High School Customer Service

Lopez, Cynthia A.

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Objective

To obtain a position that will allow me to utilize my past work experience to challenge new ones.

Education

·High School diploma - Spring High School, Spring, TX (January 2004 - January 2007)

·Associate in Science - Houston Community College, 6815 Rustic St. Houston, TX 77087 (January 2009 - current)

·Bachelor’s in Science for Information Technology - Strayer University, Houston, TX (January 2, 2018 – Present)

Skills & Abilities

MANAGEMENT

Microsoft Office

Excel Spreadsheet

Outlook

PowerPoint

Telephone

Kronos

Macess

TouchPoint

Epic

Bilingual: English/Spanish

Excellent Customer service

60 WPM (words per minute)

BrightTree

Medicare and Medicaid Experience

CMS and TMHP Experience.

Centricity (GE)

Allscripts

Experience

UT Physicians Pediatric Surgery (December 16 2019, -Current) – Senior Financial Counselor PP

Responsible for understanding and communication changes in insurance benefits and financial plans.

Collect any patients portion prior to services.

Effectively communicate with Physicians, Surgery Schedulers, Front desk & Billing regarding patients’ insurance and financial responsibilities.

Communicate with patients prior to surgeries/procedures regarding financial responsibilities. (Co-pays, Deductibles, OOP & etc.)

Performs insurance verification, authorization, and calculate patients benefits. (In office procedures)

Create an estimate quote sheet and send via MYCHART to parents.

Contact patients regarding their financial responsibilities; determine payment arrangements.

Coordinate all patients’ financial activities in a timely manner. Collect fees and deposits; generate receipts & post payments.

Appropriately document payment information in a shared excel spreadsheet.

Develop and maintain financial protocols.

International quotes.

Authorization backup

Self-pay quotes.

Performs other duties as assigned.

Senior PAR

Travel to offsite locations.

Schedules patient appointments and enters required information in the computer system in an

Accurate and timely manner.

Obtains demographic, insurance and financial information from patient or guarantor. Enters

Information in computer system with a high degree of accuracy.

Explains all required forms to the patient or guarantor and obtains the necessary signatures.

Ensures medical necessity compliance by obtaining necessary data, reviewing Compliance

System, communicating information to patient or guarantor and obtaining necessary signatures.

Protects the financial integrity of the facility by collecting patient liability, establishing payment

Arrangements, discussing payment options and screening for eligibility. Completes complex

Financial counseling including the review and submission of charity applications. Identifies

Alternative resources for financial reimbursement.

Verifies insurance eligibility and benefits and ensures all notifications and authorizations are

Completed within the required timeframes.

Posts payments in the computer system and generates the appropriate patient receipts.

Monitors, reviews and resolves patient account issues on assigned reports. Performs account

Analysis and trending.

Completes quality review and monitors for process improvement opportunities.

Functions as a team leader in the department by ensuring daily processes are complete,

Scheduling employees, providing answers to employee questions and assisting in employee

Orientation and training.

Communicates in an effective and professional manner with Physicians, Care Management,

Ancillary departments, nursing units, physicians' office staff, insurance companies, as well as

Patients and their families (all Patient Access customers). Completes thorough and accurate

Documentation.

Adheres to all university policies, procedures, and standards, within budgetary specifications,

Including time management, supply management, productivity, and accuracy of practice.

Promotes individual professional growth and development by meeting requirements for

Mandatory/continuing education, skills competency, supports department-based goals which

Contribute to the success of the organization; serves as preceptor, mentor, and resource to less

Experienced staff.

Performs other duties as assigned

Prepare financial quotes for collections of copays, coinsurance, deductibles all out of pocket expenses.

The Care Group of Texas (January 29th, - December 13,2019)

Create T19/CMN/LOMN for all supplies/equipment requested by physicians 60 days prior to expiration.

Ensures DME provider’s information is complete before faxing/mailing documents to physician offices.

Follow up on incomplete paperwork to the physician/referral source using the process set forth by the company. As a secondary to the primary person responsible for this function.

Ensure paperwork received from the physician is complete and correct.

Obtain authorization from the insurance company for supplies/equipment.

Answers and address emails/questions sent interoffice related to paperwork/authorizations within 24 business hours.

Communicate any insurance changes to the appropriate departments within 24 business hours.

Log all completed authorizations and documents as required by payor source (to include, but not limited to Title XIX’s, CCP forms, CMNs and LOMNs) in patients software program. As a secondary to the primary person responsible for this function.

Complete and clear all CMN Work List items daily.

Complete and clear all PAR Work List items daily.

Complete and clear all Tasks and WIP States daily (as scheduled).

Claim holds to be no more than $5,000.00 average for the previous 30 days at any given time (subject to change as goals are met).

Participate in all company and department meetings as required.

Adhere to company policy and procedures.

Willingly cooperate with Documentation Manager on any corrective plans of action.

