Call Center High School

GERALDINO Q. MAGNO JR.

Email: *******@***.***

Tel: 714-***-****

EDUCATION:

High School

High School Diploma, (1983)

College of Commerce (1987)

Cypress College Computer Education (1992)

Skills:

IRIS and Navigator (OPTUM programs)

CRM Sales Force program

Bilingual in English and Tagalog

QNXT QSHRE & Pursuit Intranet program

Call Center Telecommunications

NICE, Claims Vision, EAMS (Electronic Adjudication Management System)

Medic-Soft Program, IKA System

Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid,

EZ-Cap/ Facets -Billing/ Citrix, PeopleSoft

Data Entry/Mail Room/AS400, MC400

ICD-9-CPT Coding/IDX & EDI & EDX Program

UHG-Prescription Solutions-Optum-Health Branch

NICE-RIMS, PACE, Next-Gen, Guide Wire (Workers Comp)

Software for Insurance Program

Pitney Bowes and Xerox Fax/ Copy machines

Ricoh copiers/printers' machines

Able to do Clerical, Mail room, filing and all-around administration.

BMD (Ballot Marking Device) units for Election ‘2020

EXPERIENCE:

01/24 to THE JUDGE GROUP - CAL-OPTIMA HEALTHCARE/MEMBER SERVICES/PROVIDER REP.

03/24

Addresses provider inquiries, questions, and concerns in all areas, including enrollment, claims submission and payment, benefit interpretation, and referrals/authorizations for medical care.

Verifies member eligibility, claims, and authorization status for providers.

Ensures thorough follow-up and completion of all provider inquiries or requests.

Taking inbound/outbound calls from providers, hospitals, and billing offices.

Assisting members with calls about their insurance, provider change, and updating member’s records profile.

01/23 to

01/24 SPARKS ADVISORS – PATIENT OUTREACH SPECIALIST – CALL CENTER – CLAIMS PROCESSING/REMOTE

Taking incoming calls, and assisting Medicare members with their doctor’s appointments;

Answer 60-70 Inbound Calls daily

Process electronic Claims from the hospital, billing.; familiar with all claims-forms.

Resolve Member/Provider Inquiries

Provide Claims disposition

Provide Authorization status

Master internal department workflow processes

Ability to demonstrate Empathy/Compassion

Responsible for making 100+ outbound calls daily.

Outbound calls are to existing patients and asking if they’re ready to schedule there first doctor’s appointment for the year and if so… transfer call to the scheduling department, if no…. ask why or leave a voicemail.

Data entry and proper verification of patient and documentation

Ask patients if they want to participate in a 3-question survey after your call.

Software: Google Docs, Slack and Ring Voice.

12/21 to ROBERT HALF STAFFING/ LOS ANGELES REGISTRAR’S RECORDER – CALL CENTER

01/23 (Seasonal/Temporary Employment)

Assisting in election process, call center, answers incoming calls for voter’s inquiry. Troubleshooting the Marking Ballot Device unit,

Being an election-workers assist and prepares all registered voters for checking-in.

Assists voters especially ADA with disability, pre-registration and how to navigate the use of the marking ballot device.

Do sanitation after each voter on the marking ballot device unit.

Maintains proper sanitation, follow the guidelines and provides the safest vote-centers possible.

02/21to

12/21 CALIFORNIA RENTAL ASSISTANCE – HOUSING IS KEY WEBSITE –CALL CENTER

(With L.A.Business Personnel, Inc. Temp. Staffing)

Assist callers and provides CA COVID-19 Rent Relief program assistance for both landlords and tenants.

Routing each call to appropriate departments.

Landlords and renters are both encouraged to apply.

The program provides free financial assistance is available to landlords and renters who need help with unpaid or future rent or utilities.

Once an application has been successfully processed, both the landlord and renter will be notified of next steps.

All applicant information is kept private and will not be shared.

01/21 to UCI CONTACT TRACER FOR COVID-19 RESPONSE CALL CENTER REPRESENTATIVE

02/21 (TES –Temporary Employment Services at UCI)

Calling students/employees daily within UCI Campus to follow-up with the potentially exposed employees/students with Covid-19 and their health status by asking questions in the survey.

Processes assessment and metric-measure guidelines for the survey.

Doing home assessment and following up for al test results.

Educating and giving advises to all employees/students within UCI Campus about Covid-19.

Updating notes and records to all cases.

