Customer Service Prior Authorization

GENOVEVA RAMIREZ

*******@***.*** 954-***-**** Coral Springs, FL

CAREER OBJECTIVE

I am a dedicated, quality team player seeking a challenging position to expand my knowledge and experience. Motivated by challenges. Excellent organizational skills and careful attention to detail with a reputation for accuracy and quality.

WORK EXPERIENCE

Broad Path

Nov 2022 – Current

Prior Authorization Specialist

●Conducted research and analysis to identify the root causes of rejected claims.

●Collaborated with Medicare D plans, third party insurance companies, and Medicaid plans to address and resolve claim rejections.

●Demonstrated commitment to adhering to strict deadlines.

●Proactively monitored and mitigated risks associated with payer setup, billing, rebilling, and reversals.

●Maintained records and generated reports for efficient claims processing.

●Prioritized customer satisfaction by actively reaching out to doctors, pharmacists, and other professionals to gather necessary information for claims documentation.

●Ensured communication and documentation processes to enhance the efficiency of claims resolution.

Vanguard

Oct 2022 - Nov 2022

Operations Specialist

●Assisted customers with diverse needs, including business analysis and report review.

●Conducted thorough reviews of business account documents for accuracy and compliance.

●Precision and attention to detail significantly improved operational efficiency and customer satisfaction.

●Adapted and acclimated to complex software (Rumba +/Terminal) to address customer concerns

Carnival Cruise LLC

Apr 2022 - Sep 2022

Agent Resolution Specialist

●Managed a high volume of escalated calls, inbound calls, including transfers.

●Provided comprehensive support and guidance to travel agents and guests during boarding.

●Handled cruise calculations, addressed credits, promotions, and managed changes or updates.

●Proficiently navigated complex scenarios to ensure a seamless and enjoyable cruise experience for passengers.

●Upheld the highest standards of service excellence throughout interactions.

Fiserv

Nov 2021 - Mar 2022

Customer Service Associate

●Enhanced customer satisfaction through exceptional inbound call support.

●Engaged with bank clients and cardholders, actively listening to inquiries and addressing concerns.

●Focused on ensuring a comprehensive understanding of customer needs.

●Proficiently navigated complex situations, achieving efficient and effective issue resolutions.

●Left clients satisfied and confident in the quality of provided services.

Willis Towers Watson

Oct 2021 – Nov 2021

Customer Service Associate

●Supported customer enrollment for health insurance and pension plans.

●Tailored plans to accommodate changing individual needs.

●Ensured strict compliance with HIPAA regulations while handling confidential information.

Prime Billing

Sept 2021 – Oct 2021

Medical Billing Specialist (Internship)

●Managed medical billing processes during my internship at Prime Billing.

●Ensured precise data entry for accuracy and completeness of patient records.

●Posted payments accurately, maintaining financial record integrity.

●Facilitated efficient communication with insurance companies, expediting claims processing.

Humana

May 2021 – Aug 2021

YHA Customer Service Support Coordinator

●Conducted follow up with members and providers.

●Ensured timely responses to inquiries from members and providers, meeting service and quality standards.

●Made decisions based on interpreting area/department policies and determining appropriate assignment completion methods.

●Worked within established parameters to identify work expectations and maintain quality standards.

K Force DEO Dept of Economic Opportunity

May 2020 – May 2021

Customer Service Call Center Agent

●Provided valuable assistance to the unemployment office during periods of high call volume.

●Assisted unemployed members with reemployment applications and processing of benefit payments.

●Facilitated requests for benefits payments and provided general information as needed.

Kelly Services

June 2017 – May 2020

Apple Technical Support Advisor Tier I and II

●Responded to customer inquiries via phone regarding Apple products, services, and accessories, encompassing both software and hardware.

●Offered assistance with troubleshooting and provided comprehensive technical support for the products.

●Demonstrated expert knowledge of Apple products, services, and accessories to address customer questions effectively.

●Consistently maintained a high level of customer satisfaction by providing expert assistance and technical support.

EDUCATION

Southeastern College 2021

Degree in MBC

Boricua College 1993 – 1996

AA Degree in Human Resource

CERTIFICATIONS, SKILLS & INTEREST

●Certifications: Medical Billing, Coding, Microsoft

●Skills: Attention to detail, excellent communication, intricate problem-solving skills, self-sufficient, adaptable, quick learner, proficient in English and Spanish

Interests: Movies, cooking, shopping, art, home décor, reading, restaurants and sports.

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