Customer Service Client Relations

Karla Velasquez-Aleman

**************@*****.*** *2800 SW 255 Ter, Homestead, FL 33032 786-***-****

Enthusiastic, responsible, professional, team-player with outstanding customer service skills and an excellent background in client relations and solid knowledge of the computer programs.

●CPT Coding

●HCPCS Coding

●ICD-10-CM

●Bilingual-Fluent in English and Spanish

●Insurance Verification

●Claims Processing

●Medicare, Medicaid and Third Party Payers

●Telephone Triage and Scheduling

●Payment and Charge Posting

●Patient Registration

●Microsoft Office, Excel, Adobe, Odyssey

●Collections

PROFESSIONAL EXPERIENCE

Aetna/CVS- September 06, 2023-09/2024

Bilingual Sr Service Advocate- OPS

• Bilingual in Spanish

• Exceptional verbal and written communication skills

• Excellent problem solving, leadership, and customer service skills

• Experience in dealing with member escalations

• Ability to remain calm and courteous under pressure and navigate tense situations, especially during high call volume days

• Strong understanding of company products, policies, and services

• Ability to coach, train and motivate employee and offer feedback on opportunity for performance improvement

• Ability to multitask

• Ability to identify trends

• Detail oriented

• Leading and promoting change in accordance with organizational structures

Aetna/CVS- September 06, 2023-08/2024

Customer Service Representative- DSNP

●Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff. Provide excellent customer services for high volume in bound provider calls for the Claims Inquiry/Claims Research team. Extensive claims research on multiple platforms to assist providers with payment questions.

●Provides the customer with related information to answer the unasked questions, e.g., additional plan details, benefit plan details, member self-service tools, etc. Uses customer service threshold framework to make financial decisions to resolve member issues. Explains member's rights and responsibilities in accordance with contract.

●Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system.

●Educates & assists providers on our self-service options. Assists providers with credentialing and re-credentialing and contracting questions and issues.

●Assists in compiling claim data for customer audits. Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.

Community Health of South Florida Inc.

Data Entry Specialist/ Clerk III for Behavioral Health 09/2019-02/07/2021

●Fixing Error Reports

●Uploading Services to SFBHN

●Register Patient in Intergy and Credible

●Work on Timecards for Forensic and JDP Employees

●Reporting all Mental Health Services and Incidentals at the end of the month to SFBHN.

●Reconcile Services for Billing Purposes

●Ensure the Data was entered in KIS Express Software

●Send Report to Coordinators

●Verifying patient insurance

●Inputting patient services and registration in FASAMS

●ICD 10 and CPT Codes

Comprehensive Health Services/ Homestead, FL

Case Aide 03/2019-09/2019

●Ensures Case Managers initiate and maintain direct contact with each child and the child family while the child is in contact care in order to efficiently advance the child’s family reunification and release the child from the facility

●Ensures assessments are conducted in accordance with contract policies and procedures

●Reports significant incidents in accordance with contract policies and procedures

●Maintains the contact database in accordance with contract policies and procedures

●Coordinates with Medical Team for all discharge clearances

●Provides recommendations to improve compliance

●Reports any incidents to the Site Lead

●Responsible for adhering to all CHSI, contract and other state regulations

HR& Block

Tax Preparer- Cutler Bay 01-201*-**-****

Prepared W2 and Schedule C, and Corporations for clients

My Little World Preschool/ 9730 SW 183rd Street, Miami, FL 33157

Teacher (Toddler) 08/04/2014- 10/09/2015

Take care of infants and toddlers

Make lesson plans for daily class

Clean class for the following day

Teach toddlers according to age appropriate

Discuss any concern of child with parents

Engage with parents in activities with child

Arazoza& Fernandez-Fraga P.A 2100 SAlzedo Street Ste 300, Coral Gables, FL 33134

Front Desk Receptionist 08/07/2006-04/10/2012

Answer and direct phone calls to appropriate extensions

Greet and help clients with what they need

Request files from storage and sort mail

Ship packages via Fed-Ex

Do certified mail and labels

Keep track of the amount of postages sent daily

Did other work as assigned

Made appointments for clients to see attorney

Filed litigation paperwork and sent them to court

Sent invoices for clients

Made letters to be filed with complaints

Pollo Tropical 18701 South Dixie Highway Miami, FL 33157

Cashier 01/05/2006-08/07/2006

Greet Customers

Sale Food

Cash Register

Victoria Secret- Miami International Mall, Miami, FL

Sales Associate 2006/2007

Help customer with what they are looking for

Sale panties and bra within a specific time

Fix and accommodate department assigned

Try to sale as much product as possible

FIU Center for Diversity in Engineering- Miami, FL

Office Assistant 02/2006-08/2006

In charge of the Educational Logs

Making Interviews Appointments

Date Entry

Make staff time cards

Help with Payroll

File Documents

Answer Phone calls and Greet visitors

MDC Community Education- 300 NE 2nd Ave, Miami, FL 33131

Information Specialist 09/2003-02/2006

Meet with the public in person and assisted Instructor in ESL Lab

Advise students regarding course requirements and testing prerequisite

Help students select the appropriate course or schedule that the program offers

Register students and make schedule changes according to students’ needs and course availabilities through the Odyssey System

MDC Media Relations Department- 300 NE 2nd Ave Miami, FL 33131

Student Assistant 09/2003-02/2006

Cutting/Pasting/Scanning and the distribution of the Daily News Clippings.

Pick-Up/ Drop-Off Department mail and subscriptions

Answering ongoing regular telephone calls

EDUCATION

●Life and Health License 07/2024

●Columbia Southern University

Bachelor Degree in Business Administration- 05/2021

●Florida Technical College

Medical Billing & Coding-03/2019

NCCT Certified

●Miami Dade College

Associates in Arts Degree in Social Work-2004

●Miami-Dade College- Miami, FL 33131

Notary Public-07/31/2009

●Miami Dade College- Miami, FL 33032

45 Hours Child Care 07/01/2014

●Miami Dade College- Miami, FL 33032

Tax Preparer 06/27/2013

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