Customer Service Case Management
Resume:
Laura M. Reyes
Benbrook, TX *****
*****.*.*******@*****.***
Work Experience:
Go Puff Delivery
Fort Worth, TX
October 2023-Present (part-time)
Duties and Responsibilities:
●Inspects delivery vehicles and ensures the safety and security of the loading and unloading process.
●Experienced delivery driver with a proven track record of safely and efficiently delivering goods to various locations.
●Transporting goods from distribution centers to customers.
●Skilled in navigating diverse routes.
●Utilizing GPS systems.
●Contact customers to confirm delivery details.
●Determines placement of merchandise.
●Follows safety and lifting protocols during deliveries.
●Providing exceptional customer service.
Case Manager & Payer Specialist
RemX Staffing-Irving, TX
October 2023-March 2024
Duties and Responsibilities:
●Uphold all program policies and written agreements.
●Complete case management assignments.
●Maintain records of clients’ documents needed to insure proper enrollment requirements.
●Respond to incoming calls.
●Oversee and document program application and intake process including documenting applicant pre-screens and arrival.
●Administrate all case management records and documents.
●Assist in the development of computer notes to improve case management communication.
●Perform comprehensive assessment of participant needs.
●Hold clients and providers accountable to program guidelines.
●Performs financial clearance of patient accounts by verifying insurance eligibility and benefits and ensuring all notifications and authorizations are completed within the required timeframe.
●Completes appropriate payor forms related to notification and authorization.
●Coordinates the submission of clinical documentation from physicians to payers for authorization needs.
●Communicates timely with Utilization Review, and collaborates effectively with physician and facility staff to ensure financial clearance of the patients account prior to scheduled or unscheduled service during the patients treatment.
●Interprets complex payer coverage information including, but not limited to, network participation status with provider, limited plan coverage and inactive benefits.
●Documents systems according to the Insurance Verification guidelines to assure accurate and current coverage.
Patient Advocate
CornerStone Staffing – Fort Worth, TX
September 2022 to September 2023
Duties and Responsibilities:
●Collects and reviews all patient insurance benefit information from the payer to the degree authorized by the SOP of the program.
●Provides exceptional customer service to all internal team members; resolves any requests in a timely and accurate manner.
●Escalates issues accordingly.
●Maintains frequent phone contact with assigned payers.
●Reports any trends/delays to the on duty supervisor.
●Communicates effectively to ensure accurate and timely benefit investigations.
●Analysis of data and using good judgment to review data.
●Ability to work remotely; typically receives little instruction on day-to-day work.
●Oriented role that requires attention to detail and basic computer skills
●General knowledge of medical/pharmacy insurance and basic clerical skills.
Lead Medical Scheduler/Operator
Corpus Christi Urology Group - Corpus Christi, TX
September 2018 to June 2022
Duties and Responsibilities:
●Register new and established patients according to established office protocols.
●Assist patients to complete all necessary forms and documentation.
●Verify and update patient information.
●Inform patients of Urology office procedures and policies.
●Move patients through appointments as scheduled.
●Enter all relevant patient information into the data system.
●Maintain and manage patient records in compliance with privacy and security regulations.
●Confirm upcoming appointments and recalls according to office protocol.
●Check the daily appointment schedule.
●Occasionally check in new and returning patients.
●Fill in cancellations and no shows.
●End of the day general clean up.
Benefit Advisor/Customer Service Representative
The Results Companies, Blue Cross Blue Shield of Michigan-
Corpus Christi, TX
August 2016 to May 2018
Duties and Responsibilities:
●Assisting each member with their needs regarding their coverage.
●Gathering demographic and insurance policy information for each member.
●Reviewing and verifying outstanding and up to date premium payments.
●Contacting providers and facilities regarding any claims filed.
●Administrative upkeep of member data entry information.
●Ability to maintain confidentiality of all members.
●Coordinating with medical offices for patient/member care.
●Ability to navigate multiple computer systems, applications, and utilize search tools to find needed information.
Education:
Associates of Business Administration
Southern Career Institute - Corpus Christi, TX
May 1996 to May 1998
GED Diploma
Del Mar College - Corpus Christi, TX
March 1996 to April 1996
Skills:
Intermediate skills in Word, Excel, and Outlook and PowerPoint. Ability to work with all office equipment, detail oriented and ability to maintain high degree of accuracy maintaining records, organization and analytical skills, strong customer service skills, proficiency with project and time management and ability to type 40 wpm; ability to multitask; strong written, verbal, and interpersonal skills. Ability to work independently, and also as a part of a team.
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