Customer Service Data Entry

PAMELA HIDALGO

*** * **** ** #* Kent, OH ***** 914-***-**** ******.*********@*****.***

EDUCATION

Ultimate Medical Academy Associate of Science Degree – Healthcare Management, 2019

High School Diploma Palisade Preparatory School

PROFESSIONAL PROFILE

Customer service oriented professional with leadership skills and 5+ years of medical administrative, appeals grievance experience. Accustomed to working in environments where accuracy and accountability are essential. Follows policies, procedures, and guidelines to ensure consistent quality. Consistently model and inspire high levels of integrity.

Well-organized, manages time and priorities in multi-task environments.

Builds trust and respect by consistently meeting and exceeding expectations.

Actively participates in learning opportunities and adapts to new environments.

Languages: Spanish and English.

New York Office of Children and Family Services: Supervision of Children Training.

CPR and First Aid Certification.

Microsoft Office Applications – MS Word and MS PowerPoint.

KEY QUALIFICATIONS

Accounting Payroll Banking Systems Healthcare Law HIPAA Compliance Charting Filing

Processing Co-Payments Human Resource Management Organizational Improvements Appointment Scheduling Interpersonal Professional Communications Business Office Operations Medical Office Procedures

Medical Practice Management Systems Practice Structure Leadership & Management

Medical Terminology Anatomy & Physiology

Skills

Appeals and grievances

Medical insurance claims

Effective problem solver

Computer proficient

Strong data entry skills

PROFESSIONAL EXPERIENCE

Physical Therapy North Way 07/2019-04/2022

Grievance and appeals Coordinator

Gather, analyze and report verbal and written member and provider complaints, grievances and appeals

Prepare response letters for member and provide complaints, grievances and appeals

Maintain files on individual appeals and grievances

Develop and maintain positive customer relation relations with internal and external customers and coordinate with various functions within the company to ensure problems, requests, and questions are resolved timely

Assist with production functions including date entry, calls to provider offices and claims research

Initial research on each appeal and grievance

Assists member with inquires questions about their appeals

Utilizes EMR system to submit and correct claims

Posts patient and insurance payments

Sends paper claims to insurance carriers

Answers patient billing questions

Lincare – Remote 02/2018 – 06/2019

Customer Service Representative

Answers incoming and makes outbound calls to members to answer any inquiries and direct to specific departments.

Utilizes Lite EMR systems to verify patient insurance and input and make accurate changes for patient

demographics.

Places patient orders for any CPAP and oxygen tank equipment they may need.

Stays in constant communication with varying departments to ensure patients are getting the correct and necessary equipment.

Response to telephone inquiries, providing quality service to customers and associates inquiring about the availability of products or status of orders

Listen attentively to caller needs to ensure a positive customer experience

Recommend solutions within customer budgets and proactively followed up with all lead

Northway Physical Therapy – Yonkers, NY

Medical Front Desk Receptionist

Managed the flow of information in the medical facility.

Scheduled exams and appointments.

Organized paperwork and distributed information via mail, telephone, and email.

Handled patient check in and check out.

Verified patient insurance information.

Fulfilled office and clerical duties – answering phone calls, taking appointments, making outbound calls to patients, and completing and filing insurance paperwork.

Maintained a clean therapy area and set up any needed and necessary equipment.

Assisted with treating patients – applying heat packs, assisting with exercise equipment, monitoring motion tracking, measuring mobility, and performing prescribed exercises and strengthening techniques

Goal Program – School 17 – Yonkers, NY 09/2017 – 01/2018

Group Lead

oObserved students’ performance and recorded relevant data to assess progress.

oPresented subject matter to students under the direction and guidance of teachers, using lectures, discussions, and supervise role-playing method.

oSupervised students in classrooms, halls, cafeterias, school yards, and gymnasiums, and on field trips.

oReview the job description

oDeveloped tracking reports to assess metric such as outstanding balances

American Eagle Clothing Store – Yonkers, NY 07/2015 – 08/2017

Lead Cashier / Customer Service

Handled cash, documented returns, inventory and use point of sales system.

Maintained knowledge of current sales and promotions, policies regarding payment and exchanges as well as security practices and procedures.

Computed sales prices, total purchases and received and processed cash and credit payment.

Built relationships and stayed attentive to employees by motivating them to succeed and improve.

Counted the money in cash drawers at the beginning of the shift to ensure that amounts are correct and that there is adequate change

Greet customers as they enter the store

Provide superior customer service leadership

2012 Erica Grocery Corp – Yonkers, NY 08/2014 – 05/2015

Deli Clerk / Customer Service

Greeted customers, answered questions, and assisted with selection and purchase of deli items.

Prepared food items and maintained knowledge of deli products to better serve customers.

Maintained high standards for freshness and sanitation.

Provide friendly guest service

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