Customer Service Representative

Lena M. Martinez

***************@*****.***

*** ******* ***

Brooklyn, NY 11221

516-***-****

Education:

**/**-*/**** **** York College

Bachelors Degree

Major: Economics

*/** - **/** ****** Community College

Associate in Arts

Phi Theta Kappa Honors Society

Major: Liberal Arts

Experience:

5/13 - Present Rapid Realty - Sunset Park, Licensed Real Estate

Salesperson

-Solicit new renters for extensive database of listings

provided

-Coordinate with landlords to show potential tenants available

apartments

-Meet with landlords to attain new listings and information

-Advertise and attend marketing events for the expansion of

Rapid Realty

8/12 - 4/13 ComplexCare Solutions Inc., Credentialing Specialist

Responsibilities Included:

- Process Credentialing of newly onboarded clinical

employees

- Setup and orchestrate new hire orientations

- Sanctions Verifications for employees in NYS, the South

and Puerto Rico

- Perform chart audits according to client specific

Credentialing standards

- Schedule provider field training and GoTo Meetings for

online trainings

- Setup ongoing trainings for clinical staff according to

NCQA guidelines

- Resolve member complaints and requests for medical records

8/09 - 8/12 Health Care Partners MSO, Contracting Coordinator

Responsibilities Included:

- Processed credentialing applications for new providers

- Clarification of HCP Policies and Procedures for potential

applicants

- Coordinating Site Visits and New Provider Orientations

- High Volume Call Center answering approximately 150 calls

per day

- Monitored Customer Service calls for Quality and Assurance

11/07 - 3/09 HIP Health Plans of NY, Customer Service Representative

Responsibilities Included:

- Provided members with breakdown of coverage and benefits

- Enrollment of Medicare and Medicaid recipients

- Facilitated medical providers with billing and claims

discrepancies

- Provided breakdown of inappropriate coding, modifiers and

medical necessity denials.

- Utilized various programs including iHealth, CSS and e-

Paces

Skills:

- Proficient in Using Internet & All Microsoft Office

Programs

- Fluent Spanish

- Some Accounting Experience

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