Call Center Customer Service

AMPARO I . SORIA

Los Angeles, CA 323-***-**** ******.*********@*****.***

OBJECTIVE

Highly passionate and diligent to get the job done, I have over 35 years of experience in the healthcare industry. My previous experience has allowed me to wear different hats throughout my career, allowing me to overcome difficult scenarios. I bring experience and knowledge to any position; my key specialty is senior managed care and experience with working this demographic group.

E D U C A T I O N — E XPERIENCE

Santa Fe High School

Graduate 1985

SKILLS

Supervisory

development

Public speaking

Phone etiquette

Culture linguistic

Athena

COSEVA

QUEST

MRO

EZ-CAP

Expert in Medicare

Regulations

Expert in Medi-Cal

Regulations

Commercial Plan

Experience

Marketing Liaison

for Brokers

Successful

preparation/success

rates for Audits

Healthcare and IPA

Utilization

knowledge

Physician Data Trust & Midtown Medical Corporation Office Manager • Los Angeles, CA

02/2022 – Current

Developed policy and procedures to educate staff and patients to assure we run a smooth practice.

Generated revenue to the practice.

Assist with high-risk patients to ensure we follow through to meet their healthcare needs by submitting urgent authorizations request. I would communicate with

specialist, DME or diagnostic orders for are patients I maintain ordering supplies for the clinic. I worked on special project delegated by the IPA or health plan to outreach patients.

Provider Relations • Greater Tri-city -San Diego, CA 09/2021 – 02/2022

Duties- Assist providers in contractual inquiries. Capitation checks distribution. Problem solving with claims issues. Meet quality care measures in Coseva. Provider Relations • Imperial Health Holdings Medical Group

12/2019 - 2021

Customer service to assist providers to access the provider portal. Add or update provider profiles. Assist on contract issues and problem solve claims issues.

I worked on several outbound projects.

C O N T I N U E D

E X P E R I E N C E

E XPERIENCE

City of Hope= New patient registration

I registered new patients – send to RN for further information to prepare for the first consult.

Obtained prior authorizations or self-paid patients. Bio script/Walgreens-Intake Coordinator

Home infusion- Home Health

Processed orders upon discharged from hospitals.

I worked closely with discharge planers and sales reps to ensure we provider home infusions and RN HH

Obtained authorizations and ran Part D copays.

Concerto Healthcare-Utilization customer service

I was the highest call volume rep answering calls for the call center for the UM department. The calls were from providers. I processed auto approvals when pending. I trained all new staff and provided tips on handling calls in a center environment.

Alameda Alliance- Call center supervisor for over 20 employees

Maintain call center operations.

Motivate staff members, handle complex member calls, and maintain quality measures.

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