CYNTHIA C. DURAN

714-***-****

PROFILE

Healthcare Insurance Specialist with extensive knowledge in Administrative, Customer Service and Health Benefit Management procedures.

KNOWLEDGE AND SKILLS

Multi Task Oriented

Analytical/Research skills

Health Insurance Experience

Customer Service/Call Center/Administrative/Client Relations Skills

Pharmacy Benefits Management terminology knowledge

Editing and Documentation skills

Medicare/Medicaid Knowledgeable

ICD-9 coding knowledgeable

HIPAA Legal Compliance

Program and Software Skills:

Microsoft Office Suite: Intermediate Word, Intermediate Excel, Outlook, MS Access and Power Point.

PAS 7.0, Sharepoint, Production programs: UBH Facets – Claims, Customer Benefit Management System (CBMS), ELI, Linx Production, SURF, IEX, GPS, RXHD, IRIS, IBM FileNet IDM Open Client, WebEx, Consumer Database System (CDB), and Dashcloud

PROFESSIONAL EXPERIENCE:

UnitedHealth Group -

Optum Health

Employer Installation Specialist March 2015 – Present

Responsible for the installation of assigned accounts, including: structure building and billing set up, structure revisions, researching and resolving structure issues, database loading, and preparation of plan materials such as administrative documents and customer education materials. Auditing involving contract loads for adherence to quality measures and reporting standards. Adhering to HIPAA Legal Compliance.

UnitedHealth Group -

OptumRX

Specialty Prior Authorizations/Senior Pharmacy Tech May 2013 – March 2015

Provide service support for Prior Authorization of specialty medications. Receive and process Prior Authorization requests made by providers and members following clinical guidelines and formulary based on clinical criteria. Answer pharmacy benefit inquiries which could include: benefit and eligibility information, billing and payment information and explanation of benefits (EOB). Adhering to HIPAA Legal Compliance.

UnitedHealth Group -

Specialty Customer Service Representative June 2011 – May 2013

Answered incoming patient inquiries; assisted customers/pharmacies/physicians in call center environment with enrollment/eligibility, delivery orders, billing questions and trouble shooting. Assistance also included benefit eligibility questions and prescription status inquiries. Coordinated internal resolution of pharmacy claims exceptions, edits and other related issues. Adhering to HIPAA Legal Compliance.

Dentium USA, Cypress, CA

Receptionist/Office Assistant 2010 – 2011

Provided administrative/customer service office support for dental implant manufacturer. Office duties included: Answered multi-line phone system, assisted with filing, faxing and data entry. Managed the purchasing of interdepartmental supplies and inventory maintenance. Placed implant orders, printed invoices and statements using MS Active Access database for customers. Assisted Marketing Department maintaining an active trade show calendar along with coordinating travel details, researching prospect information online and distributing marketing material to customers and prospects. Arranged and coordinated travel including car, hotel, and air.

Previous career history also included administrative support in roles as Customer Service/Administrative/Office support independently and for staffing agencies from 2008 - 2010

Insurenow Insurance Services, Inc., Cypress, CA

Accounting Coordinator 2007 - 2008

Duties included balancing payroll data entries from ADP payroll reports for end of the month processing using Peachtree software and Excel spreadsheets. Follow-up made with various insurance companies for reconciliation purposes. Reconcilement of monthly ledger debits and credits using Peachtree software.

Other previous employment included:

Staffmark Office Assistant 2009/2011

Creative Color Printing Office Assistant/Customer Service 2002-2008

Nobel Biocare USA Marketing Administrative Assistant 2000-2001

Sanwa Bank California Administrative Assistant 1991-2000

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