Project Coordinator Customer Service

Monica Palacios

Phoenix, Arizona

623-***-**** ****************@*****.***

Sr Clinical Admin Coordinator Project Coordinator

Member & Provider Services Lead Credit Analysis

Accomplished professional with multifaceted expertise in all aspects of Managed Care Insurance including Customer Service and Case Management & Subject Matter Expertise with over 25 years experience.

Able to communicate effectively in great detail with individuals at all levels of management, both internally and externally within client companies. Demonstrates effective time management skills to plan, organize effectively, set priorities, meet deadlines, and handle multiple work assignments and projects while working closely with the team or on my own to meet the end goals. Solid performance in taking ownership of full lifecycle project execution with strong analytical abilities.

Areas of Excellence:

Admin Coordinating • Project Coordinator • Document Management • Lead Services Provider •

• Project Management • Communications • Quality Assurance • Organization & Time Management •

Proficiency in Microsoft Office • Word • Excel, Access • Power point • Outlook

Knowledge of Medical & Pharmacy Terminology

Experience with Medical Records (EMR) & UMR

Knowledge of ICD-10 CPT coding

Professional Work History

United Health/Optum Health Nov 1998 - Presently

Sr Clinical Admin Coordinator

Excellent relationships with providers, vendors, and members.

• Act as a Subject Matter Expert for other team members. Pod liaison between UHC and Optum health.

• Work closely with hospital and the clinical team.

• Manage incoming calls, request for services and program information from CMO’s and other clinical staff.

• Manages the referral process, processes incoming and outgoing referrals, and prior authorizations.

• Highly experience in intake, notification, and census roles.

• Acts as a technical resource to other in own functions.

• Responsible for triage of members, administrative intake of members or managing the admission/discharge information post notification.

PacifiCare, Phoenix, AZ

Project Coordinator

Responsible for various projects for Medical Directors, Concurrent Review Nurses, and Management.

• Updating OOA daily reports and daily bed day census reports

• Data Entry and verifying precertification/authorizations.

• Obtaining referrals, medical records request, and prognosis notes.

• Updating Physicians' reports. Demonstrates problem solving, analytical and communication skills.

PacifiCare, Phoenix, AZ

Member & Provider Services Lead

• Handling large volume of incoming calls in a call center setting.

• Assisting members inquires, problem solving issues and concerns.

• Build strong teamwork, manages change, ensure clear communication, and deals with conflicts as they arise.

• Excel in listening to customer needs and creating solutions.

• Provide coaching and feedback to team members and report to management.

American Express, Phoenix, AZ Oct 1995-March 1998

Credit Analysis

• Able to utilize and navigate the systems applicable to the product.

• Proven problem-solving, analytical, and decision-making skills.

• Experienced in customer inquiries on company products, services, and policies and procedures.

• Provided prompt, efficient. and exceptional customer service to American Express potential card customers/card members.

Educational Background

Associates in Applied Science 2020 from Phoenix College

Certified Admin Coord from 1995 North American College

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