Medical Billing Customer Service
Resume:
Cynthia Cervantes
Moses Lake, WA *****
**********@*****.***
PROFESSIONAL SUMMARY
Enhance team performance and maximize customer satisfaction by strategically managing calls and implementing process improvements. Talented leader offering top-notch abilities in program management, interpersonal communication and administrative oversight.
Successful at training and mentoring employees to promote a culture of collaboration and continuous improvement.
Work Experience
Medical Assistant/Intake Specialist
MED Weight loss Clinics - Florida Ridge, FL
August 2023 to Present
Intake Specialist responsibilities include greeting patients, recording personal details and gathering medical histories before the patient's appointment. Ultimately, I work directly with patients to gather their information and process them before they meet with a Doctor or medical professional in our facility Assist in examination and treatment. Call medication into pharmacies as well as required to obtain labs for patients upon initial exam for Physician to review laboratory analysis remotely.
Inform patients of costs for care being provided and guides them through insurance benefits and other appropriate resources for further information. Answer telephones, screen callers, relay messages and greet callers
Medical Billing Specialist (Temporary Contract)
April 2023 - August 2023
MediRevv – Portland, OR
Research payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment.
Submit retro-authorizations in accordance with payor requirements in response to authorization denials.
Submit detailed, customized appeals to payers based on a review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as UW Health policies and procedures.
Independently write professional appeal letters.
Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution.
Make recommendations for additions/revisions/deletions to work queues and claim edits to improve efficiency and reduce denials.
Review payor communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle leadership as appropriate.
Identify opportunities for process improvement and actively participate in process improvement initiatives.
Support co-workers and engage in positive interactions.
Communicate professionally and timely with internal and external customers.
Ability to stay calm under pressure and deal effectively with difficult people
Case Manager
IEM, Inc - Jacksonville, FL
September 2022 to June 2023
Provided Disaster Case Management services for over 100 survivors in support of the Unite Florida program within two weeks
Provided Individual Assistance resources and referrals for survivors of Hurricane Ian • Researched, analyzed, and coordinated with various federal, state, local, and nonprofit programs that can provide recovery assistance for Hurricane Ian survivors
Utilized the Unite Us system to track, manage, and refer all Unite Florida applicants • Supported the Florida Division of Emergency Management's ESF 6 during a Level-Two Emergency Operations Center activation in response to Hurricane Ian
Migrated data of over 1,000 survivor profiles from multiple databases into the Unite Us System within 3 weeks
Completed survivor outreach to ensure data accuracy and integrity for over 1,000 profiles • Utilized Smartsheet for internal data and progress tracking
Utilized 8x8 Call Center application system to complete survivor outreach
Supported the Florida Division of Emergency Management's ESF 6 during a Level-One Emergency Operations Center activation in response to Hurricane Ian
Medical Billing Specialist II
subsidiary of Zotec Partners, LLC - Indianapolis, IN
August 2021 to August 2022
Medical Billing / Coding For all Medical Providers across the United States. Coding and filing for all claims to all billable insurance carriers to get Insurance Claims accepted and paid for patients. Work on all claim denials and appeals. Medical Insurance Verification with patients calls and provide accurate, satisfactory answers to their queries and concerns
• De-escalate situations involving dissatisfied customers, offering patient assistance and support • Perform code abstraction of medical records to ensure ICD-10-CM codes are accurately assigned and supported.
• Guide callers through troubleshooting, navigating the company site/portal for all billing invoice statements to be viewed.
• Ability and desire to hit metrics upon training (idle time is also monitored on this hourly paid position) • Review customer or client accounts, providing updates and information about all billing questions or disputes.
• Collaborate with other call center professionals to improve customer service • Help to train new employees and inform them about the company’s customer management policies on customer service.
