Care Representative Customer

MIRCIA SANCHEZ

**** ******* **** **** *** *** Orlando, Fl 32821 Cell 561-***-****

Experience:

Bilingual Customer Care Advocate, Remote 08/2020-09/2022

United Healhcare, Inc - San Antonio Texas

Responsible for aswering incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs)

Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems

Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member

Review and research incoming healthcare claims from members and providers (doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits)

Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)

Communicate and collaborate with members and providers to resolve issues, using clear, simple language to ensure understanding

Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance

Spanish Video-Telephone Interpreter, Remote 11/2019 -08/2020

Language Line Solutions - Monteray, California

Responsible for handling calls on demand, and render the meaning of conversations between Spanish and English speakers; responsible for breaking the communication barrier in a wide range of industries such as: Healthcare, Government, Insurance, Financial, Utilities, Travel & Hospitality, General Business, Law Enforcement, Court, and 911. Responsible for answering video and audio interpreting sessions promptly and conduct interpretation in a friendly and professional manner. Responsible for rendering correct concepts and meanings according to the conventions of established interpretation protocol, avoiding omissions or additions. Interpreter is charged with maintaining a professional demeanor throughout the video and audio interpreting sessions at all times; remain calm during video and audio interpreting sessions in the event that one of the primary speakers is incoherent or upset, especially in emergency situations. Interpreter also had the responsibility of understanding protocol and terminology for various industries including, but not limited to, Medical, Insurance, Finance and Law.

Customer Care Representative, 07/2017 to 02/2019

Lasik Vision Institute - West Palm Beach,

Responsible for generating enthusiasm with patients and booking appointments for the LASIK Surgery Centers; responsible for answering calls and booking appointments for LASIK Centers nationwide. Conducted short medical assessment to pre-qualify patient for surgery; Answered incoming calls, responded to inquiries and made outbound calls to patients. I was also responsible for scheduling appointments and entering appointments into scheduler; made appropriate changes in scheduling system as needed to accommodate patient needs.

Long Term Care Coach Contractor with Humana, 05/2017 to 12/2017 GDKN Corporation – Boca Raton, FL

Provided telephonic long term care coaching and case management for disabled and geriatric population to prevent nursing home placement. Conducted monthly, quarterly and annual reassessment visits with members living at home, assisted living facilities and skilled nursing facilities, in order to review and update care plans and 701B assessments to ensure member needs are being met and all needed services are in place. Completed timely case note documentation in multiple computer applications and systems. Assessed clients for abuse and neglect and compiled documentation for court reports.

Lead Clinical Counselor Contractor, 10/2016 to 04/2017 Loyal Source Government Services – Homestead, FL

Managed overall supervision and coaching of a team of 5 clinicians and 8 case manager. Conducted and documented mental health assessments for all children in care as well as provided ongoing individual and group counseling in accordance with ORR policies and procedures. Screened children for human trafficking concerns and provided appropriate crisis and trauma intervention when necessary. Coordinated case management and family reunification services for children; initiated and maintained direct contact with each child and childs family while child is in ORR care to efficiently advance childs family reunification. Facilitated timely release or discharge of children to identified family members or authorized caregiver and documented provision of services in each child's case file.

Primary Therapist, 02/2012 to 01/2016

Harlem United, Inc – 306 Lenox Ave, NY - New York

Assumed role of therapist; coordinating joint services and treatment planning, assessment, reassessment and joint case conferences with other service providers to clarify and define each providers goals and objectives. Established treatment goals and objectives with clients coming out of prison, as part of interdisciplinary care planning and re-entry process. Coordinated provision of multidisciplinary services as outlined in interdisciplinary care plan with particular influence upon housing and entitlement services. Provided supportive counseling, encompassing substance use counseling, mental health counseling, HIV education and entitlement advocacy services to clients of the Adult Day Health Care program.

Master of Science: Clinical Social Work, Fordham University Lincoln Center New York, NY

Bachelor of Science: BSW, Herbert H. Lehman College - Bronx, NY

Fully Bilingual English/Spanish

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