** ***** ** ********* ******* speaking call center experience handling up to 100 calls a day
** ***** ** ********** ********** in a managed care setting working with providers and Medicare/Medicaid recipients
Experience screening patients for eligibility and benefits as well as assisting members find providers within their area for services needed
Excel in listening to customer needs product benefits and creating solutions that provides value to the customer
Extensive experience building and maintaining enduring customer relationships to boost sales and generate repeat business
September 2016 – Present (position is ending )
Bilingual Medicare/Medicaid Service Representative 9/19/2016 – Present
Working for the Commercial Repayment Center of Medicaid and Medicare Center
Receive inbound calls from members or their families regarding claim questions status of claims or documents needed for different levels of recovery status.
Help customers find providers that are in their network for services needed
Screen for eligibility and benefits
April 2015 – Aug 2016
December 2012 – March 2015
Bilingual Provider Benefit Specialist
Inbound/Outbound calls respond to telephone inquiries
Educated and answered insured/providers questions regarding dental benefits policies and procedures.
Delta Dental providing benefits and claims processing.
Processing dental claims
January 2008 – November 2012
Bilingual Customer Service Representative
Inbound/Outbound calls from telecommunication and customers
Performed different tasks and projects with this company Medco sales order processing and following with customers.
AT&T taking orders and setting up appointments for cable inland lines and internet.
July 2000 – March 2008
Bilingual Member Service Representative
Inbound/Outbound calls from Insured providers and facility taking medical insurance information opening files and obtaining medical information for precertification review.
Followed up with providers making sure all medical requirements was obtained to for utilization review.
Effectively analyzed detailed information and transforms into communicable reports both internally and externally in order to lower costs and increase profits
Maintained provider contract files and system information for the Medicare Advantage Program
Researched and solved provider issues;
Medical Billing and Coding Certificate Everest Institute – San Antonio TX
General Education Diploma Gwinnett Community College – San Antonio TX