013

Hamilton Connections Hamden, CT

CAS Medical Systems Branford, CT

Receptionist

  • Responsible for answering incoming calls from medical vendors and clients on multi phone line phone system.
  • Greet and check in clients with scheduled meetings with CEO, Director, and other staff.
  • Sort mail and distribute to designated departments and staff.
  • Perform other miscellaneous duties as assigned.

August 2006-July 2010

Health Net of the NortheastShelton, CT

Eligibility Representative

  • Responsible for adding, terming, and reinstate members to health insurance policies.
  • Adjudicate and pend enrollment applications and issues in accordance with most policies, limitations, or exclusions through automated queue.
  • Investigate and adjudicate enrollment pended documents in conjunction with underwriting and appeals for denials or approval of enrollment for prospective or current members on health insurance policies.
  • Resolve previously suspended enrollment pends through automated work queue.
  • Resolve complex enrollment issues and works closely with employer groups and brokers for resolution.
  • Communicates policies, procedures, and benefits to employees, enrolled members, and employers. Interacts with staff in other departments to clarify and resolve eligibility problems presented by members.
  • Maintains accurate eligibility records for individuals and/or assigned employer groups. Process all enrollments, plan changes, and disenrollment transactions.
  • Enter manual enrollment applications in the computer and update Conexis weekly reports for COBRA enrollees to determine eligibility and status.
  • Reviews aging to determine delinquent accounts, membership reconciliation issues from premium issues. Produces and distributes delinquent notices to members

Customer Service Representative

  • Perform cross functional tasks within the health plan operations areas.
  • Handled general inbound ACD calls, correspondence, and lobby visits for medicare clients.
  • Assisted medicare, medicaid, commercial, and prospective members with benefit coordination and benefit information. Coordinate DME benefits for members to determine if medical devices are covered. Verify and determine prior authorizations and authorizations for benefits for members and providers.
  • Service prospective members, enrolled medicare members, providers, employer, brokers, vendors, and other health net customers.
  • Responsible for resolving all customer inquiries and complaints.
  • Research and resolve claims inquiries for providers and members.
  • Provide accurate and timely responses and for entering accurate information into the customer database.

June 2005-May 2006

Ann Skopek M.D. and AssociatesHamden, CT

Medical Assistant

  • Responsible for taking patient history, vital signs, performing electrocardiograms, filing patient charts.
  • Faxing, writing, calling in prescription orders, ICD 9 CPT coding, and register patients.
  • Schedule patient appointment and process insurance/patient copays, and initiate referral process.
  • Enter and update patient demographics and insurance information in the computer. Expertise in medical terminology.
  • Initiate preauthorization on outpatient diagnostic appointments and answering phones. Perform diagnostics tests and call patients with lab results.
  • On occasion filled in for receptionist and prepare examination rooms and order medical supply inventory and maintain log sheet of medical supplies.

September 1999- May 2005

Interactive Marketing and Research New Haven, CT

Data Management

  • Responsible for conducting market penetration surveys with directors and

Managers and schedule appointments for prospective clients existing clients.

  • Work closely with Managers in conjunction with Directors with emphasis on sales of health products
  • Entered client demographic and product information in the computer.
  • Answer inbound calls and outbound calls on prospective clients and members..

November 1998-2001

CW Resources

Supervisor Hartford, CT

  • Supervised a staff of fifteen employees in the Maintenance Department.
  • Assigned and implemented work duties and tasks for employee staff.
  • Maintained inventory and supplies on a daily log sheet.
  • Administered and authorized time sheet approval and payroll distribution for employee staff.
  • Assigned other miscellaneous duties to employee staff on an as needed basis.
  • Scheduled bi-weekly meetings with employee staff to review work performance and redeterminations.