Customer Service Representative
Resume:
MARILYN FIGUEROA
Palm Coast, FL 32164
***************@*****.***
Skills Summary
CUSTOMER SERVICE/SECRETARIAL/OFFICE SUPPORT PROFESSIONAL
More than 20 years’ successful experience in customer service and support with recognized strengths in account maintenance, problem-solving and trouble- shooting, sales staff support, and planning/implementing proactive procedures and systems to avoid problems in the first place.
Possess solid computer skills.
Excellent working knowledge using both IBM and Mac systems; Microsoft Excel, WordPerfect, Microsoft Word, Power Point, Access, EZ Cap, Epic and Echo.
Knowledge of health plan benefits, authorizations, claims, billing, and ICD-10 coding.
Experience in a physician’s office, hospital, and other health care settings.
Ability to train, motivate, and supervise customer service employees.
A team player, acknowledged as “Total Quality Customer Service Professional.” Aptitude to communicate or translate from both English and Spanish (Spoken and Written)
Ability to answer phones, transfer phone calls, use fax machines, FedEx/UPS/DHL shipping experience and expert knowledge in utilizing intra/internet.
Education
Degree / Date of Graduation
National University – Major in Interdisciplinary Studies 2022
Experience
Rady Children’s Hospital – Patient Financial Services
Customer Service Accounts Specialist 04/2018 – 12/2021
Identified accounts with a self-pay balance after insurance has paid and those without insurance and will collect on those accounts. I assisted the families with financial assistance applications. I worked with families to establish payment plans in accordance with hospital policy and monitor the payment plans for compliance. I received incoming telephone calls and assisted families with information pertaining to their accounts, understanding statements, and previous insurance payments. Verified commercial insurance and Medi-Cal eligibility, applied share of costs, and update accounts with insurance information. I received patient complaints regarding billing and take appropriate action, based upon policy and procedures.
Rady Children’s Hospital - CHOC
Customer Service Representative 04/2017 – 12/2021
I received and responded to customer service inquiries (telephone, written and electronic) that may pertain to all phases of operations including authorizations, claims, and accessing provider network, providing information and/or soliciting response from appropriate contact.
I track member complaints, assisting members with resolving immediate need and forwarding issues to appropriate party to follow up and document all customer contacts, including resolution or actions taken to refer question proper entity.
I educate member families on navigation of HMO processes and provide members with physician/provider referrals within network, based on location, preferred criteria (age, gender, education etc.)
VITAS Healthcare
Admissions Coordinator 12/2010 – 03/2017
I facilitate the conversion of referrals to admissions through the completion of the intake process and the use of effective phone and customer service skills.
Responsible for answering all incoming calls and providing support to Admissions Managers, Admission Nurses and Liaisons.
Responsible for placing orders for DME utilizing a priority system based on patient needs. Communicated effectively, with empathy and compassion to patients and their families.
Allosource
Customer Service Consultant 09/2006 – 12/2010
I provided consultative services relating to human and bone tissue to numerous hospitals and surgery centers throughout the state of California and Illinois.
I assisted the Regional Manager with the day-to-day operations in distributing human and bone tissue to the designated hospitals and surgery centers. Also, I assisted with basic office functions, such as filing, answering multiline telephone calls in a promptly and very professional manner, researching issues via inter/intranet, centralized shipping/receiving, and courier functions. In addition to invoicing, crediting, and assisting customers with complex orders requests.
I worked collaboratively with medical staff and supply chain leadership to develop and maintain programs and process designed to ensure compliance in accordance with FDA regulations.
I provided administrative support and serve as a resource to enhance revenue, achieve optimal utilization, and reduce costs by keeping track of revenue via sales and inventory availability reports daily.
I assisted in establishing and implementing programs to document the proper handling of orders, receipt, and storage of human tissue. I ensure that appropriate inventory levels are maintained and communicate with customers regarding stocking, ordering and deliveries.
Social Security Administration
Claims Representative 11/1998 - 09/2006
I received and fully processed a variety of claims and post entitlement actions.
I assessed the case characteristics to delineate the evidence and supporting records needed, and furnished advice and assistance in securing documentation required to fully process a claim.
I referred applicants and other individuals to various agencies and sources equipped to provide additional program assistance and services such as welfare, section 8, medi-cal etc...
I outlined developmental actions to be taken by supporting personnel and provided other technical guidance and advice through various computer programs.
I reconciled discrepancies between case allegations and evidence and adjudicated the acceptability and conclusiveness of relevant factors such as validity of records submitted such as proof of age, medical records for disability cases and proof of identity.
I determined entitlement and final authorization or disallowance actions for payments of benefits as appropriate.
I identified persons requiring a representative payee for claimants that were not able to manage their own funds, evaluated the qualifications of prospective candidates, selected the preferred payee, and at specific intervals, reassessed the continuing suitability of such agents.
I identified, verified, documents, and reported program abuse cases or other questionable situations encountered.
Ackley Home Health
Office Manager 10/1995 – 12/1997
I independently identified and processed plans of actions to be taken to ensure the smooth operation of the office. Greeted visitors, answered questions, supervised administrative assistant and data entry personnel. I organized medical files for home health patients and assisted registered nurses in submitting medical soap notes of their visits.
I gathered and compiled financial/statistical information for various reports; prepared letters, forms, memoranda, and reports, maintained office management systems, and trained personnel on use of systems. I assisted the director and supervisors in day-to-day administrative processes district wide.
Developed and tracked internal operational procedures.
I managed daily activities such as work order process, payroll reporting, performance appraisals and general paperwork reporting including maintenance of confidential files. I supervised three full-time employees.
US Army
Medical Specialist/Combat Medic 07/1991 - 07/1995
My duties included triage determinations and treatment of personnel.
I provided medical care and "ambulance runs" when necessary. I was able to administer field and clinical treatment under the supervision of doctors, nurses, or physician's assistants. I was able to administer emergency and routine out-patient care involving the maintenance of health records and clinical files.
I was responsible for millions of dollars’ worth of medicines and equipment.
I supervised four medical specialists.
References Furnished Upon Request
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