01/20 to LOS ANGELES COUNTY REGISTRAR/MULTILINGUAL CLERK FOR ELECTIONS YR. 2020

01/21 (Contracted with L.A. Business Personnel, Inc. Temporary Staffing)

Assist in using the voting machines in order to help language minority voters better understand and feel more comfortable.

To determine which areas should receive translated material and poll-worker assistance in a certain language, the Department has developed a comprehensive language targeting database system

The Department records audio ballots in ten languages in order to provide an alternative means of voting for those with disabilities and language assistance needs.

In order to provide residents with the opportunity to fully engage in the electoral process, the Department transliterates candidate names and provides translated election materials in the covered languages to those who request it.

Poll-workers answer questions at the polls, explain the ballot and voting procedures, and assist in using the voting machines in order to help language minority voters better understand and feel more comfortable with the process.

11/19 to OPTUM RX / UNITED HEALTHCARE GROUP (Contracted with Healthcare Support Staffing)

01/20 Customer Service Advocate I

Answer incoming calls from our customers on issues related to benefit eligibility questions and prescription status inquiries

Help guide and educate customers on their prescription benefits, use of plan, formulary, premiums and status of orders, and claims or inquiries

Ask appropriate questions and listen actively to identify any questions or issues while documenting required information in computer systems

Identify issues and communicate solutions and steps to customers, pharmacies, and physicians with prescription orders and reorders

Escalate drug related calls as appropriate to licensed pharmacist for resolution

Coordinate internal resolution of claims exceptions and other issues toinclude determining appropriateness of overriding pharmacy claims edits and error messages

Make outbound calls to customers on prescriptions withhold orders and payment issue

May also assist with entering new prescription orders into system

Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance

06/19 to RICOH of America /Irvine

11/19 Field Service Representative (FSR)

Performs and assists with ensuring services are completed according to Ricoh Service Excellence requirements

Flexible with travel within a geographic territory

Works with a flexible schedule to cover time off requests for contracted customers' onsite staff, which may include managerial duties.

Embraces the diverse customer environment and maintains excellent customer focus while performing on site duties.

Responsible for customer satisfaction by engaging end-user feedback and escalating concerns to the account manager and helps support resolution.

Works to learn and manage all aspects of the RICOH Service Center in the absence of the Site Manager or Supervisor.

Assists in the coordination of work assignments to meet specific deadlines and service deliverables.

Assists in copy/print production center and performs all functions required for the completion and delivery of all copy requests. May include the usage of all finishing equipment such as binding, folders, laminators, etc.

Filing and labeling of documents and other materials for storage and retrieval.

Processes all incoming and outgoing mail and packages. This includes sorting, delivery, packaging, as well as shipping and receiving.

Provides courier service for the pickup and delivery of mail and copy jobs, on campus and offsite.

Other duties as assigned

03/19 to SEDGWICK CMS-TPA-Third Party Administrator (Contracted with PRG Recruiters Staffing)

06/19 Office Claims Assistant Coordinator

Process mails, separating and distribution of claims on different department;

All RFA’s (Request for Authorizations) Claims goes to specific assigned examiners

Date stamp all claims received with the use of perforated machine daily,

Collecting faxed-documents, claims on a daily basis,

Creating and typing form letters.

Sets up, maintains and locates claim files.

Processes packets daily

10/18 to MOLINA HEALTH CARE (Contracted with Healthcare Support Staffing)

03/19 HEDIS Coordinator Representative

Assisting with project management by coordinating the identification, pursuit and collection of medical records and other data in collaboration with other Medical Record staff

Assists the Manager and Supervisor(s) and / or performs the coordination and preparation of the medical record collection process that includes the pursuit via phone call, fax, mail, electronic medical record system retrieval and direct onsite pick up

Participates in meetings with vendors for the medical record collection process

Collects medical records and reports from provider offices, loads data into the Medical Record application

Performs administrative and office support activities.

Answers and transfers incoming telephone calls.

Receives and directs visitors.

Performs word processing, filing, and email/faxing

Medical Records Collector will work collaboratively in outreaching to providers in order to pursue medical records via phone call, fax, mail, electronic medical record system retrieval and direct onsite pick up, for Medical Record projects.

Under the direction of the national and/or regional lead, the Medical Records Collector supports the annual audit and other Medical Record like audits, by organizing provider outreach, pursuit, collection and upload of provider medical records into the internal database.