Other duties as requested by Manager.

Texas Children’s Pediatrics, Pediatrics Medical Group (August 28th, 2017-January 3rd, 2019)

·Greets patients and visitors upon arrival utilizing Creating SMILES philosophies and AIDET principles.

·Assists patients with check in / check out.

·Answers telephones within 1 ring and direct calls per practice protocol.

·Document complete and error free messages in telephone encounter and routes to appropriate area per practice protocol

·Keep hold time to less than one (1) minute.

·Receives less than three (3) customer service complaints during evaluation period.

·Assists the patients, when requested, in the completion of forms or other requested documents.

·Ensure all necessary patient forms are completed for the visit and scanned into electronic health record.

·Communicate with patients, staff, and providers regarding arrivals, delays, and practice processes.

·Alert practice staff and providers of any changes or discrepancies in patient’s scheduled appointments.

·Proactively approaches dissatisfied customers and implements customer service recovery measures.

Texas Children’s Hospital (Health Plan) (July 20th 2015 – August 25th, 2017)

Member Service Rep

·Identifies and Handles routine incoming customer or prospect inquiries or requests.

·Uses health plan resources and the Contact Center’s policies and procedures to provide complete, accurate and timely responses.

·Assist Members with routine servicing inquires including but not limited to selecting a primary care physician, member identification cards, transportation arrangements, and issues with provider accessibility and eligibility inquires.

·Assist providers with routine servicing inquires including but not limited to: verifying eligibility and covered benefits and services.

·Uses the Contacts Center’s technologies and processes to ensure contact handling accuracy and operational effectiveness.

·Files complaints and appeals on behalf of Members within the regulatory timeframe and in compliance with departmental policies and procedures.

·Maintains and updates Members’ individual eligibility records. Enters changes in demographic and other relevant information into Touchpoint as required.

·Uses customer service skills to optimize the opportunity of each customer contact. Builds and strengthens relationships by providing quality customer service.

Centene Corporation/ AcariaHealth Pharmacy (July, 2013- July 19th,2015)

Insurance Verification

·Patient Care Coordinator.

·Reach out to all new patients and introduce them to services and products via telephone.

·Respond to incoming calls and answer any related questions.

·Maintain patient census and reach out to patients prior to them needing their medications.

·Ascertain from the patient all of their supply needs and review medication inventory.

·Offer any additional support or assistance, such as consultations with pharmacists and classes.

·Maintain statements and inform patients of co-pays and past due amounts.

·Process payments in

·Schedule delivery of medication after all patient needs are addressed.

·Document all related communications with pharmacy personnel, patients, physicians, nursing agencies and other related individuals.

·Provide technical support to physicians, nurses, and patients.

·Assist and maintain all related pharmacy records (prescription logs, care plans, medication profiles, and any other related files) as determined by the pharmacist.

·Perform various related tasks as determined by management or the State Board of Pharmacy or Joint Commission.

·Supervisor of Urgent Order.

·Point of Contact for 5 VIP doctor accounts.

·HEP C TEAM for Patient Care Coordinator.

·Oncology Team (10/13/2014 – July,2015)

·Obtain PA for all Oncology patients.

·Inputting data for patients.

·Verification.

·Processing.

·Eligibility and Benefits.

·Knowledge with Medicare and Medicaid Managed care reimbursements.

·Obtaining Copay Assistance for patient who cannot afford copay amounts.

·Single Point of Contact for all East Coast Oncology doctor offices.

·Single Point of Contact for major insurance company of New York and New Jersey.

AAPEX Community Pharmacy (April, 2012- April,2013)

Pharmacy Technician/Insurance Verification

·Pharmacy.

·Verifying.

·Processing.

·Check in and manage inventory.

·Insurance Claims.

·Insurance Deductibles.

·Eligibility and Benefit.

·Knowledge with Medicare and Medicaid and Managed care reimbursements.

·Obtaining Prior Authorization.

·Data Entry.

·Answering Phones.

·Filling and sending CCP / LMN / TITLE XIX forms to the Provider’s office.

Joshua’s Pharmacy (September 2011 - April,2012)

Pharmacy Technician

·Fill Prescriptions

·Check in inventory

·Enter data

·Organize

·Insurance Deductibles

·Eligibility and Benefit

·Knowledge with Medicare and Medicaid and Managed care reimbursements

Houston Community College, (August 2008 - June 30, 2011)

Administrative Secretary

·Filing

·Answering Phones

·Data entry

·Making Appointments

·Greeting Students

·Helping Students

·Making Copies

·Administrative Secretary

Di Lauren Productions, (January 2006 - July 2008)

Administrative Se

·Maintain Work Station

·Print Documents

·Design Business Cards

·U-P-S Shipping and Handling

·Make Appointments

·Data Entry

·Answering Phones

·Receptionist

·Filing

Contact this candidate