Customer Service Medical Records

ROMON

IVERSON

Eastvale, CA • 909-***-**** • ************@*****.*** OBJECTIVE Leverage my expertise in Sales Coordination Sales Support, Customer Service, CRM, Administrative Support, Account Management to plan, develop and implement business solutions. CAREER

SUMMARY

• Twenty years of corporate and B2B experience, fast learner and self starter.

• Able to multitask, learn new job requirements/functions and thrive in a highly metric driven environment.

• Results oriented, accepts responsibility for individual performance, able to work independently and focus on providing excellent results in a team driven model and minimal supervision. PROFESSIONAL

EXPERIENCE Blueshield of California – (Contract - Wollborg Michelson) REMOTE Care Gap Closure Outreach Specialist (August 2024 to December 2024)

-Made outbound calls to members for auditing purposes. CONTRIBUTIONS

Completed special projects through assigned by management.

• Conducted outreach to members to resolve barriers to care and educated on missing gaps in care.

• Assisted in scheduling appointments and documented member interactions in BSC systems and Excel tracking spreadsheets.

• Followed up with members and reminded them of upcoming appointments.

• Reached out to providers to secure medical records for BSC members.

• Sent communications via fax and email to provider offices and ensured timely follow up.

• Documented medical record retrieval activities in systems and ensured documentation was complete and detailed.

• Responded to customer inquiries via telephone and accurately addressed providers, hospitals and medical record vendor queries.

• Coordinated with other departments as needed to ensure timely responses.

• Engaged in provider follow up to ensure medical records are received within required deadlines.

• Expedited and resolved complex issues and escalated medical record retrieval issues as needed.

• Assisted in scheduling and coordinating team activities.

• Performed additional administrative duties as needed. Kwikset Corporation – (Contract - Aston Carter) REMOTE Technical Support Representative (April 2023 to November 2023)

-Received consumer calls and emails regarding program/install issues. CONTRIBUTIONS

Received consumer calls and emails regarding problems, installation instructions and general product information.

• Answered high volume incoming technical support calls.

• Offered knowledge to consumers and directed them to the proper source if necessary.

• Handled a strong volume of calls with tact, diplomacy, and strong consumer service orientation in accordance with company guidelines.

• Required basic knowledge of computer software for data input and retrieval.

• Responded to consumer repairs and requests according to Consumer Service procedures.

• Evaluated product problems, determined if product needed to be scrapped or if it could be repaired.

• Assisted consumers on products such as installation techniques, product features and models etc. as requested by consumer service supervisor.

CalOptima Healthcare – (Contract – Healthcare Support) Orange, CA Medical Support Associate (January 2023 to March 2023)

-Reviewed and processed prior authorization requests from medical providers. CONTRIBUTIONS

• Assisted the nurse in gathering medical records and obtains appropriate diagnosis and procedure coding.

• Performed data entry into appropriate databases for monitoring, tracking and trending of events.

• Collected additional information from health members and providers to complete referral review.

• Authorized services according to authorization guidelines and verified eligibility.

• Documented all contacts and case information in the system using standard charting format.

• Received referral requests via phone, fax and electronically and enter in database.

• Attended and participated in departmental and company Zoom meetings.

• Assisted the team in carrying out departmental responsibilities to support team goals. Anthem Healthcare Cerritos, CA

Member Support Representative (November 2018 to March 2022)

-Assisted Medicare Advantage patients with questions at first point of contact. CONTRIBUTIONS

• Conducted outreach to members to resolve barriers to care and educated on missed gaps in care.

• Assisted in scheduling appointments and documented member interactions in BSC systems and outreach tracking spreadsheets.

• Followed up with members and reminded them of upcoming appointments.

• Reached out to providers to secure medical records for BSC members.

• Sent communications via fax and email to provider offices and ensured timely follow-up.

• Documented medical record retrieval activities in systems and ensured documentation was complete and detailed.

• Responded to customer inquiries via telephone and accurately addressed provider, hospital, and medical record vendor queries.

• Coordinated with other departments as needed to ensure timely responses.

• Engaged in provider follow-up to ensure medical records were received within required deadline.

• Expedited and resolved complex issues and escalated medical record retrieval issues as needed.

• Assisted in scheduling and coordinating team activities.

• Performed additional administrative duties as needed. Prime National Solutions, LLC Norco, CA

Customer Support Associate (April 2018 to November 2018)

-Conduct analysis of consumer credit files to identify and remove questionable, negative items. CONTRIBUTIONS

• Partnered with real estate and mortgage professionals to increase their closing rate.

• Empowered consumers with negative credit to significantly increase credit scores.

• Attended network meetings to increase referral partnership participation.

• Submitted credit removal packages to processing department for approval.

• Provided applicants with options based on their credit worthiness.

