Resume

Sign in

Customer Service Representative

Location:
Miami, FL
Posted:
October 25, 2018

Contact this candidate

Resume:

CLARISEL MADRUGA

Primary305-***-****

ac7h5r@r.postjobfree.com

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

Miami, FL 33186

OBJECTIVE

Administrative/Lead/Supervisor position allowing for parlay of demonstrated organization, customer service, and communication skills proven for 12 years of successful profitable employment.

EXPERIENCE

HYGEA/MedCare

September 2016 – 2018

REFERRAL DEPARTMENT SUPERVISOR

Review urgent referral reports

Direct day-to-day work

Ensure patients have been cleared for specialty service office visits and certain procedures

Lead and participate in process improvement activities.

Encourage and build mutual trust, respect and cooperation among team members

Provide guidance and direction to staff members including setting performance standards and monitoring performance

Train and instruct staff members in job duties

Discuss job performance problems with staff members to identify causes and issues and work on resolving problems

Maintain up-to-date knowledge of insurance plans and billing rules

Assist Referral Coordinators with coding issues

Ensure that referrals are addressed in a timely manner

Apply knowledge and application of ICD-10 and CPT coding

Communicate coding issues to provider via electronic communication

Functions as a resource to the referral team and providers regarding referral processes and education

Works and supports Director of Billing Operations to provide ongoing education regarding referral processes and requirements

Works and supports Director of Billing Operations to review complex referral process and requirements

COMMUNITY HEALTH OF SOUTH FLORIDA

January 2015 – September 2016

LEAD MANAGED CARE TECH II

Process authorization request for emergency treatment, specialty and ancillary services for managed care enrollees.

Ensure referral request forms are accurately completed and processed in a timely manner.

Enter authorization in computer system for all clients enrolled in HMO.

Complete a minimum of 20 referrals per day.

Respond to telephone inquiries regarding coverage and benefits, appointments, referrals, etc., from clients, insurance companies, personnel and providers.

Schedule appointments with health care providers.

Participate in Performance Improvement Activities.

Participate in appropriate continuing education in-service training.

Maintain current licensure and/or certificates.

Performs other duties as assigned.

EVEREST INSTITUTE KENDALL CAMPUS, MIAMI, FLORIDA

April 2008 - Oct. 2014

SENI OR CAREER SERVICE REPRESENTATIVE

Developed and maintained externship site list that is regularly updated and uploaded onto our computer system.

Coordinated with the faculty externship supervisors, and students in advance of the externships to provide them with all of the student's paperwork after the externships have been approved.

Organized and held orientation meetings with students in advance of their externships.

Collected, reviewed, and maintained required paperwork from students before, during, and after externship rotations.

Communicated with externship site supervisors before and during the externships, then collect final evaluation forms from externship site supervisors and review with students.

Completed externship file upon ending of final externship, review final evaluation, and submit final grades.

Performed site visits only when necessary.

Prepared letters of completion to verify hours for national certification.

Assisted students with graduation process.

Conducted seminars on resume writing, interviewing and job search skills.

Audited student files.

Assisted students in job placement.

Established recruiting requirements by studying organization plans and objectives; meeting with managers to discuss needs.

Determined applicant requirements by studying job description and job qualifications.

Determined applicant qualifications by interviewing applicants; analyzing responses; verifying references; comparing qualifications to job requirements.

Often called upon as “Acting Director” when appointed Director is absent.

UMHC/UNIVERSITY OF MIAM JOSEPH APPLEBAUM MRI CENTER, MIAMI, FLORIDA

May 2004 - April 2008

BUSINESS OFFICE/FRONT – END LEAD

• Verified insurances, and obtain authorizations when needed.

• Assisted different departments in registering their patients.

• Prepared weekly staff evaluations.

• Communicated medical concepts and instruction to patients.

• Rapidly learned and mastered varied computer programs.

• Knowledge of obtaining authorizations for diagnostic exams, and small procedures.

• Oversee Front - End staff at ADIC

• Assisted with the introduction and implementation of new techniques and procedures for registration, ensuring all staff are competent

• Assisted in maintaining proper Front - End staffing levels.

• Provided leadership, education, and orientation to all Front - End staff.

• Provided staff with job standards, and descriptions.

• Monitored Phone Calls through Symposium for proper Customer Service

PRIME CARE OF CORAL GABLES, MIAMI, FLORIDA

Nov. 1998 - May 2004

REFERRAL COORDINATOR/SUPERVISOR

• Answered high volume of incoming calls.

• Obtained authorizations for diagnostic exams, special procedures, and surgeries.

• Insured all patients received their authorizations in a timely manner.

• Coordinated small procedures with different hospitals/Outpatient surgical facilities.

• Supervised two referral coordinators

SKILLS PROFILE

• IDX

• RIS/PACS

• Health Works

• Cane-Care

• Outlook

• Excel

• PowerPoint

• Microsoft Word

• Internet Explorer

Campusvue

MDFlow

EDUCATION

UNIVERSITY OF PHOENIX (6/2011)

BACHELORS DEGREE

HEALTH MANAGEMENT

MIAMI DADE COMMUNITY COLLEGE 05/2008

ASSOCIATES DEGREE

MIAMI, FL

REFERENCES

• Available upon request



Contact this candidate