Customer Service specialist
Resume:
Phoenix, AZ *****
*******@*****.***
YESENIA RUIZ
PROFILE
To obtain a position where I can ensure my extremely dedicated and detailed oriented extensive customer service expertise. My stellar customer satisfaction record along with my excellent executive medical field background and work ethic can assist with improving the company’s overall growth.
SKILLS & ABILITIES
Highly skilled and diverse, performance driven account management professional with excellent computer skills including but not limited to Word, Excel, PowerPoint office equipment to include a printer, scanner, fax machine and copier ect. Fast paced learner who can succeed in any field. Strong Organizational and management skills. Excellent interpersonal and communication skills. Superior breadth of customer care experience .Works very well in a fast paced environment, proficient knowledge in performing secretarial, administrative, clerical and front office duties with skills in answering a multi or single line phone, directing calls according to company requirements, responding to and sending emails and faxes, as well as typing correspondence, updating spreadsheet for tracking and establishing critical information, designing new presentations and tracking inventory for upcoming and outgoing shipments of any kind. Performs well with little to no supervision, in both independent operations and team dynamics with techniques in motivating and training others. Mastering the ability to perform inbound and outbound calling in any customer service role that exhibits professionalism, tenacity, thoroughness and dedication with solid work ethics and an outgoing and friendly demeanor.
EXPERIENCE
HOME HEALTH COORDINATOR/ APPEALS AND GRIEVANCES, CARECENTRIX
10/ 2016 – 05/2022
Coordinated health at home through care coordination and value-based benefit management. Worked in a fast paste and high call volume call center environment. Specialized in showing great empathy and patience to deal with difficult callers and or complex requests. As a care coordinator specialist, I collected time sensitive documentation required to manage patient’s cases of care from beginning to end while complying with all policies, including HIPAA/PHI policy. Strived to meet and exceed individual performance goals in areas of: Call Quality, Attendance, Adherence along with Problem Solving Skills. Coordinated Dural medical equipment, home health and infusion medication services to be approved delivered to patients’ home in timely manner. Supported clinical nurses and ensured patients are serviced in a timely manner, according to customer requirements. Provided focused resolution, support, and information to patients, providers and clinical staff. Managed cases and requests for services in a timely accurate manner. Collected, verified and confirmed non-clinical information and escalated issues as needed. First point of contact for patients needing home healthcare services. Receiving and responding to incoming calls from medical providers, health insurance, referral sources and potential and current patients.
Moved my way up and ended my time with CareCentrix in the appeals and grievances department as the last point of contact for full member and provider resolution.
BILINGUAL CUSTOMER SERVICE EXPERT, AVESIS VISION AND DENTAL
06/2009- 11/2015
Provided world class caller experience to members and providers measured by after call surveys. Interacted with representatives of health care providers and associated health plans relating to all aspects of relevant health plan programs and benefits. Used Avesis system applications and reference resources to investigate, analyze, and resolve caller inquiries with focus and fully responding to and anticipating other information they may need. Responsible for managing customer interactions according to defined procedures and customer service protocols and documenting each interaction in Avesis’ customer service application. Maintained production and phone quality standards to support individual and team goals and initiatives. Constantly following prescribed procedures and policies for assisting callers and documenting each customer service encounter. Maintained confidentiality and adhered to HIPPAA requirements. Exposure to Medicare, Medicare Advantage and or Medicaid insurance also included private personal insurances. Fluent (reading and writing) advantage in English and Spanish.
Marketing Consultant, Strategic Alliance Marketing
08/2008 – 04/2009
With the largest direct marketing presence in Arizona, leading the way in prospect generation and audience research. Continually worked to perfect the art of reaching people amid all excitement. We provided numerous professional organizations with assistance in marketing development. The goal was to create advocacy within the community. Assisted in developing new and enhanced patrons. Focused demographic distributions designed to increase visibility, brand awareness and drive consumer action.
Case Manager, Hospital patient services
11/2007 – 08/2008
Worked in Hospital Emergency Room worked in a fast-paced environment servicing Emergency room non-insured patients, analyzed and assed patients needs for financial assistance for medical care. Processed and submitted state insurance applications for all non-insured ER patients. Specialized in applications for AHCCCS, Medicaid, Medicare advantage, ALTC (Arizona Long Term Care Services). Offered multiple assistance programs such as out of state Medicaid enrollment services, charity application assistance, prenatal programs, victims’ compensation and on and off site Medicaid eligibility services. Responsible for many other duties such as greeting patients, answering incoming phone calls, scheduling and confirming appointments. Supported patients and all ER staff to ensure efficiency in all aspects of operation.
EDUCATION
ARIZONA STATE UNIVERSITY –TEMPE AZ, FORENSIC PSYCHOLOGY
Current student – GPA 3.5
Maryvale high school class of 2006- Gpa 3.8
COMMUNITY SERVICES AND LEADERSHIP
Co- President and Founder, Tolleson Jr Wolverines Youth football and Cheer non-profit org.
A nonprofit youth tackle football and cheerleading league for the community. We service the phoenix greater are. Offering football and cheer programs to children ages from 5-14 yrs. Our Programed has reached over 400-500 kids In the community. As the feeder team to Tolleson Union High School we work directly with the high school, cultivating student athletes by preparing them to handle the pressure of balancing both academics and sports, both mentally and physically. Also providing volunteer hours for current highschoolers and giving them the opportunity to give back to the community. Assisting the youth, providing foundations to tremendous life skills the kids can carry on through life such as camaraderie, teamwork, discipline and work ethic that will help shape our children into well rounded adults. Building community in low-income areas.
REFERENCES
UPON REQUEST
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