Customer Service Technology Solutions

VANESSA OTERO

646-***-**** *******.****@*****.*** Port Richey, FL

PROFESSIONAL EXPERIENCE

CSTS - Customer Service and Technology Solutions, LLC., Spring Hill, FL

Grievance & Appeals Specialist September 2022 - Present

Coordinate, track, & log appeals and grievance from receipt to resolution ensuring timely completion

Act as a liaison to correspond and communicate with providers, members, and insurance carriers

Perform administrative activities by documenting authorizations, reviewing insurance decisions, and forwarding treatment authorization to providers

Conduct research, including requesting member records, organize documentation, and prepare written summaries of cases including the resolution for appeals /grievance files when required

Florida Joint Care Institute, Trinity, FL

Scheduling Specialist November 2020 - September 2022

Managed scheduling and rescheduling of patient appointments while addressing direct inquiries

Updated the patient information using the Allscripts/Rivit/Modern Med software for all patients

Collected copayments, coinsurance, deductibles, and outstanding balances during patient visits

Bilingual translator for patients

NYC Health & Hospital/Lincoln, Bronx, NY

Clerical Associate III Inpatient Unit/Telemetry August 2011 - June 2019

Managed patient call bell, code emergencies and route all patient requests to assigned Nurse or Head Nurse

Adhered to coding procedures and promptly contacted the designated Hospital personnel to address patient coding issues

Admitted and discharged patients

Organized and coordinated transportation and follow-up appointments for discharged patients

Performed clerical duties in relation to records, files, and invoices

Sustained and ordered unit supplies

EDUCATION

Monroe College, Bronx, NY

Bachelor of Science in Health Service Administration August 2010

Relevant Coursework: Visiting Nurse Services, NYC Department of Health; Office of Vital Records

SKILLS

Knowledge of Medical Terminology and Procedures

Microsoft Office: Excel (Proficient), Word (Intermediate), PowerPoint (Proficient), and Outlook

Experience with Salesforce, EClinical, Allscripts, NextGen, Uniportal, Adjundication

Bilingual in English and Spanish

Typing 60 WPM

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