Customer Service Medical

JOLEEN FLETES

**** ********* ******, ********, ** 92345 ? H: 760-***-**** ?

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

PROFESSIONAL SUMMARY

To further my personal and professional growth and experience within your

company and to use my skills and

attributes to develop my career.

SKILLS

CPR/First Aid certified Efficient and reliable team player

HIPAA compliance Critical thinking

Certified Medical Office Assistant Attention to detail

Report analysis Adaptable

Articulate and well-spoken Quality assurance

Customer service-oriented Professional phone etiquette

Flexible Excellent communication skills

Accurate and detailed Pleasant demeanor

WORK HISTORY

Medicare Grievance and Appeals Analyst, 04/2006 to 02/2010

Aetna Inc.

Oral and written communication with members of the Health Plan

Timely resolution of Medicare Advantage and Medicare Part D member

complaints in accordance and

compliance with Health Plan and Regulatory requirements

Timely resolution of Medicare Advantage Pre-service and Post-service

Appeals in accordance and

compliance with Health Plan and Regulatory requirements

Triage, disbursement, tracking and resolution of executive complaints as

well as complaints forwarded by

the Better Business Bureau, State Departments of Insurance, State

Attorney General Offices, Congressional

Representatives, CMS and Department of Managed Health Care

Forwarding Medicare Advantage Pre-service and Post-service appeals to

Maximus Federal Services for

level 2 review

Interdepartmental communication and correspondence

Working closely with the Executive and Regulatory Resolution Team and

Regulatory agencies to ensure

compliance with Health Plan guidelines as well as Federal regulations.

Maintained accurate records of patient care, condition, progress and

concerns.

Took advantage of opportunities for continuing education, quality

assurance and performance

improvement activities.

Patient Relations Coordinator, 02/2005 to 04/2006

San Bernardino Medical Group

Liaison between patient and physician

Grievances and complaints

Health care and laboratory auditing

Provider and specialty referral surveys

We care letters

Medical records correspondence

Health Plan reporting

Processing the dismissal of noncompliant patients

Organization of patient education programs

Marketing

Instruction of select educational classes

Processing of death certificates

Documentation of Advance Health Care Directives and patient instruction

New patient orientation representative

Clinic organizer

Correspondence management

Monitoring of patient compliance

Working closely with Health Plans to ensure patient satisfaction

Using problem solving skills to manage stressful and difficult

situations.

Maintained accurate records of patient care, condition, progress and

concerns.

Monitored vital signs, such as blood pressure and pulse.

Responded appropriately to the physical, emotional and developmental

needs of patients.

Obtained information about clients' medical history, drug history,

complaints and allergies.

Maintained a clean, healthy and safe environment.

Performed clerical duties, such as word processing, data entry,

answering phones and filing.

Documents objective data and routine aspects of patient care.

Provided a comforting and soothing environment.

Took advantage of opportunities for continuing education, quality

assurance and performance

improvement activities.

EDUCATION

Nationally Certified Medical Assistant: Medical Assisting, 2004

United Education Institute - San Bernardino, Ca

Emergency Medical Technician: 2005

Emergency Medical Institute - Victorville, Ca

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