Service Representative Customer
Resume:
Jennifer Penafiel
Morrisville, PA
adwqcq@r.postjobfree.com
Dedicated customer service representative. Great customer rapport. Looking to continue great customer satisfaction and contribute to the success of the company. Have great reliability, I’m driven, and excellent time management ability. Work Experience
Intake Specialist
Zoll Lifevest Services - Morrisville, PA
April 2022 to Present
• Creation of patient record
• Verification of benefits
• Triage, work and resolve intake orders
• Explain medical need and educate insurance case managers on LifeVest system to obtain authorization for services
• Obtain necessary documentation (medical order, clinical notes, testing) and submit to insurance carrier for coverage determination
• Obtain authorizations as required by payer
• Execute timely follow up on all assigned tasks
• Identify qualifying diagnosis based on payer requirements
• Triage fax documents for timely review
• Communicate authorization results and order status to sales representatives
• Complete fee calculator and inform billing department of appropriate charges
• Contact customers, physician offices, and sales representatives to relay and/or obtain insurance information and/or additional documentation to assist with seeking reimbursement and coordination of benefits
• Knowledge of MCD, MCR, PAP, CHARITY CARE, HPA, HMO, PPO, etc. Director of Admissions HMO
Hudson View Care and Rehab Center - North Bergen, NJ September 2018 to May 2021
• Manage and supervise admissions staff.
• Handled inquiry calls from hospitals, families, etc., and provide appointments for tours.
• Maintain updated bed availability and facility services information.
• Ensured all papers are properly filled out and input into our EMR.
• Verified patient insurance / demographics
• Obtained Prior Authorization, and Insurance Verification for all patient's medical and demographic information necessary to process the referral.
• Answered and responded to calls regarding insurance related issues in courteous and professional manner.
• Updated any changes of insurance within our EMR
• Verified out of network/in network benefits with insurance companies such as, United Health Care, Well care, and Medicare.
• Knowledge of MCD and MCR.
• Worked with nursing and housekeeping staff to maintain knowledge of number of beds available.
• Participated in meetings to alert appropriate staff members of projected admissions, room changes, discharges, etc.
• Communicated special needs of new admissions to staff to ensure a smooth transition. Coordinating Procurement Agent
SKYLINE HEALTHCARE SERVICES - Totowa, NJ
February 2016 to May 2018
· Prepared purchase orders and reviewed requisitions for goods and services.
· Purchased the highest quality merchandise at the lowest possible price and in correct amounts.
· Coordinated with suppliers to resolve performance related issues.
· Calculated & created PPD reports to determine facility’s weekly & monthly budget
· Monitored shipments to ensure that goods come in on time, and in the event of problems trace shipments and follow up undelivered goods.
· Reviewed all competitive proposals to select best sources. Education
Associate in Liberal Arts & Sciences
Mercer County Community College - West Windsor, NJ January 2019 to August 2021
Skills
• Customer service experience (2.5 years)
• Excellent written and verbal communication skills
• Organizational and Problem-Solving Skills (2.5 years)
• Computer Skills: Word, Outlook, Excel, and Power Point (5 years)
• Medical / Insurance System Knowledge (Point Click Care, MyAbility, NJMMIS, etc.) (4 years)
• Fluent in English and Spanish
• Insurance Verification
• EMR Systems
• Medical Office Experience
• Ordering System knowledge
• (Oncare, Procurement Partners, Medline.com, HD Supplies, etc.)
• Medical Records
• HIPAA
• ICD-10
Contact this candidate