Customer Service Data Entry

AMERICA Y. HUERTA

******.*******@*****.*** 714-***-****

SKILLS & QUALIFICATIONS

Bilingual: English/Spanish

Knowledge of MS Word, Excel, and Outlook

Multitask oriented

Good organizational skills

Works well under pressure

Works well independently or as part of team

Good logic application

Follows directions well

EXPERIENCE

Clinical Support Coordinator

Aditi Consulting/Blue Shield of CA - Remote

12/2024 to Present

Telephonic outreach to members as directed by protocol or RN care manager or social worker.

Assists with system letters, requests for information and data entry.

Back up to phones when needed.

Provides administrative/clerical support to medical and disease management programs.

Acts as a liaison, gathers information, and track all patients referred to the care management programs.

Assists in coordinating care for specific high risk/high-cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc.

Documents all patient specific information in appropriate information systems.

Assists in verifying health plan benefits and coordinating ambulatory services.

Demonstrates cultural competence to work effectively, respectfully, and sensitively within the client’s cultural context.

Conduct the Health Risk Assessment (HRA) with the member via telephonic.

Customer Service Representative, Sr.

Info Way Solutions LLC/CalOptima Health - Orange, CA

04/2024 to 10/2024

Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.

Addresses member and provider inquiries, questions and concerns in all areas, including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care in-person or telephonically.

Serves as a senior resource for other team members (i.e., solves complex challenges, answers uncommon questions and shares complex processes and procedures).

Supports in the coordination of member’s health care and social service needs both within and outside the medical group and CalOptima Health.

Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.

Maintains departmental productivity and quality standards.

Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction. Provides additional follow-up assistance as needed.

Patient Services Associate

Family Health Matters - Anaheim, CA

01/2024 to 03/2024

Welcomes patients and visitors by greeting them in person or on the telephone; by answering questions or referring inquiries.

Schedule, cancel, confirm, or reschedules appointments according to scheduling guidelines.

Answers incoming calls and follows up on voicemail messages professionally.

Actively verifies patient’s insurance ahead of scheduled appointment.

Collect co-pays and record transaction(s) in patient account following protocol.

Always provides patient-centered customer service.

Follows up with patients when they are a no-show for an appointment by calling patients to reschedule and documents interaction as a telephone encounter.

Maintains patient confidentiality as required by HIPAA in all daily work.

Monitors provider schedules to identify errors or opportunities for improved schedule efficiencies.

Customer Service Representative II

Liberty Dental Plan - Remote

10/2023 to 12/2023

Answering 30+ calls per day.

Thoroughly documenting all customer transactions in host system.

Safeguard and secure all PHI from misuse in strict accordance with LIBERTYs Information Security Policies and Procedures.

Provide excellent customer service to all incoming/outgoing callers and answer and document inquiries related to dental benefits, eligibility, provider information, fulfillment requests and other miscellaneous inquiries.

Patient Services Representative II

AltaMed Health Services - Anaheim, CA

08/2020 to 10/2023

Answering 40+ calls per day.

Collect/update/verify all pertinent patient demographic and insurance information.

Relay patient questions, requests, and other calls to the appropriate person/department.

Accurately schedule, reschedule and/or cancel medical appointments as requested by the patient and in accordance with AltaMed’s Appointment Scheduling Policy.

Confirm patient appointments 24-48 hours in advance.

Teller/Manager

Main International Group Corp - Anaheim, CA

07/2013 to 08/2020

Keeps current on all policies and procedures when facilitating transactions including cashing checks, money orders, and assisting customers wire money internationally.

Acknowledged for remaining friendly and professional when making daily calls to customers to let them know the exchange rate.

Selected to make difficult calls regarding getting checks back from bank due to possessing outstanding ability to remain respectful and professional while working towards an acceptable arrangement such as having them sending in a replacement check.

Demonstrates great speed and accuracy when inputting information into our computer system Refers to detailed training when facilitating loans.

Greets customers entering the establishment, ascertains their individual needs, and assists them with their selection as necessary.

Verify inventory compilations by comparing them to physical counts of stock.

Ensure store remains clean, welcoming, and free of potential hazards.

EDUCATION

HSE Academy GED

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