Customer Service Medical, conflict resolver, benefits analyst

Phone 714-***-****

E-mail: *.******@*****.***

Cynthia Nguyen

Objective

I would like to utilize my skills and knowledge for personal and professional growth in the medical industry. I have a broad spectrum of knowledge in each field I've obtained in the past 10 plus years and have adapted to changes. I am looking for REMOTE work rather than in an office setting. I am open to data entry, claims, eligibility & benefits, appeals and grievances which all include internal and external customer service.

Education

Goldenwest College 2000-2007 Costa Mesa, CA

Fountain Valley High School 1998-1999

High School Diploma

Languages

English (fluent)

Vietnamese (fluent)

Work experience

Monarch Healthcare/ Optum Services / United Healthgroup

09/07- 04/2018

Customer Service Representative

Interact with internal/external customers to provide and process information in response to inquiries, questions, concerns and requests for services in a fast paced, busy call center.

Interact directly with customers either by telephone via call center, electronically via email or face to face on occasion.

Respond promptly to customer inquiries regarding bills, requests for information on plan, eligibility, and benefits.

Handle and resolve customer call complaints via forwarding to Quality Dept.

Verify insurance through internal database and Health plan’s database

Set up/follow up Interpreter Services for members

provide excellent customer service skills and knowledge

Educate our customers if they do not understand their plans with balancing the business practice

Maintain customer databases recording specific call data.

Communicate and coordinate resolutions when issues are presented.

Give claims statuses to providers; send claims with identifiable issues back for adjustments.

Discuss claims’ issue and work internally to review and provide an explanation as to why a claim is denied or paid correctly by understanding the provider’s contracts.

Assist members with their issues with doctor’s offices, authorizations, claims, bills, help coordinate a case manager through our clinical department.

Newport Center Medical Group 01/06 – 08/07

Front Office Medical Assistant

Answer phones and deliver accurate, detailed messages to the doctor. Expedite messages returns and pharmacy phone calls.

Assist in checking in and checking out patients.

Collect payments on Co – pays and bill statements from patients.

Schedule, confirm, and balance out Doctor’s appointments according to the type of procedure.

Obtain medical records authorizations and payments and print out medical records and send out to appropriate offices.

Obtain prior authorizations for medications.

Deliver accurate medical service to patients’ needs.

Parkinson’s & Movement Disorder Medical Group 3/06- 12/06

Fountain Valley, CA

Front Office Manager

Ensured employees deliver accurate medical service accordingly

Trained staff to respond to patient’s needs in a timely manner

Assisted patients to check – in & check - out, set appointments and accept co-pay as well as taking vital signs

Responsible for retaining insurance authorizations for procedures, follow ups, and new consults.

Expedite paperwork regarding disability, DMV paperwork, Immigration and Naturalization, eligibility Insurance, follow ups on Worker’s Compensation and Medical Records.

Managed two offices in patient care and treatment

On-Call 24/7 for hospital patient care

Managed a staff of four in implementing efficient customer service

Net Visibility Newport Beach, CA 6/05 - 3/06 Newport Beach, CA

Business Development Analyst

Presented business proposals to potential small businesses.

Introduced and assisted clients in understanding their network search engines, web traffic, and keywords in providing solutions.

LA Chemical Huntington Beach, CA 3/05 - 6/05 Market Pollster

Gathered information from past and present customers of LA Chemical via the internet and phone calls.

Collected research sample data from companies, evaluate and review for accuracy before turning into supervisor.

Notified sales department of potential customers through initial telephone consultation.

Baskin Robbins Garden Grove, CA 2003 - 2005 Garden Grove, CA

Sales Team Leader

Displayed marketing materials for promotions and future items

Delivered oral and written directions

Managed and balanced cash register for daily profitability report

Planned weekly shipment and organized inventory control

Provided customer service

Trained new employees on how to provide fast and friendly service

Computer and Software experience

Basic computer configuration, Windows 95/98/2000/XP/Windows 8, Internet, Microsoft Excel, Microsoft Word, Microsoft Outlook, Typing 55 wpm, and 10 key stroke, EZ Cap knowledge, Practice Connect, Image Net, Misys EMR, Misys Tiger

References

References Available Upon Request

Contact this candidate