Customer Care Rep
Resume:
Monique Flores
Los Angeles, CA, *0042
****************@*****.***
OBJECTIVE:
To obtain a permanent position within a professional environment where I can utilize my strengths in Medical
billing, Front Office, and Customer service skills to their utmost potential.
EXPERIENCE:
03/22-Current Home Instead Pasadena, CA
Caregiver
Assist with common activities of daily living and build a lasting relationship with you and your family. Help to
enhance the aging experience by providing practical support at home with a human touch. Personal care
assistance helps adults maintain dignity as they age while receiving the care needed to stay healthy and
independent.
06/15- 12/15 Care 1st Health Plan Monterey Park, CA
Claims Representative
Responded to telephone and written inquiries related to status of claims, researched status for providers and
documented on tracking system, data entry and maintenance of provider inquiries, including findings in
computerized tracking system/logs responded to inquiries, reviewed Care1st Division of Financial
Responsibility Matrix, advised of claims processing guidelines/protocols such as claims timely submission and
payments, and assisted with batching claims on HCFA 1500 forms and UB 04 forms.
10/14-01/15 Regal Medical Group/Aerotek West Covina, CA
Customer Service
Answer phones, provide assistance to patients face to face meetings with any bills or concerns, assisted
providers with any issues with eligibility on authorizations or claims, route calls to appropriate departments,
verify eligibility and benefits, and mail distribution.
06/07-11/13 SynerMed Monterey Park, CA
Customer Care
Answer phones, monitor queue, perform research on DOFR issues, assist Clients and Member on
authorizations and claims, research problems with eligibility on authorizations and or claims to our Eligibility
Departments to utilize any other source to resolve the problem, research on claim issues, and route to auditors
for review by email to the Claims Department for the clients for reprocessing as a Customer Service Inquiry if
not processed correctly for further review, email um/cm for urgent referrals, medical record review to route to
appropriate department, contact PCP’s office to submit authorizations for Members, assist members on
balance billing, and transportation.
EDUCATION:
01/06-06/06 Allied School Los Angeles, CA
Phlebotomist Extern: Greet patients, Filing, Draw blood, EKGs, ICGs, and Pulmonary Function Test.
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