DEON ROSS
Worcester
Summary
Healthcare operations professional with 6+ years of experience supporting Medicare Advantage, Medicaid, member enrollment, appeals processing, billing, and customer service within highly regulated healthcare environments. Skilled in researching and resolving complex member issues, processing appeals in accordance with regulatory standards, maintaining detailed documentation, and collaborating across departments to support operational efficiency and member satisfaction.
Overview
8
8
years of professional experience
Work History
Enrollment Specialist
Point32Health
05.2022 - Current
- Support enrollment operations for Medicare, Medicaid, Government Plans, Health Connector, and HSA membership processing.
- Investigate and process member enrollment appeals in accordance with internal policies, regulatory requirements, and turnaround standards.
- Perform daily membership and premium reconciliations using 834 and 820 state files to ensure data accuracy and timely resolution of discrepancies.
- Research and resolve complex enrollment and benefit-related issues while collaborating across internal departments.
- Maintain accurate documentation and detailed member records while managing high-volume operational workflows.
- Train and support new hires while assisting leadership during staffing shortages.
Medicare Representative
Point32Health
04.2020 - 05.2022
- Provided support to Medicare members regarding benefits, claims, eligibility, appeals, grievances, and billing inquiries.
- Educated members on pharmacy coverage and pharmacy appeals process. Submitting Coverage Determinations and Tier Exceptions.
- Maintained accuracy on call quality while attaining QC scores of 97% and above monthly.
Healthcare Billing & Collections Specialist
ROI Healthcare Solutions (Cognizant)
07.2019 - 04.2020
- Reviewed insurance coverage, coding, billing details, and payment responsibilities for healthcare accounts.
- Researched billing discrepancies and insurance claim issues to support account resolution while complying with HIPAA.
- Offered guidance on payment plans and appeal rights regarding billing inquiries.
- Communicated professionally with patients and insurance representatives regarding healthcare billing concerns.
Pharmacy Technician
CVS Pharmacy
04.2018 - 07.2019
- Supported pharmacists and patients in a high-volume retail pharmacy environment while resolving insurance issues.
- Verified Medicare, Medicaid, and commercial insurance benefits to support prescription fulfillment.
- Maintained HIPAA compliance and accurate records while assisting patients with healthcare-related concerns.
Fulfillment Associate (Part-Time)
Amazon
10.2024 - Current
- Support fulfillment operations while consistently meeting productivity and quality standards in a fast-paced environment.
- Maintained accuracy, efficiency, and attention to detail while working within time-sensitive operational deadlines.
Education
Bachelor of Arts - General Studies (Business Administration Concentration)
Southern New Hampshire University
Manchester, NH05.2026
Associate of Science - General Studies
Quinsigamond Community College
Worcester, MA05.2017
Skills
- Appeals & Grievances
- Medicare Advantage
- Medicaid
- Member Enrollment
- Regulatory Compliance
- CMS Guidelines
- Documentation
- Claims Support
- Data Reconciliation
- Cross-Functional Collaboration
- HIPAA Compliance
- Healthcare Operations
Timeline
Fulfillment Associate (Part-Time)
Amazon
10.2024 - Current
Enrollment Specialist
Point32Health
05.2022 - Current
Medicare Representative
Point32Health
04.2020 - 05.2022
Healthcare Billing & Collections Specialist
ROI Healthcare Solutions (Cognizant)
07.2019 - 04.2020
Pharmacy Technician
CVS Pharmacy
04.2018 - 07.2019
Bachelor of Arts - General Studies (Business Administration Concentration)
Southern New Hampshire University
Associate of Science - General Studies
Quinsigamond Community College