Carla Rambo

Positive, friendly, professional with experience in Call Center Environment.

Winters, CA 95694

adxsu8@r.postjobfree.com

+1-530-***-****

I have worked in call centers for inbound and outbound lines of business relating to Medicaid and appointment scheduling. I have also given instruction /lab for Medical Billing and Coding programs for Carrington College and MTI College.

Authorized to work in the US for any employer

Work Experience

Call Center Representative

MagellanRx Management - Rancho Cordova, CA

October 2020 to March 2022

Provide information regarding Medicaid claims, denials, eligibility for medications either from a beneficiary, pharmacy or managed care provider. Guide people on how to use the state website/portal as well as find other information as needed.

Patient Service Representative- Outbound

Triwest Healthcare Alliance - Rancho Cordova, CA

November 2019 to June 2020

• Make outbound phone calls to Medical offices to Schedule appointments for Veterans.

• Verified Veteran VA authorizations where correct and complete.

• Verified providers were credentialed with Triwest Healthcare Alliance.

• Faxed required paperwork to Medical providers when necessary.

• Contact local VA to trouble shoot paperwork errors or to escalate requests.

• Contact Veteran to confirm availability/and confirm address, or to complete preregistration.

• Call Veteran to provide appointment information.

• Document all transactions in CRM.

Adjunct Medical Billing and Coding Instructor

MTI College - Sacramento, CA

May 2017 to January 2018

• Assemble lecture materials and distribution of study guides.

• Ability to address student needs and resolve issues with diplomacy and tact. Ability to maintain confidentiality. Guide students to develop and maintain professionalism.

• Often give life experiences or story's related to billing or coding topics.

• Excellent verbal communication skills including ability to project voice and be clearly understood when speaking in front of a group/class.

• Complied with policies, regulations, and codes of conduct governing all aspects of job responsibilities.

• Working knowledge of Word, Excel, PowerPoint, and Outlook, Medisoft and Harris Tracker software.

• Fills in as a substitute for other instructors as needed.

• Maintained Spreadsheet tracking of homework/test scores.

• Maintained attendance tracking.

Medical Billing and Coding Instructor/On-line Hybrid Instructor Carrington College - Sacramento, CA

June 2014 to January 2017

• Highly organized and detail oriented.

• Interacts effectively and professionally with students, staff, faculty,

• Exceptional customer focused skills. Ability to address student needs and resolve issues with diplomacy and tact.

• Interpersonal skills including questioning, listening and showing concern and respect for others.

• Solid writing skills to communicate effectively in memos, letters, and via email.

• Excellent verbal communication skills including ability to project voice and be clearly understood when speaking in front of a group.

• Ability to maintain confidentiality.

• Possess a high degree of integrity and commitment to comply with policies, regulations, and codes of conduct governing all aspects of job responsibilities.

• Computer literacy skills including working knowledge of Word, Excel, PowerPoint, and Outlook.

• Completes other duties as assigned.

SHP Call Center Representative

Kelly Services (HealthNet International) - Rancho Cordova, CA January 2014 to July 2014

• Perform Provider and Group transfers & Update/Add Member Information

• Follow up on Prior Authorizations & Perform Claim Status inquiries

• Submit Appeals and Grievance per guidelines

• Maintain HIPPA compliance for all verbal/written and electronic transactions. Beneficiary Service Center Analyst

ACS A Xerox Company - Sacramento, CA

July 2011 to March 2012

• Determined Medi-Cal Beneficiary Eligibility

• Verified Medi-Cal Provider Status

• Determined Medi-Cal Medication coverage status

• Adjudicated Medi-Cal Beneficiary claims for out of pocket expenses

• Documented all inbound/outbound calls

• Maintained Spreadsheet tracking of claims received and updated outcome

• Generated letters of approval/denial based on research of claim Call Center Representative

EDS - Rancho Cordova, CA

February 2008 to July 2011

• Answered all incoming calls regarding Medi-Cal account/claims/denials

• Knowledgeable in all Medi-Cal Call Center Skill Sets Level III

• Family Pact Team Lead

• Used CRM, CA-MMIS programs to respond to Provider Inquiries

• Maintained documentation of all calls

• Cal-Optima Specialist for Medi/Medi Cross Over Claims Megellan RX

Education

A.A.S degree in Medical

Heald Business College - Rancho Cordova, CA

B.A. degree in Liberal Arts/ Geography

California State University Hayward - Hayward, CA

B.A

Skills

• 8000 KPH

• Typing 50 WPM

• MS. Office Suite

• Medical Terminology

• Anatomy/Physiology

• Filing

• HCPCS/ICD-9 & 10/CPT

• Billing\Coding Software

• CA-MMIS

• Optum EHR Software

• HIPAA Compliance

• Ins. Authorizations

• CMS1500

• UB04

• Referrals

• Medical Billing

• Dental Billing

• Data Entry

• Medisoft Software

• Bookkeeping

• Optum 360

• CPT/ICD-10 software.

• Classroom Management

• Customer service

• Medical Office Experience

• Insurance Verification

• Computer Literacy

• Medical Records

• Windows

• Microsoft Excel

• Word processing

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