Customer Service Associate

Suehaley Rijo

**** **** **** ****** ******** NY *1224 929-***-**** ************@*****.***

Objective

Clinical service associate with 3+ years of experience in the healthcare industry. Proven ability to provide excellent customer service, manage patient records, and coordinate care. Employment History

ArchCare Community Life Assessment scheduler 9/1/2022 – 5/3/2023

• coordinate appointments for nursing assessments, planning weekly nursing schedules, determining appointment lengths and making phone calls to Members regarding their appointment or meeting times.

• create and maintain the schedules of nursing, balance the availability and resources against incoming requests to ensure all tasks are completed on time and adjust schedules as necessary to accommodate changes in priorities or deadlines.

• Advanced knowledge of confirming and rescheduling appointments, as well as recordkeeping practices

• A strong work ethic customer service, strong communication skills

• Experience and a positive with a winning personality and attitude, Multitasking,

• Assist with translations, as needed Follow up with LHCSAs and other community organizations for notes, reports, PCA issues, etc. confirm faxes as received. Outreach to MD offices to obtain signed Service Plans or other documentation/information needed.

• Provided excellent customer service to patients and families, Coordinated care between patients, providers, and other departments.

• Resolved patient complaints and concerns in a timely and efficient manner. ArchCare Community Life Call Center Member Services Representative 6/20/2021 – 6/29/2022

• Notify LHCSAs, DME companies, and other vendors/providers of member’s disenrollment. Inform company that the authorizations will be ended and effective date. Any disenrolled or discontinuation/interruption of service to end the authorizations.

• Mail Member Service Plans to members, A/R, MDs and document activities. Scan Service Plans to Mediture TruChart MARCH, SARCH, Epaces, Wellsky Portal.

• Identify, research, and resolve member issues navigating current computer system (Mediture).

• Handle queue faxes, upload signed service plans request to authorization department. Check eligibility for Medicare ArchCare Advantage members HMO, ArchCare Community Life, Scanning of documents to TruChart including IADs, Action Taken Forms, reports, notes, Health care Proxy forms mailing of documents staying mindful of time-sensitive issues.

• Generate service requests forms and telephone notes (Mediture) within regulatory time frames.

• Reviews demographics in electronic record to validate accuracy and update as needed Outreach to members/caregivers to confirm receipt of DME, supplies ordered and other authorized services.

• Assistance with transportation, as needed. Work with members to access transportation directly as much as possible. Benefit Verification, Eligibility Verification. Avondale Care Group Home Care Coordinator 3/2020 – 5/31/2021

• Resolved high-volume Health aides daily by training staff and providing resolutions through effective communication with clients and vendors, aides.

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• Working from a remote home setting and in the office.

• Communicate with clinical managers, insurance verifiers and other parties involved in the client care.

• Insures continuous client coverage in accordance with authorized hours, case load 162.

• Inputs all changes in service an authorizations into the computer system immediately upon receipt of such authorizations, attendance, compliance etc

• Ensures that client records are up-to-date and complete and that they are continually maintained in all areas of compliance contract.

• Log time sheets, processes timesheets for payroll and assists in resolving payroll problems.

• Liaison with MCOs, MLTCs to notify them of any changes in client needs.

• Rotates on call with other administrative staff, both weekly and weekends.

• Answers calls from home attendants relating to payroll and timesheet.

• Managed and distributed home care staff and resources effectively while ensuring that patients were treated with care and respect safety with PPE.

• Coordinated and monitored strategies for members and families to improve health and quality of home care.

• Maintained professional relationships with external MLTCs, service community. Education

2019 ASSOCIATE BOROUGH OF MANHATTAN COMMUNITY COLLEGE

High school diploma equivalent 4/30/2019

Skills & Abilities

• Bilingual Punctual, articulate, and supportive team players with excellent computer skills. Passion Team Worker, open to change. Active listening, communication, problem -solving, empathy, Patient focus, Attention to detail, Medical Terminology

References

Available on request

Contact this candidate