Rebecca Escarsega

adr8dh@r.postjobfree.com

210-***-****

Objective: To use my experience and training to find an occupation that will advance current skill set, to provide a variety of job opportunities.

Skills:

7 years Customer Service

7 years Call center (inbound and outbound)

2 years Office Clerk/Data Entry

Basic Computing - Average typing speed 45 WPM.

Intermediate Software skills- Microsoft Suites, World Wide Web and social media

Teamwork/Communication – Proficient working as member of a team or individually. Strong multi-task, written and verbal communication skills.

Medical Background- Knowledge in Medical Terminology, Records, Pharmacy, Authorizations, Insurance, Claims, Medical office background

Education:

Warren High School Diploma June ‘13

Southern Careers institute Pharmacy Technician August ‘13- April ‘14

The university of Arizona global Campus Bachelor’s degree in Psychology November ’21 Current

Work Experience:

Superior Health Plan Service Coordinator 1, Level 3 population September 2019-Current

Identify special needs members through the completion of health screenings and other resources. Conduct screening and develop interventions per program guidelines. Collaborate with various departments to coordinate member care and referrals to and community support systems, such as Centers for Independent Living, Area Agencies on Aging, Local IDD Authorities, and LMHAs. Educate members about covered services including Consumer Directed Services, LTSS, and Value-Added Services as appropriate, and non-covered services such as how to access affordable integrated housing. Educate members with special needs to foster compliance with program and positively impact outcomes. Participate in initial and ongoing training as required. Perform outreach to members as needed. Assist with training new hire classes. Trained new hire classes by shadowing through zoom meeting.

Centene Corporation Medicare Support Team April 2018-September 2019

Currently part of the Medicare Support team. Along with daily duties of a CSR II agent, assisting agents via Skype Chat- Work Processes, navigating our systems, Documentation, Claims issues, Rewards issues, Assist with any questions or issues which the agent is unable to handle. Complete reports/ special projects assigned by leadership: Aging Report, submitting ticket requests, A&G outbound call initiative, Assisting Supervisor's, Leads, and Member Advocates as needed. Trouble shooting system issues: Managing down scripting, Member and provider callbacks, Inbound/Outbound calls, Escalated calls, Kudos calls, Jump in to take inbound call to assist when there is a high call volume, Disenrollment Survey calls, Medicare Voicemail Box (return calls) Process Material Requests: Compile spreadsheets for submission to CCS productions for material request unable to process in OMNI, Request expedited materials through submitting Ember tickets, Request EOB’s through Emdeon system and mail out to member's Process Manual Material Requests including the following PHI/AOR forms, OTC Brochures, Disenrollment forms, Claim Reimbursement forms, EOB’s accessed through Emdeon

CVS Caremark Aetna Medicare Representative August/2016-October/2017 Referenced materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters. Helped members and/or providers regarding website registration and navigation. Educate members and/or providers on health plan initiatives Provide first call resolution working with appropriate internal/external resources and ensure closure of all inquiries. Processed customer correspondence and provide the appropriate level of follow-up in a timely manner. Researched and identified processing inaccuracies in claim payments and routed to the appropriate team for claim adjustment. Categorized trends related to member and/or provider inquiries that may lead to policy or process improvements that support excellent customer service and impact quality and performance standards. Work with other departments on cross functional tasks and projects as needed. Provided excellent customer service to internal partners. Approved and denied medications for doctor’s offices. Work prior authorizations for doctors, Nurses, Medical Assistants. Handle correspondence from emails and faxes. Provide doctors’ offices with any current questions they have with member’s medications. Use AS400 to run Test claims on all calls