Remote National Client Service Manager
AnswerNet Communications - Pennsylvania
March 2021 to July 2021
Responsibilities
• Quoting, order processing, generating license keys, and invoicing as well as all record-keeping pertaining to sales and licensing of our Analytical products, services, and integrated solutions • Generating new qualified leads by conducting research to identify decision-makers, sales deal catalysts, and influencers within targeted accounts
• Sustaining our current customer base through maintenance and subscription renewals and prioritizing responses to their ongoing needs
• Researching named target accounts in industry, market, business strategy and/or technology trends aligning with Lumina marketing initiatives
• Creating and delivering compelling content and consistently following through on sales & demand generation campaigns
• Working closely with the sales and marketing team to understand and improve the execution of campaigns. Collaborating in the planning and execution of company marketing and sales initiatives – providing input from market engagement with prospective customers
• Planning and scheduling sales and marketing engagements with Lumina management including customer site visits, industry events, and performance updates.
Remote Tech Call Center Team Leader
Havas STREET - San Diego, CA
March 2020 to February 2021
Technical supervisors oversee employee performance in a certain department of the organization. They monitor the installation, repair, troubleshooting, and maintenance work of technicians. They supervise teams of technicians, oversee workers, and perform inspections on work orders.
Remote Call Center Lead Supervisor
UNITEDHEALTH GROUP - Tampa, FL
September 2019 to August 2020
Work from home position mentoring/monitoring daily quality of service performed by a team of 25 agents I supervised. Agents are servicing providers and medical facilities in demographic areas contracted to service our United States Veterans for medical and dental care. Responsible for first-level response and resolution of escalated issues with external and internal customers. Responsible for the overall delivery of benefits and services by providing support and guidance to existing and potential customers to ensure continued membership.
Primary Responsibilities:
Coordinating, supervising and accountable for the daily activities of business support, technical or production team or unit.
• Attend meetings and trainings as requested and maintain up to date knowledge of all programs and systems.
• Meet Quality Assurance (QA) and other key performance metrics Ability to work from home with remote working free from distractions.
• Coaching/Training agents on any concerns or issues needing improvements by 1:1 with agents. • Utilizing all sources for hands on training such as; virtual training with applicable training systems, taking calls with agents, or more hands on approach by using any method to support each agent to feel confident on every call taken.
• Worked with staff by providing a dynamic atmosphere of work.
CNA Mentor/ Case Management
NEXT STEP INC - Seattle, WA
November 2017 to August 2019
Work from home position counseling and mentoring new nursing students going through our nursing certification program online. Demonstrated on a daily basis performing in a fast work environment with means to multi-task on every occasion possible. Coaching and training new nursing students through courses successfully to obtain certification. Caseload consisted of 120 new students/enrollees tracking/ coaching all completed coursework while mentoring their study plan and addressing any adverse issues for each student that made completion of coursework unattainable. Fierce attention to detail while creating, analyzing new startup software monitoring reports and reaching analytical goals set for future succession for the company.
Primary Responsibilities:
Case Management with collaborating change and revisions to all online educational training programs. Accommodate daily studying plans for new enrollees' succession for completion of startup certified nursing online program.
Meet Quality Assurance (QA) and other key performance metrics Ability to work from home with remote working free from distractions.
Scheduled and provided opportunities for quality training on a regular basis for compliance and accordance for corporate and regulatory standards.
Maintained the efficiency of the health care services provided in the facility, while overseeing the needs of the staff and complying with the government regulations. Experienced in managing day-to-day administrative tasks of a healthcare to deliver a high-level of customer service, and maximize patient satisfaction along with the knowledge of current healthcare laws and procedures, medical issues, and terminology, medical billing procedures, including insurance benefits
Effective written and verbal communication skills as well as the ability to establish and maintain strong working relations with cross functional departments, co-workers, and patients
Solid leadership and management skills along with the ability to build professional working environment for both office management staff, and medical teams
Strong analytical skills along with the ability to research, evaluate, and solve complex administrative and operational problems
Excellent organizational and time-management skills with the ability to handle multiple priorities within specific deadlines.
