Customer Service Representative
Resume:
Shaila Cabrera Luna
Shrewsbury, MA *****
******.*******@*****.***
Professional Summary
A very responsible person, with a spirit of learning, effort, dedication, and commitment to reach my goal, and perfection in my work. Having the ability to multi-task and work well in a fast-paced environment. I had given my all in every job that I had it didn't matter if it was out of my comfort zone I checked myself and provided the best of everything that I could do. You would gain a very optimistic, think-out-of-the- box, ongoing, and kind person. Self-motivated, driven to succeed. With problem-solving skills. Developing within my responsibilities according to my position the best techniques to meet the needs to improve and do the job asked to do—the ability to successfully communicate with all levels of the workforce. With a gap of almost 3 years, I got a chance to spend more time with my daughter since we had to move to another country, and being able to give her the stability that she needed before going back to work, allowed me to improve in my persona knowing exactly what I wanted to be in the future for her. Authorized to work in the US for any employer
Work Experience
CSR - Customer Service Representative
Ged Lawyers-Boca Raton, FL
December 2024 to Present
Essential Job Functions
• Onboard and service new and existing clients (PIP medical providers)
• Responsible for building and maintaining client relationships
• Efficiently review client patient files in a strategic manner, every 45 days
• Verify, scan & upload pertinent medical documents (AOB’s, EOB’s, patient ledgers & HCFA’s) needed to send a demand letter to the insurance carrier
• Meet annual KPI goals (client case volume & client reviews)
• Follow up and obtain all information needed for rejected patient files
• Understand and decipher insurance policy language
• Ability to determine available insurance benefits and/or if benefits are exhausted
• Demonstrate ability to establish collaborative client relationships to retain their business, loyalty and obtain referrals
• Navigate Ged Lawyers client financial portal and print reports prior to client visits
• Understand the use of CPT codes, ICD 9/10 codes, modifiers, denial codes, and fee schedules (Medicare/ Workers’ Compensation)
• Calculate payments of claims according to fee schedule and determine available benefits and/or if benefits are exhausted
• Use of basic mathematical skills: Addition, Subtraction, Multiplication, and Division
• Knowledge of the difference between a policy number/claim number, what they represent, and how it affects the process
• Identify problems and solve according to protocol
• Ensure proper processing of Clients that require special criteria
• Identify and escalate any client service challenges so they can work to resolution
• Maintain and uphold the privacy, confidentiality and security of protected health information internal and external to the work environment for written, verbal and/or electronic communication in compliance with HIPPA Privacy Rules.
Insurance Coordinator
HSMC-Milford, MA
May 2023 to December 2024
• Responsible for ensuring that all required client documentation is present in the file.
• Responsible for ensuring appropriate authorizations are received. Follow up with companies as needed.
• Collect information as requested by insurance policy and maintain file.
• Documents all correspondence with the insurance company.
• Gathers documentation for insurance company, when required.
• Maintains a list of individual contacts at insurance companies.
• Tracks termination of previous policies and effective dates of new insurance.
• Ensures timely completion and delivery of face sheet to the billing department.
• Works with client companies to obtain necessary information and resolve problems
• I served as a translator when needed by the company with the programs that I'm working with and helped my coworkers when needed.
Third Billing Party Coordinator
HSMC-Milford, MA
October 2021 to May 2023
• Perform coding and billing tasks on a computerized health information technology (HIT) system.
• Utilize a combination of electronic health records (EHR) and paper patient records to perform billing duties; maintain an accurate, legally compliant medical record. With different programs like Allscripts, Kareo and others.
• Submit insurance claims to clearinghouse or individual insurance companies electronically or via the paper CMS-1500 form.
• Follow up and resubmit claims in a timely fashion.
• For patients with coverage by more than one insurer, prepares and submit-secondary claims upon processing by the primary insurer
• Follows HIPAA guidelines in handling patient information.
• Make necessary arrangements for medical records requests, completion of additional information requests, etc. as requested by insurance companies.
• Respond to inquiries from insurance companies, patients, and providers.
• Regularly meet with Intake and Collection Specialists to discuss and resolve reimbursement issues or billing obstacles.
• Perform additional duties as requested by the Supervisory or Management team.
• Other reasonably related duties as assigned by the Director of Professional Billing, Associate Vice President of Revenue Cycle, Vice President of Financial Operations, and/or the President. Service Coordinator
Masis Staffing Solutions-Webster, MA
May 2021 to September 2021
• Responsible for planning and executing a consistently high volume of recruiting activities.
• Managed new candidate's job orders and job safety analysis through Masis Staffing Solutions CRM Software.
• Worked with payroll.
• Kept updated records of termination of employment on CRM software and cooperate with unemployment investigations.
• Kept strict attention to detail to all candidate-related processes including screening, interviewing, training, onboarding, and termination.
• Maintained a high fill ratio required for successful performance of the branch.
• Developed creative recruiting strategies to bring valuable candidates to the pool.
• Communicated efficiently with Branch Manager and Business Development Manager on the status of job orders and all other clients or candidate relevant matters.
• Maintained a strict level of confidentiality and adherence to company policy while interacting with candidates and clients.
