RONNE “RENEE” BABCOCK

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

Orange CA 928**-***-****

SUBJECT MATTER EXPERT/SR ESCALATIONS REP

SUMMARY OF QUALIFICATIONS

● Excellent Customer Service skills, both written and verbal

● Proficient in Internet, Microsoft office, CRM,10 key by Touch,Cisco, Nice,,IEX,CMS and Workforce Management Applications

● Able to balance competing demands of a fast paced environment effectively

● Expert at operating the Call Center phone system and to efficiently handle incoming calls to meet or exceed the callers expectations

● Always exceeded goals and very reliable

● Excellent organizational, administrative and time management skills

● Knowledgeable of Medical terminology, Medical billing and coding, and DOFR.

● Well organized, systems oriented and instinctive attention to detail EMPLOYMENT

Molina Healthcare, Long Beach, CA 6/2014 to

Present

Subject Matter Expert/Sr Escalations Rep

● Handle incoming calls from members and providers regarding claims,continuity of care,durable medical equipment supplies and explanation of benefits

● Extensive Knowledge of Medicare and MMP Dual Demonstration Plans in various states

● Trained new hires as need

● Assists provider contracting with obtaining the provider billing information for possible contracting

● Provide assistance with prior authorizations/referrals for specialist and work closely with providers to assure they are completed

● Resolved inappropriate billing, provider searches, out of network contracting at the members request

● Work with case managers on a daily basis with any issues or concerns the members might have

● Assisted and educated member service agents when they needed assistance or knowledge of how to handle various issues

● Achieve individual performance goals as it relates to call center objectives

● Managed to resolve member’s complaints, appeals and grievances, including transcribing the members concern, research and gave timely resolution

● Handled disenrollment of health plan requests for the members

● Always exceeded goals of in the department

● Create claims project for providers with 10 or more claims

● Provide copies of EOB’s to providers as requested.

● Send claims back for reprocessing and adjustment

● Research and resolve issues with compliance department

● Analyze CTM Complaints

● Work daily on projects to resolve and process appeals and grievances Pinnacle Claims,(Covered California, Inc) Irvine, CA 10/2013 to 4/2014

Marketplace Call Center Agent

● Fostered and built collaborative working relationships with Agents, Employers, Employees/Dependents, Qualified Health Plan(QHP), federal and state agency contacts and other stakeholders within HBEX administration

● Subject matter expert for Health Benefit Exchange

● Proficient in eligibility/enrollment process regarding health care exchange

● Provided telephonic and web-based outreach to provide informational support to assist with QHP selection, application completion and benefit termination ADP Payroll Services, La Palma, CA 1/2008 to

6/2013

Sr Payroll Support Analyst

● Responsible for answering questions and processing about payroll/benefit input from inbound 800 call center and provide a resolution. Assisted clients with processing and balancing of payroll to bank reconciliations, posting of deduction codes and misc. other items. Instructed clients on set up of new 401K plans, levies and interstate set ups for payroll processing. Also assisted with quarterly tax filing and balancing to payrolls.

● Utilizes call center knowledgebase, case management and client data base systems.

● Provides tier one customer service support to the clients. Hansen Beverage Company,Corona, CA 9/1994 to

1/2008

Sr Merchandising/Sales Rep for Club Accounts

● Managed and ensured all Club/Drug Stores had stock

● Worked with store Managers and Demo Supervisors on obtaining end caps for new items and special programs throughout each month on beverage product

● Tracked weekly sales and reported them to corporate office

● Rotated and replenished stock when needed

● Prepared Monthly Financial Statement for Route Sales

● Managed a fleet of 4 delivery truck drivers

● Processed Accounts Payable and Receivables

EDUCATION

High School Diploma

Institute of Banking Certificate

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