Marta Ivelisse León

** ********** *******,

Apt *D Edificio 2A

Carolina, PR 00983

ad32c9@r.postjobfree.com

407-***-****

Objective

A responsible and challenging position, which requires a high degree of responsibility, with opportunity for advancement, in all phases of Customer Service within Company growth. Experience

Aerotek, Maitland, FL

Customer Service Representative I

July 2017 - March 2020

Respond to telephone or written correspondence inquiries from members and/or providers within established timeframes utilizing current reference materials and available resources. Provide assistance to members and/or providers regarding website registration and navigation. Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application. Process written customer correspondence and provide the appropriate level of timely follow up. May coordinate member transportation and make referrals to other departments as appropriate. Maintain performance and quality standards based on established call center metrics including turn-around times. 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. Experienced with IEX/NICE. Cisco based telephone systems and skills based routing

Penang Nursery, Apopka, FL

Office Administrator Assistant

April 2016 – July 2017

Performs general clerical duties to include but not limited to: photocopying, faxing, mail distribution and filing. Coordinates and maintains records for staff office space, phones, company credit cards and office keys. Creates and modifies various documents using Microsoft Office. Performs Accounts Payable, coordinates presentations/events including flights, accommodation and rental/set-up booth. Temporary position. SimonMed Imaging LLC, Altamonte Springs, FL

Patient Financial Services

February 2015 – April 2016

Responsible for performing the appropriate processes to verify patient eligibility and benefits. Also to collect insurance information via multiple methods, run test claims and complete administrative duties as assigned. Determine the patient's financial responsibilities as stated by insurance. Configure coordination of benefits information on every referral. Ensure assignment of benefits are obtained and on file for Medicare claims. Bill insurance companies for therapies provided. Document all pertinent communication with patient, physician, insurance company as it may relate to collection procedures. Identify and coordinate patient resources as it pertains to reimbursement, such as copay cards, third party assistance programs, and manufacturer assistance programs.

3PV Third Party Verification, Altamonte Springs, FL Verification Representative

May 2011 – May 2013

To perform inbound/outbound calls from/to customers and vendors at the point of sale to verify the orders by following a verification script/rebuttal and input information into the 3PV system. If successful, the information is forwarded to the respective Vendor/Company. Notate proper information into the system thru Microsoft Office, Word and Excel programs. Boston Diagnostic Imaging/Dr. Richard J. Bagby MD, Altamonte Springs, FL Patient Financial Services

September 2006 – March 2010

Obtain and verify insurance eligibility for services provided and document complete information in the system. Perform prior authorizations as required by payer source, including procurement of needed documentation by collaborating with physician offices and insurance companies. Collect any clinical information such as lab values, diagnosis codes, etc. Determine the patient's financial responsibilities as stated by insurance. Configure coordination of benefits information on every referral. Ensure assignment of benefits are obtained and on file for Medicare claims. Bill insurance companies for therapies provided. Document all pertinent communication with patient, physician, insurance company as it may relate to collection procedures. Identify and coordinate patient resources as it pertains to reimbursement, such as copay cards, third party assistance programs, and manufacturer assistance programs. Handle inbound calls from patients, physician offices, and/or insurance companies. Resolve claim rejections for eligibility, coverage, and other issues.

Healthfirst Insurance of NY, Maitland, FL

Member Verification Rep/Member Services

July 2008 – February 2009

Receives inbound calls from sales representatives at the point of sale to conduct verifications with new members by following a verification script and input information into Healthfirst Medicare/Medicaid information system. Also conducts outbound verification calls with new members when a verification call at the point of sale is not possible. In addition to conducting verification calls, the Verification Department also receives disenrollment calls from members. Verification Reps attempt to retain members who are requesting Disenrollment by explaining policies and procedures, problem solving, and offering alternatives. If unsuccessful, they begin the Disenrollment process by mailing out a disenrollment form to the member and noting the request in the Healthfirst Medicare system. The Member Services Verification Rep needs to complete a HIPAA and Marketing crossed training. Trained in Sales and Member Services. Access on Time, Altamonte Springs, FL

Billing Representative

February 2004 – May 2004

Billing Customer Service Representative Coordinates billing functions to insure accuracy, efficiency, and maximum financial return; includes insurance verification, pre-certification, payment posting, Medicare billing compliance, and reimbursement tracking; maintains knowledge of billing codes, rules, and regulations; audits medical documents; serves as resource to faculty, vendors & staff. Also deal with inbound and outbound calls of vendors and members. And translate documents to Spanish language. Temporary Position. Education

Escuela Superior Cecilio Lebron Ramos

Patillas, PR August 1990 – June 1993

Business Course/Accounting Computer Secretary

High School Diploma

Skills

Telecommunications, Call Centers, Customer Experience, Medical Insurance, Workforce Management Training, Customer Service, Team Leadership, Secretary including Microsoft Word, Excel, Accounting in computer, Business math, Filling, Management & Supervisor skills, Sales, HIPAA, etc.

References

Jon Preslar 407-***-****

Justin Sellers 407-***-****

José Padilla Laboy 814-***-****