Customer Service Quality

**** ***** ****** **, *******, CT ***** - 860-***-**** - ******@*****.***

Monique Soto Martinez

Objective Obtain a professional career at a highly recognized and

respected organization.

Experience 1/2008 - Present Aetna Hartford, CT

Information Consultant (Strategic Proposal Writer)

Achieve revenue, customer, membership and/or profit earnings

growth by providing strategic and technical support

throughout the sales support process.

Participates in proposal strategy development.

Addresses questions or issues to enable efficient completion

of the request.

Proposes solutions for meeting the plan sponsor's needs.

Gathers information from source systems to complete requests

which may include: Network statistical data,

Provider counts and reimbursement information, Turnover

data, Questionnaire responses, Relevant standards and

statistical facts for proposal,

Customize questionnaire responses based on case-specific

quotation strategy and customer priorities.

Conduct thorough research to create questionnaire responses

where a standard response does not exist.

Works with team to support follow-up questions or concerns

related to submitted proposals which may include

clarification of statistics, additional product and service

information, etc.

Supports field sales and service staff with ad hoc requests

for information to create value-added materials to market

Aetna's capabilities.

2005 - 1/2008 Aetna Middletown, CT

Credentialing and Application Management- Quality

Verification Analyst (Subject Matter Expert)

Possesses a working knowledge of Business

Review/Credentialing processes, EPDB, EPC, CARDS, CAQH

(Council for Affordable Quality Healthcare), ECHS, IOP.

Directly contacts providers/producers and/or outside

entities to clarify data quality issues.

Maintains high production and quality factors. Provides

telephonic education to providers/producers on credentialing

policies and procedures.

Researches and prepares risk sensitive or complex business

review/credentialing verification items for CPC.

Provides issue resolution for providers/producers, during

the credentialing or data management processes.

Responds to network or provider/producer inquiries,

including contracting and credentialing policy, procedures,

credentialing status. Perform data entry and systems

maintenance as needed; align data across systems.

8/2006 - 4/2007 Yale Psychiatric Institute New Haven, CT

Business Associate Psychiatry

Casual/Weekend position with in Dual Diagnosis. Receive

inbound calls re: patients. Directly contacts

providers/producers and/or outside entities to clarify data

quality issues.

Work closely with physicians and clinicians to ensure proper

patient charting. Track/Maintain patient status, such as,

bed swaps, 1 step bed transfers, admissions and discharges

via CCSS/SCM system.

2002 - 2005 Aetna Middletown, CT

Credentialing and Application Management Quality Analyst

(Subject Matter Expert)

Receive inbound calls from providers checking on their

application status, in a professional, courteous manner.

Proficient in the following systems: EPDB, EPC, Net Bus,

CARDS, DAS, MTable, Eligibility Tool.

Work closely with Project Managers and Provider Relation

Liaisons to ensure proper update for the Eligibility Tool.

Assisted in training three new hires on Initial Application

process and a vast array of problem calls. Train co-workers

as back-ups to complete reports handled on a daily basis.

Achieve or exceed, "quality", identified in performance

standards: 100% Phone Monitoring.

Extensive knowledge of the end-to-end process in

Credentialing, which allows for accurate and consistent

responses in a timely manner.

Created workflows for Initial and Re-credentialing

application process. Participant in the restructuring of the

JVS for Credentialing and Application Management.

Monitor incoming calls received by Customer Service

Representatives to determine whether representative is

courteous and professional also whether the resolution given

is within Criteria Guidelines.

Education 2008 -Ongoing Tunxis Community College Farmington, CT

Associate in Business

Ongoing

Profile

Organized, highly motivated, and a willing team player.

Proven ability to communicate with all levels of management

and personnel.

Strong commitment to accomplishing personal goals in line

with company objectives.

References References are available on request.

Contact this candidate