04/18 to BEACON HEALTH OPTIONS

10/18 Clinical Schedule Coordinator, (Contracted through Konnect Resources Staffing)

First line responders at a busy Call Center, providing guidance, support and information to the community, plan members, providers or other service agencies

Verifies member eligibility for services through state and county information systems

Enters relevant call notes and information in Flex-Care program

Coordinate with the team (Utilization Review Clinicians, Care Coordinator II) in accommodating member’s needs

Consistently provides members, providers and internal staff with exceptional customer service

Provides community-based and other needed resources to members

Processing and doing data entry on member’s profile & information

11/17 to NDS-NEXT DAY SERVICES (NORCO)

04/18 Mail Courier

Delivering a wide variety of items

Following delivery driving routes and time schedules

Pick up mails on businesses and drop off at the post office, completes log/reports

10/17 to SCAN HEALTH PLAN

11/17 Member Service Advocate, (Contracted through The Judge Group Staffing)

Provides quality for SCAN members and inputting information and doing data entry on members updates and profiles..

Educates members, family, friends, providers and caregivers regarding benefits and plan options

Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer

Familiarity with CPT and ICD-10 Coding.

Provides follow-up with customers (providers) by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution.

Escalates appropriate issues to management or other departments as required.

Provides claim status and support for submission of claims.

Consistently meets and/or exceeds the departmental standards, including, but not limited to: quality, productivity, and adherence to schedule and attendance.

Responds appropriately and in a timely fashion to customers (internal staff/providers) by answering telephonic inquiries concerning benefits, eligibility, referrals, claims and all other issues while following departmental policies and procedures and job aids.

08/14 to ANSAFONE CONTACT CENTERS

10/17 Customer Service Representative

After hour’s answering service; taking inbound calls from different of clients/providers.

Taking incoming messages and calls from different companies.

Inbound call center assisting with health insurance needs for customers.

07/13 to MOLINA HEALTHCARE

08/14 Member Service Representative

Inbound call center, assist Molina members and potential caller; Eligibility Verification for

Member Set up for Transportation Services; Assist Nurse Advice line;

Outbound Call Center services, calling MEDICAL and providers for verification,

Interactive Voice Response

HIPAA and HEDIS Compliance Verification

Verification of Eligibility on a member; Pharmacy, Prescription Refill & Verification

Call Center experience in MEDICAL, MEDICARE & HMO, other health care environments; Live Chat Services

08/08 to KELLY STAFFING SERVICES

07/13 Data Entry/Customer Service Rep

Clerical functions, Data Entry processor.

Answer phones and sorting and distributions of mails, back up receptionist.

07/08 to VERIZON WIRELESS

08/08 Clerical/Data Entry (Contract)

Work directly with customers via telephone, and email to describe products and/or services in order to persuade potential and current customers to purchase new products and/or services

Call Center- Inbound & outbound, calling on delinquent customers account to collectpayments.

Clerical or Mail Room Jobs temporarily

Accepts on and off temporary jobs, Claims Processing-Data Entry

Customer Service, Meeting Sales Goals, Closing Skills,

Self-motivated and very attention on every detailed

Serves customers by selling products; meeting customer needs.

Accomplishes sales and organization mission by completing related results as needed.

06/08 to CORVEL CORPORATION 07/08 Claims Processor

Processed Workers Comp-Medical Claims with ICD-9 Codes, EOB

Assisted in Mail Room department

Distributed incoming and outgoing mails

Answer phones inquiry

02/07 to UNITED HEALTHCARE GROUP

06/08 Claims Processor

Processed Insurance Claims, CMS-1900, UB-92 hospital bills

Process daily Claim payment check run and EOBs per assigned LDP Company and ASO

Process capitation payments and reporting utilizing software data and Excel skills

Process provider refund letters and reporting utilizing software data and Excel skills

Process commission payments and reporting utilizing software data and Excel skills

Process stale dated claim checks and research as needed

Data entry from live claims to electronic on database.

Answers incoming calls from Insurance company

Assisting mails for distribution

Sorted incoming and outgoing mails

Ensured received information from all sources is complete and accurate.

03/95 to PITNEY BOWES AND IMAGE STAT - COPY SERVICES

06/00 Copy Clerk/Processor/Mailroom Clerk

Handle clients in the absence of front desk personnel

Operate jam clears on printers and copiers

Restock office supplies and handle minor repairs, determine correct postage in machine.

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