JULIA SENA

adp162@r.postjobfree.com · *** La Plata Rd. NW Albuquerque, NM 87107·

505-***-****

Professional Summary

Highly professional and meticulous Enrollment Specialist with comprehensive background in health administration and insurance paperwork. Exceptional abilities to maintain member confidentiality and accurate bookkeeping. Able to function well independently or as a member of a professional health administrative team. Core Qualifications

● Considerable experience in billing and accounting invoicing

● Exceptional mastery of general bookkeeping principles and techniques

● Strong knowledge of client eligibility requirements for enrollment processing

● Excellent research and evaluation skills

● Outstanding oral and written communication abilities

● Good facility with basic mathematical operations Group Administration Specialist/Delta Dental of New Mexico- 10/06/2014-09/09/2019

● Handle all Eligibility submitted through Salesforce database by Group Administrators to be enrolled/termed and/or make changes.

● Handle all incoming calls from Group Administrators and/or their Agents/Brokers in regards to eligibility inquiries and/or changes via our our web portal.

● Upload, Process, Produce Electronic Eligibility to our system, and process the Discrepancy Reports for the groups.

● Process Renewals for all small group pools and prepare for mail out to them and their Agents/Brokers.

● Make all renewal and contract changes for all groups.

● Enter new small groups in our ETS system and produce all new materials including contract, and Summary of Benefits.

● Process Recon for large group Bernalillo County Monthly.

● Process regular audit reports for Large group pools and/or ASO groups.

● Process daily cases/requests sent to group administration in Salesforce database.

● Responsible for regular updating of all group administration policies and procedures.

Collections Specialist/Presbyterian/Excel Temp- 03/03/2014-03/25/2014

● Handled all incoming correspondence on claim denials from commercial, auto, and workman’s comp insurance, and outgoing calls to different insurance companies to gain information for payment on claims.

● Responsible for sending medical records, itemized bills, and eob’s upon request via fax or certified mail.

● Worked with systems such as: epic, methodcare, hpf, and medicpac to look up member accounts, and processed all data entry into Excel Spreadsheets.

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CUSTOMER SERVICE REP 2/ T-MOBILE USA- 11/2007-09/2013

● Interact with customers to provide information in response to inquiries surrounding billing, products and services via telecom.

● Prepare and process refunds on behalf of customer requests

● Created payment arrangements to assist clients as needed

● Set up charges and adjustments as necessary

● Retention queue taking over 100 calls a day

● Responsible for retaining all customers from a Sales/Customer Service approach

Skills

● Knowledge with working as a billing specialist, specifically principles and processes for providing exceptional customer and personal services.

● Highly skilled in maintaining strong relations with customers, clients, and co-workers

● Able to review and reconcile invoices

● Ability to verify data of individuals on their plans

● Highly professional and meticulous Enrollment Specialist with comprehensive background in health administration and insurance paperwork. Exceptional abilities to maintain member confidentiality and accurate bookkeeping. Able to function well independently or as a member of a professional health administrative team.

● Proficient in Word, Excel, Outlook, and Power Point

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