• Made numerous outbound calls to prospective clients. Blue Dot Safes Pomona, CA

Customer Service & Support Associate (October 2017 to April 2018)

-Deliver technical service and support to clients via phone, email and 3rd party software. CONTRIBUTIONS

• Provided technical and dispatch problem resolution to end users.

• Performed question diagnosis while guiding users through step-by-step resolutions.

• Verified proper user credentials and authorities.

• Followed standard processes and procedures.

• Researched required information using available resources.

• Attended various team meetings to inform and offer departmental solutions. Staffmark-Ecolab Riverside, CA

Customer Service Specialist (April 2015 to September 2017)

-Expedited supply chain logistical shipments to various carriers throughout several geographical regions.

CONTRIBUTIONS

• Interacted with customers by phone and email, received orders, changes in service.

• Adjusted complaints concerning billing for services rendered for correctness.

• Processed and input all customer orders and receipts using multiple applications.

• Ran stock reports to check for product availability to ensure proper inventory.

• Generated all related paperwork and necessary information required for customer orders.

• Worked with management regarding product routing for customers.

• Maintained customer files and followed all regulatory policies and procedures. State Farm Chino Hills, CA

Sales Coordinator & Marketing Representative (May 2013 to March 2015)

-Developed and implemented marketing campaigns for business and residential customers to generate sales.

CONTRIBUTIONS

• Developed leads, scheduled appointments, identified customer needs.

• Worked with the agent/colleagues to establish and meet marketing goals.

• Used a customer-focused, needs-based review process to educate clients about insurance options. Consumer Debt Assistance, LLC Irvine, CA

Inside Sales Representative (July 2010 to May 2013)

-Managed large debt portfolio of new and existing customers for local startup debt settlement firm. CONTRIBUTIONS

• Served customers by providing product information, handling incoming customer phone calls, processing orders and resolving order management issues.

• Processed orders and provide efficient response and resolution to all customer requests.

• Assisted customers with inquiries or issues concerning orders.

• Followed up and provided feedback for all customer issues.

• Analyzed, reviewed, and processed customer requests for return authorization and credits.

• Maintained effective communication with customers to ensure accurate billing and shipments.

• Contributed to team effort by accomplishing related results as needed.

• Applied knowledge and skill to complete a wide range of tasks. Morgan Drexen, LLC Anaheim, CA

Inside Sales Representative (June 2009 to July 2010)

-Coordinated multi-department interaction to expedite and resolve challenges the law firm clients face and be the advocate for law firm clients within the scope of work. CONTRIBUTIONS

• Responsible for one-on-one telephone conversations with existing law firm clients and addressed their administrative questions, needs or concerns regarding their accounts.

• Provided account info for debt settlement programs to consumer and business clients. Pinnacle Financial Corporation Walnut, CA

Mortgage Sales Coordinator (June 2006 to June 2009)

-Established and maintained a client database by selling, promoting and marketing mortgage loan products in person and over the phone to existing and potential mortgage loan customers. Cingular Wireless Anaheim Hills, CA

Corporate Customer Service Representative (January 2002 to June June2006)

-Provided customer service for National Business Services (Enterprise) division to corporate clients. CONTRIBUTIONS

• Served customers by providing product information, handling incoming customer phone calls, processing orders and resolving order management issues and Tier 1 tech support.

• Processed orders and provide efficient response and resolution to all customer requests.

• Assisted customers with inquiries, order issues follow up and provided feedback.

• Analyzed, reviewed, and processed customer requests for return authorization and credits.

• Maintained effective communication with customers to ensure accurate billing and shipments.

• Contributed to team effort by accomplishing related results as needed.

• Assigned specific offline projects and daily operations activities.

• Applied knowledge and skill to complete a wide range of tasks. Cingular Wireless Anaheim Hills, CA

Wireless Fraud Risk Analyst (December 2000 to December 2002)

-Investigated identity and cloning fraud while working with law enforcement agencies. LA Cellular/at&t Wireless Cerritos, CA

Credit Risk Analyst/Client Support Representative (December 1994 to December 2000)

-Prioritized high work volume daily by communicating to assigned customers. CONTRIBUTIONS

• Obtained appropriate credit information and analyzed credit history for recommendations of extension of credit and credit limits.

• Identified and presented to management accounts requiring change in extension of credit or third-party collection action.

• Reviewed and released pending customer orders by assessing credit worthiness, open invoices, in-process payments, payment history etc. in accordance with department guidelines.

• Proactively tracked, resolved, and escalated invoices for timely payment. SYSTEMS KNOWLEDGE:

Microsoft Office Suite, Teams, Zoom, Citrix, Facets, Epic, CS Admin, My Powr, CUP, Compass, Medysis, Lighthouse, Avaya, Dun & Bradstreet, FMS, (CRM) - Salesforce, ERP, SAP, Zendesk, ServiceNow

EDUCATION Cypress College Cypress, CA

Associate of Arts, Business Finance December 1990

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