DENISE TIJERINA

***** ******** ** #**** ******, TX 78748 512- 766- 1156

ad1prv@r.postjobfree.com

OBJECTIVE

Highly organized individual with strong interpersonal skills, seeking to secure a challenging and rewarding career with a company where my skills are effectively utilized to their fullest potential and produce continual experience with growth opportunities.

SKILLS PROFILE

- Bilingual (Spanish), outstanding communication skills with all levels of company personnel and customers.

- Proven ability to work effectively and collaborate with people.

- Ability to prioritize tasks, use time in the best way possible and work within appropriate policies and procedures.

- Expert level in all facets of computer/data entry (MS Word, Excel, Power point, Access, Outlook & 10 key). Ability to type 50 wpm.

- Expert with verifying insurance programs such as TMHP Medicaid, Superior, Molina, United HealthCare, & Amerigroup.

- Experience with accessing TIERS, Snap, Medicaid and TANF benefits. Skill Highlights

Strong organizational skills Telephone inquiries specialist Active listening skills Customer service expert

Sharp problem solver Adaptive team player

Courteous Demeanor Filing

Energetic work attitude Data Entry/10 Key

Ability to work as a team member Prioritize various responsibilities Manage time appropriately

Knowledge with incontinence supplies such as diapers, wipes, feeding tube, feeding bags, feeding machine, syringes, and bandages to hold tubing in place due to my children using these supplies at one point. EMPLOYMENT HISTORY

HEDIS ADMIN ASSISTANT- REMOTE (WORK FROM HOME)

CVS/LANCESOFT- AETNA

01/2023-03/2023

WORKED WITH HEDIS PROJECT

Call provider offices to Request/Validate facility addresses Collect and review medical records

Retrieve and fax medical records to ensure correct DOS Document all outreach efforts

Customer Service/QI Specialist – Remote (Work From Home) Pyramid Consulting/Centene Corporation

1/10/2022 – 05/06/2022

Call provider offices to Request/Validate facility addresses Collect medical records for HEDIS project.

Provided data entry to change addresses into system. Upload records upon receipt.

Documenting all outreach efforts.

Customer Service Representative

Aerotek/Superior Health Plan

11/26/2019 – 03/11/2020

Document all activities for reporting and resolution through the customer relationship management application (CRM).

Answer inquiries from providers regarding claim, eligibility, covered benefits, authorization status issues. Provide first call resolution through issue documentation and resolution with appropriate internal resource, follow-up and ensure closure with the contact who initiated the inquiry. Respond appropriately to provider issues and concerns and provide trending feedback to improve the customer experience.

Process customer correspondence and provide the appropriate level of timely follow up. Manage service-related follow up items and outstanding tasks in accordance with established turnaround times.

Aid provider regarding website registration, navigation and customer related inquires. Educate provider on health plan initiatives during interactions with providers via telephone. Maintain performance and quality standards based on established call experience guidelines. Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations’ team for claim adjustment.

Identify any trends related to incoming or outgoing calls that may provide policy or process improvements to support excellent customer service, quality improvement and call reduction. DocuManage Coordinator

Longhorn Health Solutions

08/27/2018 – 08/29/2019

1 Year experience in a busy DME (Durable Medical Equipment) office. Experienced in verifying insurance coverage, and qualifying criteria that is needed for home medical equipment and incontinence supplies patient may need. Verifying ICD-10 codes on a daily basis.

Utilized medical knowledge to identify qualifications for various medical equipment. Spoke consistently with patients in reference to their care and durable medical equipment needs. Organization of medical records.

Processed orders from physician offices, hospitals and referrals from insurance agencies for incontinence supplies or medical equipment.

Recert paperwork on a daily basis for patients needing recertification for their supplies. Answered phone calls and answered questions on a daily basis from patients, doctors offices and insurance agencies regarding patient’s paperwork and/or orders. Office Assistant/Cleaning professional

Arise & Shine Cleaning Services

03/2011 - 01/2015

Supervise and assign the work of maintenance employees Administered everyday activities of cleaning staff

Inspect work for completeness.

Determine material, equipment, and supplies to be ordered Transfer equipment and personnel from one project to another as necessary. Performed regular everyday inspections

Maintained data system

Assist with cleaning of commercial and residential Sweep/vacuum, Clear debris, move heavy furniture and equipment, use chemical cleaners, Monitor the security of a building.

Program Tech II,

Maximus

Austin, TX

Worked for CHIP health insurance conducting data entry. 05/2009 — 04/2010

Used appropriate designated work instructions and other instructions to execute routine and repetitive tasks. Ensure the confidentiality and security of all information Accurately perform data entry in accordance with department policies and procedures Perform other duties as assigned by management

Customer Service Advisor II,

Health & Human Services

Austin, TX

05/2007 — 10/2007

Perform moderately complex customer service functions in a call center environment to process client request for program services. Work involves interviewing clients and making eligibility determinations for Food Stamp, Tanf, and Texas Works Medicaid programs. Complete FS, Tanf, and Medicaid case maintenance activities to provide timely client services. Process agency reported changes for cases and other case activities. Complete additional tasks, projects or assignments upon request

Administrative Tech III, 02/2004— 02/2007

Health & Human Services

Austin, TX

Worked in the Data Integrity Department, conducting data entry, using Uniscope software. It was my responsibility to enroll newborns onto TP45, newborn medicaid. Each day I would receive a certain amount of client forms that needed to be entered daily. I would perform inquiry for Med. cases to verify client information. At the end of the day I corrected all fatals, if any, and tallied the amount entered for that day. The number entered must match number of forms given. All entries are kept noted in logs. I was given cases that needed to be denied and given back to workers, reports such as Rn69's, which determined if the client had 2 open Med. cases. In that case I was to deny one and check for managed care on both opened and denied cases to decide if the client had overlapping coverage. I processed force changes to coverage, merge client numbers which had a report to go along with that called the merge error list. At the end of the month all reports were due. Also worked a report which involved making name changes for newborns. Also conducted Data Entry duties to verify client cases and numbers, merge order requests, force changes, and all reports. Clerk III, 04/2003— 02/2004

Dept. of Health & Human Services

Austin, TX

Worked the front desk and assisted clients with applying for assistance, such as Food Stamps, Medicaid, Tanf. I took client applications, screened the clients to see if client met requirements for emergency assistance. Worked with Tiers and Arev software. If clients were not in systems, I would register the client application into Tiers software. Assisted clients with inquiries pertaining to FS, and Med. cases. Performed inquiries on client case/cases. Also scheduled appointments, answered multi-line telephone and assisted clients via telephone on inquiries pertaining to case, issued out temporary medical cards. I also served as EBT clerk. As EBT clerk I was in charge of issuing clients their Lonestar cards when client had already been interviewed by worker. Performed finger imaging whiled entering all client info into LSIS software. Would also do mail outs for Lonestar cards. At the end of day as EBT clerk I would make report on all client cards issued that day.

EDUCATION

Austin,TX

- Austin Community College – G.E.D (1998)

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