Customer Service Data Entry

Alice C. Sandoval

Albuquerque, NM *****

Comfortable to work remotely Can commute onsite for Training, meeting and connectivity issues.

Skills

Years of Experience

Customer Service\Call center

20+

Healthcare

20+

Medical Terminology

10+

Microsoft office Excel, Outlook, Word

25+

Summary

Dedicated healthcare professional with extensive experience in customer service, Medicaid administration, and claims processing.

Strong background in scheduling, prior authorizations, and insurance verifications across various healthcare settings, including hospitals and managed care organizations

Proven ability to manage high volumes of inbound/outbound calls and assist low-income families with Medicaid applications, SNAP, and LIHEAP.

Skilled in data entry and documentation management, with a focus on accuracy and compliance.

Skills

CRM

FACETS

Microsoft office Excel, Outlook, Word

MS Windows

Managed care

IDX Scheduling

Medical Terminology

EPIC

PALCO

OMNIAID

FOCoS

DOCFINITY

Salesforce

Multi-tasking

Education & Certification:

Albuquerque Technical Vocational Institute Pharmacy Technician – Certificate

Albuquerque Technical Vocational Institute Electronics – Diploma

Valley High School High School Diploma 1978

Professional Experience:

State of New Mexico Albuquerque, NM - Remote

Dec 2023 - June 2024

Medicaid Representative

The State of New Mexico is back logged on Medicaid applications since the COVID Pandemic contracted to working from home reindex check stubs, recertifications, and Renewals for New Mexico low income families.

Intake new applications for Medicaid, SNAP, and LIHEAP.

Handled calls from Medicaid members to obtain new insurance information.

Ardent Health Services Albuquerque, NM

January 2023 - August 2023

Scheduler/Call Center Representative

Answer in-bound calls from/for Lovelace Medical Group for primary care appointments, prior authorizations, insurance verifications, requesting medications both new and refills.

Managed 50 – 75 inbound and outbound calls from members and providers.

Conduent Albuquerque, NM - Remote

February 2021 - January 2023

Liaison/Customer Service Rep

Liaison for Member Via Medicaid participants that are needed timesheets, mileage, or vendor payments form issues by emailing the Employer of Record, Consultant, or Support Broker.

Index in coming forms to make sure they are correctly filled out for PALCO who makes sure all paperwork and taxes are submitted.

Tricore Albuquerque, NM

Nov 2020 - February 2021

Data Entry Clerk

Temporary data entry clerk for COVID lab claims to be entered into TRICORE system.

Data entry up to 45+WPM

Presbyterian Healthcare Albuquerque, NM - Remote

Jan. 2019 - Oct. 2019

Customer Service Representative

Answer in-bound calls from Presbyterian Centennial Members for new ID cards, giving benefit information, checking on Prior Authorization for member, filing appeals and grievance

Updating Primary Physicians, arrange for transportation, lodging, and reimbursement

Processed claims for State of NM Reclamation

In bound calls from Doctors’ offices with Prior Authorizations and members eligibility and claims

Aerotek Albuquerque, NM

Sept. 2018 - Jan. 2019

Scheduler

Scheduled Presbyterian members for Specialty Clinics

Call to verify addresses, change in medical offices, and phone numbers for patients

Emailed nurse stations for Prior Authorization and for returning member phone calls

Make calls to members to change member's schedule if doctor is out or needed in surgery

Molina Healthcare Albuquerque, NM

Oct. 2016 - June 2018

Medicaid Claims/Customer Service Rep

Receive In-bound calls from providers to check on status of member’s claims,

Check on Prior Authorizations, and appeals

In-bound calls from members to update personal information, add/remove dependents, change their Primary care providers, and send out ID cards and member hand booklets

Do special projects concerning multiple claims for individual members or providers

Other Experience:

USPS Albuquerque, NM

Dec 2019 – Oct 2020 Mail Carrier

Express Scripts Albuquerque, NM

Jan. 2015 - Sept 2016 Pharmacy Technician / Customer Service Rep

Aerotek Albuquerque, NM

Dec. 2013 - Aug. 2014 Pharmacy Technician/Data Entry

UNM Hospital – UNM Cancer Center Albuquerque, NM

April 1998 - Sept. 2012 Pharmacy Technician roII/Customer Service Rep

Contact this candidate