Customer Service Management

Cynthia Ayala

**** * ******

San Antonio, TX ****8

Cell: 210-***-****)

Desire a position with a company where I can apply my skills and experience to contribute value and have opportunities for career

growth in the Health Care industry. I am a very goal-oriented individual, with strong interpersonal skills. I work very well in groups

and just as efficient individually. I value honesty, teamwork, and integrity. I am also just as ready to contribute, meet, and exceed

company expectations.

COMPETENCIES:

Contracting Physicians Hospitals & Ancillaries Organization & Presentation Experience Orientation & Interpersonal Ability

Training & Development Medical Terminology Marketing Proficiencies

Claims Analysis & Processing ICD9 & CPT Coding Proficient in all MS Office Suite

EMPLOYMENT HISTORY:

Natus Medical/ NSHP DATA Technician II (10/13 to 09/14).

Develop strong relationship with physicians.

Visit Hospitals to see that they are in compliance with the screening process and documenting of the Newborn babies.

Support all program resources to ensure data management systems are consistently functioning.

Utilize appropriate in-house systems during each project.

Act as a liaison between multiple business partners to identify and resolve problems and concerns.

Educated provider managers on coding for risk adjustments and revenue reporting to Molina Healthcare Inc.

Assist with completion of special projects as requested by various internal departments or in support of requests from

regulatory.

Experience working with babies with disabilities.

Molina Health Care, Provider Relations Representative (05/10- 04/13).

Conducted oversight of any corrective action plans.

Tracked and communicated all network changes to our providers.

Ensured provider services are delivered without gaps and identified functional deficiencies in plan of care.

Acted as a liaison between multiple business partners to identify and resolve problems and concerns.

Verified the accuracy of diagnosis information submitted on claims/encounters for the purposes.

Ensured compliance to accreditation, state, and federal regulations.

Preformed annual HEDIs chart reviews as determined by clinical process quality managers or contracted plan.

Facilitated surveys and site visits.

Educated provider managers on coding for risk adjustments and revenue reporting to Molina Healthcare Inc.

Assisted with completion of special projects as requested by various internal departments or in support of requests from

regulatory agencies and external organizations.

United Health Care, Provider Contract Specialist (03/09 – 04/10)

Negotiated hospitals and Ancillary contracts.

Conducted provider orientations to all new providers.

Assisted with re-credentialing of contacted network providers, if needed.

Negotiated Hospitals and Ancillary contracts

Facilitated surveys and site visits

Implemented fees schedules analysis and negotiations for physicians and facilities including laboratory services.

Contacted new providers; and ensure that credentialing application was submitted.

Ensured appropriate communication of Provider Service’s initiatives and contracted network provider issues.

Maintained regular contact with key provider organizations and act as a liaison to internally resolve complex issues.

Prepared subcontract agreements and reports, teaming agreements and non-disclosure documentation.

Centene Corporation/Superior Health Plan, Appeals and Grievance Coordinator (01/07-01/09)

Assisted with coordinating general support to teams in reviewing, researching, investigating, negotiating

and resolving all types of appeals and grievances.

Identified and analyzed trends for all appeals and grievances.

Conducted root cause analysis by identifying potential compliance, process, or systemic breakdowns and

communicated findings to management.

Collaborated with internal departments to resolve member complaints/grievances according to regulatory

timelines.

Responsible for follow up and resolution of providers’ service issues that arise, including but not limited

to, eligibility, claims, capitation, credentialing, encounter data and member benefit programs.

Acted as a liaison between all departments.

Met with the State on Monthly bases on member and provider compliance.

Corresponded both verbally and in written form regarding escalated member grievance and appeals and

provider issues.

Developed effective working relationships with the applicable regulatory agencies and plan personnel and

assisted in preparation of summary grievance reports to regulatory agencies.

Maintained confidentiality of data and all communications and interactions, internally and externally.

Experience with Microsoft Office tools, including Word, Excel, PowerPoint, Access, Project, Visio, and Share

Point.

Customer Support Help Desk/Kelly Services (12/03 – 01/07)

Provided direct website support to USAA members and employees on operational, technical, and business application

environments.

Provided excellent customer service while identifying, prioritizing, and resolving problems in a timely manner.

Highly motivated and willing to work shift assigned.

Provided sales to members on all back products.

Experience with Microsoft Office tools, including Word, Excel, PowerPoint, Access, Project, Visio, and Share

Point.

IT Customer Support Help Desk/Remedy Staffing (12/01 – 12/03)

Provided direct website customer support services to USAA members and employees on operational, technical, and

business application environments.

Provided excellent customer service while identifying, prioritizing, and resolving problems in a timely manner.

Worked with other IT areas to resolve complex problems.

Connected meaningfully with customers to build emotional engagement and customer advocacy.

Delivered optimal customer experience.

Used Outlook, Word, Excel, Access and PowerPoint to develop presentations and brief all levels of Management.

USAA, Technical Writer (06/98 – 07/01)

Served as a Technical Writer for documentation of Operations Support processes using the Info Mapping Tool and the

Platinum Process Continuum (PPC) WEB based tool, also formerly known as the James Martin Methodology.

I have five years experience working systems implementation procedures, scheduling and coordinating work

independently with minimal supervision.

Worked with various units to collect and analyze process flow for information to develop or change documented

processes.

Have documented several processes for the Technical department.

Supported the Milestone Decision Memo (MDM) effectively interacting with customers at all levels with technical matters.

Used Outlook, Word, Excel, Access and PowerPoint to develop presentations and brief all levels of Management on

process documentation outputs.

USAA, IT Staff Support Specialist (01/96 - 06/98)

Served as a focal point for system-maintained information and interfaces with various management activities to update

and prepare various reports.

Made recommendations and determined areas for process improvement.

Provided systems security access to TSO, CMS, LAN IDs, Service Center and maintained inventory of LAN security

access.

Maintained Technical Systems tape library and provided support for users.

Collected all telephone reports for Operations Support and performed monthly reports using Excel and Access.

USAA, IT Support Technician (01/92 - 01/96)

Responsible for providing Service Center access and conducting user sessions.

Supported manager with Budget Call and Manpower/Organization Change Request. Initiated and processed Information

Technology Company (ITCO) job requisitions for the unit.

Produced numerous graphs that depicted trends in problem areas and developed all presentations for the Service

Availability Index for Operations in Power Point.

I have worked with Change Control and Problem Management.

Bilingual

USAA, Purchase Order Technician (01/91 - 01/92)

Responsible for processing purchase orders for USAA and entering annual purchase orders from vendors in CICS-MSA.

Ordered supplies for USAA in large quantities.

Responsible for end-of-month payments for vendors.

Worked with management and contractors to ensure contract compliance.

Bilingual

Quantum SW Medical Management, Provider Relations Lead (08/88 - 01/91)

Experience with the worksite setting to drive awareness and enrollment in to our clinical and wellness programs.

Accurately manage multiple technology systems simultaneously.

Clearly understand the culture of Health through education, awareness, and engagements in respective health

management programming which will include a thorough understanding of the clients, goals and needs related to program

and initiated promotion. Assisted clients’ employees with issues such as claims resolutions, understanding EOB.

Educated members about the managed care services provided via Quantum SW Medical Management Corporation and

associated health plans.

Educated and promoted preventive care visits to members and providers.

Conducted new member welcome calls and visits. Identified potential "high risk" members assisting them in accessing

care and services.

Conduct site review and document information which is integrated to the proper department.

Contact new providers and ensure that credentialing applications is submitted.

Contact this candidate