Education
Certification Medical Billing and Coding in Medical Billing & Coding/ Administration Assistance in Healthcare Administration
Clover Park Technical College - Tacoma, WA
June 2021 to Present
Associates in Arts Degree w/emphasis clinical counseling
Colorado Christian University - Denver, CO
2013 to 2019
Certifications and Licenses
ITIL Certification
Certified Scrum Master
CPR Certification
CNA Expired Certification July 1998- 2012 Expired
Assessments
Work style: Professionalism — Proficient
Tendency to be accountable, professional, open to feedback, and act with integrity at work Full results: Proficient
Recruiting — Proficient
October 2022
Managing the candidate sourcing and selection process
Full results: Proficient
Work style: Reliability — Proficient
March 2023
Tendency to be reliable, dependable, and act with integrity at work
Full results: Proficient
HR: Compensation & benefits — Proficient
July 2022
Knowledge of compensation and benefits programs
Full results: Proficient
Case management & social work — Proficient
July 2021
Determining client needs, providing support resources, and collaborating with clients and multidisciplinary teams
Full results: Proficient
Customer focus & orientation — Proficient
April 2022
Responding to customer situations with sensitivity
Full results: Proficient
Sales skills — Proficient
September 2021
Influencing and negotiating with customers
Full results: Proficient
Customer service fit — Proficient
November 2022
Measures the traits that are important for success for customer service roles Full results: Proficient
Technical support: Customer situations — Proficient
September 2022
Responding to technical support situations with sensitivity
Full results: Proficient
Protecting patient privacy — Proficient
July 2022
Understanding privacy rules and regulations associated with patient records Full results: Proficient
Medical billing — Proficient
July 2022
Understanding the procedures and forms used for medical billing
Full results: Proficient
Management & leadership skills: Impact & influence — Proficient July 2022
Choosing the most effective strategy to inspire and influence others to meet business objectives Full results: Proficient
Case management & social work — Proficient
August 2023
Determining client needs, providing support resources, and collaborating with clients and multidisciplinary teams
Full results: Proficient
Spreadsheets with Microsoft Excel — Proficient
August 2021
Knowledge of various Microsoft Excel features, functions, and formulas
Full results: Proficient
Administrative assistant/receptionist — Proficient
September 2022
Using basic scheduling and organizational skills in an office setting
Full results: Proficient
Analyzing data — Proficient
August 2023
Interpreting and producing graphs, identifying trends, and drawing justifiable conclusions from data Full results: Proficient
Basic computer skills — Proficient
November 2022
Performing basic computer operations and troubleshooting common problems Full results: Proficient
Customer focus & orientation — Proficient
July 2021
Responding to customer situations with sensitivity
Full results: Proficient
Attention to detail — Proficient
August 2021
Identifying differences in materials, following instructions, and detecting details among distracting information
Full results: Proficient
Medical receptionist skills — Proficient
September 2022
Managing physician schedules and maintaining accurate patient records
Full results: Proficient
Customer service — Proficient
July 2021
Identifying and resolving common customer issues
Full results: Proficient
Supervisory skills: Motivating & assessing employees — Proficient
August 2023
Motivating others to achieve objectives and identifying improvements or corrective actions Full results: Proficient
Work motivation — Proficient
August 2021
Level of motivation and discipline applied toward work
Full results: Proficient
Written communication — Proficient
August 2021
Best practices for writing, including grammar, style, clarity, and brevity
Full results: Proficient
Work style: Conscientiousness — Proficient
October 2022
Tendency to be well-organized, rule-abiding, and hard-working
Full results: Proficient
Call center customer service — Proficient
August 2021
Demonstrating customer service skills in a call center setting
Full results: Proficient
Protecting patient privacy — Proficient
April 2023
Understanding privacy rules and regulations associated with patient records
Full results: Proficient
Customer focus & orientation — Proficient
October 2022
Responding to customer situations with sensitivity
Full results: Proficient
Additional Information
My career has been working in Customer Services, Management and Leadership roles for 20yrs. In my last 10 years all managerial positions have been remote.
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