SYLVIA GARZA

adu1t5@r.postjobfree.com

210-***-****

Objective

Compassionate and conscientious individual seeking an opportunity as Medical Claims or Data Entry position with a company that can best utilize my many office skills and abilities, performing hands on creating rapport with clientele and ensuring they receive the highest quality of service.

Skills and Qualifications

Type 45+WPM

Strong leadership abilities

Proficient in English and Spanish

Excellent verbal and written communication skills

Ability to work with detailed data with a high degree of accuracy using 10-key by touch

Professional Experience

Maximus Inc.

AST Representative II 09/2018 – 04/2019

Recertified or enrolled members according to their qualifications required by state law for Government assistance using state guidelines for SNAP (Supplemental Nutrition Assistance Program), TANF (Temporary Assistance for Needy Families), Medicare, Medicaid, and Chip.

Processed applications using workflow/job, alfa-numeric Data Entry and Excel spreadsheets.

Performed other job tasks assigned by supervisor including mentoring 12 individuals when supervisor was unavailable.

Molina Healthcare,

Enrollment Representative II 11/2011 – 10/2017

Enrolled, recertified, and maintained electronic Medical Records to assure they were complete and accurate by updating members medical and providers demographical information by implementing proper HIPPA and company policies. Trained 4 representatives in performing job duties and understanding company and law practices.

Assigned providers to members that were in network or out of network according to members preference.

Responded to inquiries from Government entities, insurance companies, and providers pertaining to members eligibility for Medicare, Medicaid, or dual eligibility such as STAR PLUS via E-mail, mail or by phone.

Verified insurance and ensured Eligibility (ELG) and Other Insurance Verification (OIV) claims were submitted with a goal of zero errors.

Ran monthly aging accounts and receivable reports to follow up on unpaid claims aged over 30 days.

Davila Pharmacy,

Medical Billing /Collections Specialist 09/2010 – 10/2011

Managed account balances to discover outstanding debts or other inconsistencies.

Collected all information needed to calculate bills receivable (order amounts, discounted rates etc.)

Checked the data input in the accounting system to ensure accuracy of final bills.

Sent payment reminders; issued invoices or bills and contacted customers by phone or email to collect on unpaid debts; updated accounting and Medical Records with new payments, balances and customer demographics pertaining to RX (prescriptions’) or Durable Medical Equipment.

CVS Caremark, San Antonio, TX

Customer Service Representative 11/2008 - 12/2009

Maintained a large volume of calls for a large pharmaceutical company (CVS).

Met personal or team targets by meeting incoming/outgoing call quotas.

Followed communication procedures and guidelines pertaining to HIPAA and company Policies.

Took payment information and other pertinent information to place or cancel RX (prescription) orders.

Resolved product RX (prescription) or other service problems by clarifying the customer’s complaint; determining the cause of the problem by selecting and explaining the best solution to solve the problem; expedited correction or adjustment to proper department if necessary and followed up to ensure proper resolution.

Education History

Job Ready Training, San Antonio, TX Vocational School Medical Administrative Asst / Billing & Coding Specialist

Texas A&M University, San Antonio, TX 1 Year of College Business Technology

S.A.I.S.D. San Antonio, TX Academic Studies G.E.D.

Awards/Acknowledgements

Customer Service (Inbound sales) -CVS Caremark

Volunteer Experience

Health and Human Services Commission

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