Service Representative Customer

Mayra Aguilar

***** *** **** ** ******* Hills, CA 91344

Phone: 818-***-**** Email: ***********@******.**** JOB OBJECTIVE

To obtain a position in a Medical/Healthcare management office setting where I can utilize my extensive experience in the healthcare industry. I plan to utilize my well versed experience and knowlege gained by working in many rolls in the healthcare maintenance organization throughout the years; as well as back and front office experience in an infusion pharmacy. I have also completed a medical assistance training course and hands on training for procedures and front and back office. My roles in all different aspects the healthcare management and medical office experience help guide me through any new opportunities and challenges. I welcome new challenges that will help in my growth in any part of the medical industry and will allow me to continue to built new skills, as I am aware that the medical industry is an always changing experience and I welcome all new endeavors. SKILLS & ABILITIES

WORK EXPERIENCE

In Home Support Services, Los Angeles, CA

Caregiver, Care coordinator. – July 2014- October 2022

Responsible for managing and coordinating care for Disabled/Seniors

Provided assistance with day to day activities; transported to and from medical appointments and treatment centers.

Administered medication as instructed by patients physician. Assisted physician in creating a treatment plan that would fit and also be followed by the patient depending on the patient’s lifestyle needs. Reported any significant issues to patients family and physician.

Exotic Stone Works, Van Nuys, CA

Office Manager -.December 2019 –October 2021

• Responsible for all daily activities; invoicing; responding to calls, mail, e-mail inquiries from customers and vendors

• Booking keeping; monthly reports; Licensing; Insurance, contracts

• Payroll and payroll reporting to EDD and IRS as needed Accounting Principles, Burbank, CA

Temp position at SAG-AFTRA

Membership Services Representative -.October 2018-January 2019

• Responds to telephone inquiries regarding plan benefits, medical claim status including correspondence

• Documents all calls handled and consistently meeting established call quota

• Requests applicable correspondence for providers and participants.

• Follows up on outbound calls

OptionCare, Sun Valley, CA

Intake referral coordinator. – June 2016- June 2017

Takes referral from referral source via phone, fax, email, Clinical liaison, etc.

Coordinates referrals between different business units (e.g. pharmacy, nursing, warehouse, etc.)

Coordinates referrals with external sources (sub-contractors, other healthcare providers) and the patient.

Strong knowledge of managed care

organization processes; referrals, benefits, etc.

Excellent customer service skills; empathetic,

caring, and trustworthy

Bilingual (Spanish and English)

Medical Assistant training

Knowledge of Medical Terminology and ICD-9/

CPT coding

Front/Back Office Skills

Patient Relations/Patient Charting

CPR/First Aid Certified

Health Care Navigator

Completes and accurately enters patient demographic and therapy information into the system. Regal Medical Group, Northridge, CA

Duals Care Coordinator – March 2015- June 2015 (temporary assignment)

Responsible for managing and coordinating care for Dual Medi-Connect patients. Assisted the case managers in developing a comprehensive care plan for patients.

Responsible for opening case management cases, Facilitate appointments for the member, which include Health Plan Programs related to their diagnosis, PCP and specialist appointments and transportation if needed.

Tracing the patient’s compliancy with physician’s orders and evaluating PCP or specialist access issues. Participated in patient education regarding urgent care, hospice, flu vaccination clinics and other issues related to chronic disease care. The goal of the Duals Care Coordinator was to effectively assist in managing members on an outpatient basis to assure the appropriate level-of-care was provided, to prevent re-admissions and ensure that the members’ medical, environmental and psychosocial needs were met over the continuum of care as directed by the case manager.

L.A. CARE Health Plan, Los Angeles, CA

Member Relations Specialist – 2011 to 2013

Responsible for identification, documentation, investigation and resolution of complex cases within a 48-72 hour turnaround for all cases whether presented by the members, legal representative, or providers.

Coordination of care cases involved benefit coordination, provider assignment, continuity of care/treatment with in and out of network providers.

Build strong rapports with internal and external departmental units to ensure that all cases were processes promptly and with the best outcome to ensure the member was received quality care. When appropriate cases were referred to the plan partners for resolution. Promptly contacted and processed claim issues. Blue Shield of California, Woodland Hills, CA

Lead Supervisor/Manager - 1998 to 2004

Lead Supervisor for the intake of appeals, expedited appeals and grievances. Ensured all cases were handled in the appropriate timeframe set by the CMS guidelines.

Created and updated department policies and procedures, ensured that all representatives were updated and trained on the new policies. Conducted staff meetings and employee trainings.

Prepared schedules; monitored and reviewed calls; ensured all calls were answered quickly and in a professional manner. Analyzed call log reports and reviewed call abandonment rate, average speed of answer, call lengths; prepared summary of all call information for upper management. Teletech Telecommunications, Burbank, CA

Customer Service Representative – 1997 to 1998

Inbound call center, provided customer service, and placed orders for several products (mobile phones, AOL credit cards and reward point awards).

Social Security Administration Office, San Fernando, CA Customer Service Representative – 1996 to 1997

Date entry, filing; formulated and prepared correspondence letters. Answered customer inquiries over the phone with excellent customer service. Translated for Spanish speaking customers during in-bound and follow up interviews.

EDUCATION AND TRAINING

Charter College, Santa Clarita, CA

Medical Assistant Program and Certification 2009 to 2010 California State University Northridge, Northridge, CA

General Education 1997 to 1998

REFERENCES

Available upon request.

Contact this candidate