• Created recruiting and interviewing plans for each open position, including collaboration with hiring managers on prescreening questions.
• Created a talent pipeline by building relationships with qualified candidates in prioritized skills sets; developed a pool of qualified candidates in advance of need.
• Actively network through industry contacts, association memberships, trade groups, and employees.
• Committed to meet or exceed performance goals set up by the executive team and safety standard goals established by the Risk Department.
CSR - Customer Service Representative
Wipro Limited-Guaynabo, PR
December 2020 to March 2021
• Build sustainable relationships and trust with customer accounts through open and interactive communication
• Provide accurate, valid and complete information by using the right methods/tools
• Meet personal/customer service team sales targets and call handling quotas
• Handle customer complaints, provide appropriate solutions and alternatives within the time limits; follow up to ensure resolution
• Keep records of customer interactions, process customer accounts and file documents
• Follow communication procedures, guidelines and policies
• Take the extra mile to engage customers
• Ensure excellent service standards, respond efficiently to customer inquiries and maintain high customer satisfaction.
Office Operations Supervisor of the Recruiting Department U.S. Census Bureau-Guaynabo, PR
January 2020 to November 2020
Supervise the Recruiting Assistants and clerks while they're looking for training sites for the enumerators and Field Supervisors for the training that they would be taking. Approved the payroll Of the Recruiting Assistants and Clerks. Work with the form D-617.3, making sure what they did in the day. Coordination of the events program for each day.
Assistant Manager
Fundacion Ayuda al Inmigrante-Puerto Nuevo, PR
April 2019 to March 2020
My responsibilities were to translate any legal documentation that the client would need to fill out and apply for a Visa, Green Card and Citizenship with the USCIS. Manager of International Purchasing Department
Álvarez y Sánchez C. por A-Santo Domingo, DO
January 2011 to August 2012
• In charge of the purchase orders made to our distributors.
• Responsible of coordinating imports together with the customs department and everything related to this.
Customer Service Supervisor
Gano Excel Dominicana SRL-Santo Domingo, DO
2010 to 2011
• Supervise the customer to obtain the service and the product by the time they arrive at the office.
• In charge of expense reports.
• In charge of translations of documents to be sent abroad.
• The main objective was to provide the tools for ease of management of the system when interacting with the customer by phone or in person.
Administration Assistant Hospital Division Department Bio-Nuclear, S.A-Santo Domingo, DO
2008 to December 2009
• Gathering of information from the different dialysis units in order to take census of the number of renal patients in the country.
• Organization of the daily agenda of my supervisors.
• Control and monitoring of the activities of the sales personnel in the visits to the clients.
• Monitoring of renal patients supplies.
• Daily communication with the suppliers of our lines.
• Responsible of the organization for the training of the nurses of our clients. Customer Service
Centro de Idiomas Berlitz-Santo Domingo, DO
2005 to 2007
• In Charge of welcoming the people interested in our services as well as following up the students of the center.
• In charge of the collection of payments.
• Organization of the teaching department including their group and individual schedules.
• Adjustments and changes for customers.
Education
Bachelor's Degree in Tourism and Hotel Management in Tourism and Hotel Management
Universidad APEC-Santo Domingo, Domincian Republic December 1999 to July 2004
Associate's degree
Skills
• Merchandising
• Computer skills
• ICD-10
• Inventory
• Patient service
• Microsoft Excel
• Leadership Experience
• Team Building
• Communication skills
• Workday
• Pricing
• Operations Management
• Communications
• Conflict Management
• Spanish
• Human resources
• Marketing
• CPT coding
• Medical collection
• Madison CRM (Less than 1 year)
• Payroll (1 year)
• Employment & labor law
• Recruiting
• Bilingual
• Time Management
• Guest Services
• Social media management
• Medical Coding
• Office Management
• HRIS
• Microsoft Word
• Veradigm System (3 years)
• ICD-9
• Assistant Manager Experience
• CGMP
• Basic Math
• Salesforce
• Computer networking
• Multilingual
• SharePoint
• Research
• Marketing (1 year)
• retail sales
• MS Office
• Workers' Compensation
• Cash Handling
• Data collection
• Filing
• E-verify Certification (1 year)
• Human Resources Management
• Medical Billing
• Performance Management
• Leadership
• QuickBooks
• Negotiation
• English
• Administrative Experience (10+ years)
• Customer Service
• Inventory Control
• Benefits administration
• Microsoft Office
• SAP
• Front desk
• Management
• Windows
• Project management
• Event Planning
• Employee Orientation
• Supervising Experience
• Training
• Data management
• Data entry
• Typing
• Accounting
• Google Docs
• Talent acquisition
• Payroll (Less than 1 year)
• Payroll
• ICD coding
• Budgeting
Languages
• Spanish, English - Expert
Certifications and Licenses
Office Operations Supervisor
March 2020 to Present
This certificate is to learn how to do appointments and orientation with the staff, managing people, performance management, managing payroll and overtime. Administrative Clerk
January 2020 to Present
To known the story of the Census and what exactly we would be doing in the office Additional Information
Knowledge of Office Package
Contact this candidate