Customer Service Quality Assurance

Karen Berríos Barrera

787-***-**** ad5rcv@r.postjobfree.com Toa Alta, PR 00953

PROFESSIONAL SUMMARY

Specialized in competitive manufacturing with a focus on quality management, I have a proven track record in knowledge management projects for various companies and industries. With two decades of experience handling sensitive documentation, my expertise lies in providing specific solutions for short and long-term competitive control. I excel in assigning prices to manufactured products, skillfully negotiating with health insurance providers to manage contracts. My proficiency extends to gathering comprehensive information for determining the sales potential of a product or service, involving collection, counting, presentation, synthesis, and analysis.

SKILLS

Process Improvement Training and Development Conflict Resolution Adaptability Customer Service Decision Making Quality Assurance Problem Solving Effective Communication Lean Manufacturing Six Sigma Strategic Planning Statistical Process Control Statistical Data Analysis Quality Auditing Health Plans Operation Analytical Chemistry Sales GMP GLP. EXPERIENCE

Bard – BD (Becton Dickinson) January 2016 – February 2024 Health Plans Coordinator and Logistics Specialist

Specialist in negotiating prices for the contracting of Becton Dickinson's manufactured products, specifically meshes, stents, and VCF, in collaboration with health plans in Puerto Rico. Auditing medical records to ensure compliance with the necessary medical requirements for surgeries. This involves thorough verification of ICD-10 (diagnosis) codes as requested by physicians, confirmation of CPT codes, and scrutiny to ensure each request includes a progress note or recent study justifying the proposed surgery. Verify the presence of a signature, date, NPI, and license. Serve as a collection specialist for private cases excluded from implant coverage and those requiring direct payment. Billing specialist, processing transactions through authorizations issued by various medical plans in Puerto Rico and responsible for the billing inventory of products used in surgeries. Responsible to extend to coordinating logistics for the effective distribution of products, ensuring seamless operations. My role within the company was essential to have precise control of the inventory of the products used in surgeries and in turn to achieve 100% sales. Triple SSS (McKesson) Nov 2011 – January 2015

Coordinator of medical services

Provided information about medical plan (pre-certification studies), Triple SSS private, government health plan and Medicare Advantage. Notified approvals and denegation to providers and patients. Completed all processes for the clinical representative to initiate medical studies. Verified if CPT codes (procedures) pre- certify for the coverage. Verified codes all (ICD-10) diagnoses. Handled requests for pre-certification studies and procedures for Medicare population. Worked on patient admissions and provided the authorization number to the facility.

Telemedik December 2010 – October 2011

Customer Service Representative

Provided information about medical plans (telephone numbers of primary physicians and specialists, guidance on the eligibility process, duplicate cards, and orientation to apply for pregnancy coverage, orientation to apply for catastrophic coverage, certificates of covers and others). Pfizer June 2008 – August 2009

LIMS program developer

Tasks focused on the implementation of LIMS (Laboratory Management System). Peer review for data entered in LIMS application. Project based on information management to support the operations of a laboratory. Reviewed of mathematical calculations specific to each sample. RG Financial March 2007 – January 2008

Customer Service Representative

Provided bank customer service, including answering the phone. Prepared end of the month reports, including received calls, cancellation of loans, cold calls, walk-ins, and origination of loans. Accounts Receivable.

Institute of Forensic Sciences February – May 2005 Chemistry Practice

Collecting samples at a crime scene and then making the relevant analysis. Performed color test to all controlled substances. Performed confirmation test in the GC/MS; if this was degraded because of the temperature, an analysis in a HPLC was performed. Urine analysis was performed under room temperature in a GC/FID. When firearms were taken, and these had mutilated identification marks or serial numbers, corrosive chemicals were to be used in the ballistic area. Corrosive chemicals, when applied correctly, can reveal the identification mark or serial number. Completed each custody chain processes to avoid analysis cancellation. Worked with microscopic analysis. Kept an exact and precise report of every analysis worked with. Calibrated equipment.

Sears Bayamón August 2000 – March 2006

Customer Service Representative

Organized and placed merchandise on the sales floor. Focus on sales and customer satisfaction. EDUCATION

Polytechnic University of PR – Hato Rey, PR

Master’s degree in Competitive Manufacturing – Graduation: June 2010 Major in Quality Management

Inter American University – Bayamón

BS in Forensic Chemistry – Graduation: May 2005

KNOWLEDGE & TECHNICAL ADDENDUM

Knowledge programs: CCMS, QNXT, TSOL SQL, CMS regulations, policies, and procedures, Microsoft Office, Outlook and JDE.

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