Remote Customer Service & Healthcare Administrator (Bilingual)

Irene V. Perez

■ Houston, TX ■ 832-***-**** ■ ********@******.***

Bilingual: English & Spanish

Professional Summary

Customer service and healthcare administration professional with 20+ years of experience in call centers, patient advocacy, medical collections, and quality assurance audits. Proven expertise in Medicare/Medicaid claims, insurance verification, and revenue cycle management. Skilled in de-escalation, training, QA auditing, and building strong patient/provider relationships. Recognized for problem-solving, efficiency, and bilingual communication.

Core Skills

•Quality Assurance & Audits: 5 years conducting QA audits to ensure compliance, accuracy, and process improvements

•Customer Service & Call Center: 15+ years handling 60–90 daily calls, de-escalation, member education

•Healthcare & Insurance: Medicare/Medicaid billing, EOB review, claims appeals, HIPAA compliance

•Leadership & Training: 10 years supervisory/training experience, mentoring new hires

•Technical Tools: Epic, Facets, Meditech, Availity, Compass, Outlook, Microsoft Office, provider portals

Professional Experience

Elevance Health Plan – Remote

MAPD Customer Service Rep II Oct 2024 – Present

•Assist Medicare members with claim inquiries, PCP changes, and benefits review.

•Submit grievances and appeals, dispute balance billing, and update demographics.

•Utilize multiple systems including Compass, Medisys Facets, and Anthem web portal.

Conifer Health Solutions – Remote

AR Specialist (Medicare, Medicaid, Commercial) Feb 2023 – Present

•Review and resolve accounts for Medicare, Medicaid, and commercial insurance.

•Submit corrected claims, verify eligibility/benefits, and handle denial management.

•Manage provider communications and appeals via Availity, BCBS, Cigna, Noridian, etc.

Acclara – Remote

Customer Service Representative II Jan 2020 – Feb 2023

•Handled 60–90 daily calls regarding billing, statements, and insurance.

•Educated patients/providers on EOBs, UB04, HCFA 1500.

•Collected co-pays/deductibles and supported revenue cycle improvements.

•Mentored new representatives to improve service quality.

Asurion (AT&T; Project)

Bilingual Claims CSR Jun 2019 – Jan 2020

•Resolved claims inquiries with empathy and accuracy, averaging 70–80 calls daily.

Memorial Hermann Sports Medicine

Patient Advocate Aug 2018 – Jan 2019

•Managed patient check-in/out, insurance verification, scheduling, and payments.

Medix Personnel Agency (Temp)

C4 Specialty Scheduler May 2018 – Aug 2018

•Registered new patients in Epic and scheduled specialty appointments.

Randstad Personnel Agency (Temp)

Telemarketing Assignment Sep 2017 – Aug 2018

•Scheduled 15–30 appointments daily during insurance open enrollment period.

Quality Assurance Auditor – Remote

Jan 2015 – Dec 2019

•Conducted quality assurance audits on call recordings, claims processing, and account reviews to ensure compliance with Medicare, Medicaid, and commercial insurance regulations.

•Developed and maintained QA scorecards to track performance trends and accuracy.

•Provided coaching and feedback to representatives based on audit findings, improving accuracy and customer satisfaction.

•Partnered with leadership to implement process improvements that reduced errors and enhanced compliance.

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Education & Certifications

•Notary Public – State of Texas

•Additional certifications or training (if applicable, can be added here)

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