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Devlin Foster

Research Specialist at MAXIMUS

Summary

I am a loyal professional with demonstrated leadership and experience working in diverse environments. I have experience with Medicaid Management Information Systems and proprietary software implementation. Experience in healthcare transaction standards. Proficient in Microsoft Office: Word, Excel, PowerPoint, SharePoint, Lotus Notes, Outlook and MS Office. Ability to research, evaluate, analyze, resolve, and present solutions to problems. Experience with Medicaid Management Information Systems implementation. Ability to read and interpret process and workflow diagrams and work instructions. Strong organizational skills and able to handle multiple tasks. Strong technical problem solving. Proactive in identifying and addressing issues. Strong written and oral communication skills.

Work History

Sep 2015Present

Research Administrator

Maximus Inc

Research Administrator Responsible for servicing the individual consumers of the NYSOH/ACA marketplace, including but not limited to, assisting Medicaid individuals and families in applying for health care coverage. My responsibilities included handling special escalations that came from the normal enrollment work flow. Utilizing eMedNY, an access method used to submit HIPAA-compliant transactions to the eMedNY system via a web-based application. I answered general inbound calls and place outbound calls with the goal of increasing business, customer satisfaction, and customer retention. I followed basic procedures and scripts, using fundamental knowledge of company and project directories, services, and products to assist customers and clients. Received work via escalated queues or spreadsheets by using established processes to research and complete tasks. 

Aug 2013Sep 2015

Quality Control Administrator

Maximus Inc

I was responsible for monitoring and evaluating tasks completed within the enrollment and eligibility dept. for completeness and accuracy. Conducted quality assurance monitoring, reviews and audits in accordance with Maximus NYSOH implementation. Instrumental in co-creating work instructions for the Quality Control dept. at it's inception. Included, but was not limited to, the linking of documents to a consumers account in the NYSOH Marketplace, reviewing manual notices before they are sent to the consumer, ensuring that outgoing Returned Mail was correctly processed before being resent. I conducted quality control for completeness, accuracy, consistency and conformity. I was also the Point Of Contact between the Q.C. dept. with other dept. Managers and Director. I oversaw and supervised the staff in the absence of my immediate supervisor. I met or exceeded all dept. performance requirements associated with the Quality Control Dept.

Jan 2012Aug 2013

Senior Loan Processor

First Niagara Bank

I processed Non Secured loan applications in which I gathered, analyzed and processed necessary documentation from the applicant, credit bureaus, employers, and various creditors to verify financial information and credit standings. I communicated with bank managers and underwriters to resolve problems or questions regarding application information. I updated consumer program disclosure contracts per State and Federal regulatory requirements.

Apr 2011Jan 2012

Order Entry Technician

Davis Vision

I communicated vision benefit plan information to members, while providing excellent customer service. Made follow-up calls regarding clarification of benefits, receipt of billing statements from providers, eligibility issues. Differentiated between answer desk issues and support staff issues.

Feb 2008Apr 2011

Substance Abuse Claims Processor

United Healthcare/Optum

I provided general claims support by reviewing, researching, investigating, processing and adjusting claims. I authorized the appropriate payment or refers claims to investigators for further review. I also conducted data entry and re-work; analyzed and identified trends and provides reports as necessary. I consistently met established productivity, schedule adherence, and quality standards. I recognized claims by determining claim type-HCFA, Hospital, UB, and/or RX and calculated other insurance and re-pricing benefits. I updated and maintained claims tracking database and reviewed and processed daily reports.

Apr 2001Feb 2008

Health Insurance Claims Adjuster

Empire BlueCross BlueShield

I was responsible for reviewing, researching, and adjusting Federal and State Government regulated Insurance plans such as Medicare Advantage, Medicaid Managed Care plans, Child Health Plus, Family Health Plus and Healthy New York. I processed policy changes via phone, mail and fax. I also explained features and benefits of the policies to help promote sales. I performed administrative tasks such as maintaining records, composing business correspondence, and other company documents, updated and changed policies. I responded to inquiries received via fax, written correspondence, or by telephone call.

Dec 1998Apr 2001

Health Insurance Claims Processor

Uniprise

I adjudicated health insurance claims, reviewed insurance policies, determined appropriate coverage, obtained information from individuals, and used different computer programs to access or retrieve data. I paid, denied, or sent claims for further review.

Education

20012003

A.S Communications

Columbia Greene Community College

Certifications

20142016

Maximus

Certifications: HIPAA EDI Standards CMS 2013

Health Insurance Portability and Accountability Act (HIPAA) EDI Standards (2014)

2013 Medicare Part C and Part D Reporting Requirements Data Validation (2014)

HIPAA Compliance Training Certificate (2014)

Diversity in the Workplace Certificate (2014)

Information Security Awareness Certificate (2015)

Leadership: Establishing Influence Certificate (2015)

Affirmative Action Rules: Section 503 & VEVRAA (2015)

Affirmative Action/EEO Compliance Certificate (2015)

Anti-Corruption Compliance Certificate (2015)