Patient Services Member

Hilda DeLaFuente

*** ****** **. *********, **. **063 – 210-***-**** – *.*****@*****.*** – Linkin.com/in.hilda-delafuente-0b9984143

Objective

Seeking a challenging position which will enable me to utilize my skills developed through my education and experience and to promote the mission and goals of my employer.

Experience

United Health

Quick Assist Advisor

September 2021 – March 2022

Served as an ongoing, point of contact for members, primarily via the phone channel (may also will use email, chat, text), delivering compassionate support to members, creating a memorable, positive experience.

Provide holistic family support to members who may have special needs themselves or may be caring for children or family members with special needs, owning end-to-end resolution of issues.

Focus on team work and fostering strong team environment through activities including mentoring and acting as a resource for colleagues.

Created and built ongoing relationships with others including both members and teammates.

Made decisions independently and solve problems creatively and completely using sound judgment and critical thinking.

Responsible for providing high quality member experience as reflected in post contact surveys and member feedback.

CommuniCare Health Centers

Patient Service Supervisor – San Antonio, TX.

June 2007 – January 2021

Supervised personnel to include recommendations for recruiting and dismissing; performance evaluations, recommended merit increases and salary adjustments by timely submitting performance evaluations, provided training, work allocation and problem solving.

Responsible for analyzing the Patient Services effectiveness and implementing improvements to systems and programs in collaboration with health center managers, providers, and department heads to ensure the smooth operation of the Patient Services Department and member satisfaction.

Directed all appointment scheduling activities for CommuniCare – Bexar, Hays, and Comal counties clinical sites; ensure that patients were scheduled according to protocol and that clinic schedules were set in relationship with provider schedules.

Ensured the Service Excellence Agents and the Member Services Representatives were trained and kept up to date on the Center’s credentialed health plans and/or renewals to make certain effective delivery of maximum allowable reimbursement from payors to include conducting internal audits/controls.

Produced operational reports and conduct frequent quality assurance audits of Call Center and member services staff.

Ensured that each call center staff met 140 to 150 answered calls per day with no more than 10% dropped calls.

Created and updated a list of preferred specialty network for Bexar, Hays, and Comal counties; our self-pay patients saved thousands of dollars for visits and procedures

Strategically, confirmed all members utilizing Center’s services were scheduled for annual member orientation.

Responded to or redirect telephone calls to appropriate staff and departments.

Maintained a current understanding of clinic operations and procedures.

Served as the Member Services liaisons and assists members with any complaints, comments, or suggestions to ensure member satisfaction and retention.

Present to others via telephone or directly in a personal and professional manner. Obtained a 4.5 rating or above in the inter-department service survey. Obtained a 3.5 overall rating in quarterly leadership empowerment survey.

13 years of experience in Customer Service.

Education

Hallmark University – San Antonio, TX.

2017 - 2019 Bachelors on Business Healthcare Management

Career Point Institute – San Antonio, TX.

2006 – 2007 Medical Secretary (Certificated)

Texas University of Pam-American – Edinburg, TX.

1989 – 1991 Art (Associates Degree)

Donna High School

1986 -1989 (High School Diploma)

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