Order Entry & Coordination Specialist Resume Title

GERALDINO Q. MAGNO JR.

Email: *******@***.***

Tel: 714-***-****

EDUCATION:

High School

High School Diploma (1983)

College of Commerce (1987)

Cypress College Computer Education (1992)

Skills:

AIS Program; Best Care Program

IRIS and Navigator (OPTUM programs)

CRM Sales Force program

Bilingual in English and Tagalog

QNXT QSHRE & Pursuit Intranet program

Call Center Telecommunications

NICE, Claims Vision, EAMS (Electronic Adjudication Management System)

Medic-Soft Program, IKA System

Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid,

EZ-Cap/ Facets -Billing/ Citrix, PeopleSoft

Data Entry/Mail Room/AS400, MC400

ICD-9-CPT Coding/IDX & EDI & EDX Program

UHG-Prescription Solutions-Optum-Health Branch

NICE-RIMS, PACE, Next-Gen, Guide Wire (Workers Comp)

Software for Insurance Program

Pitney Bowes and Xerox Fax/ Copy machines

Ricoh copiers/printers' machines

Able to do Clerical, Mail room, filing, and all-around administration.

BMD (Ballot Marking Device) units for Election ‘2020

EXPERIENCE:

12/24 to BLUE SHIELD OF CALIFORNIA (CLINICAL SUPPORT COORDINATOR 2)

Current

Review CAL-AIM Community Supports Screening documents to determine member eligibility for CAL-AIM Community Supports.

Follow up with internal staff and providers to support the successful referral and enrollment of members into CAL-AIM Community Supports services.

Process daily service authorizations and denials for requested Community Supports services.P

Perform data entry, tracking, and case documentation for all members referred for services, including enrollment status, authorizations, encounter data, care coordination activities, clinical case records, and regulatory reports.

Support with reconciling provider invoicing and claims.

Support with sending communications to Community Support Providers to ensure timely submission of deliverables and reports.

Review Provider reports to ensure accurate data collection and reporting

Respond to inquiries regarding service authorization request status.

Actively participate in Multidisciplinary Team meetings to coordinate member care and support member retention in CAL-AIM Community Supports services.

Conduct outreach calls to members, as needed, to verify engagement in Community Supports services.

Participate actively in ensuring that all state and federal rules and regulations are followed.

Perform other assigned duties, as required.

04/24 to ALISO RIDGE BEHAVIORAL HEALTH MEDICAL RECORDS CLERK

12/24 (With Robert Half, Inc.)

Retrieving TARs (Treatment Admission Records) from Best Care program.

Protects the confidentiality of the patient's record and the hospital's liability when releasing information to third parties.

Performs insurance verification. thru AEVS Medical Website

Maintain updated files.

Update file information.

01/24 to THE JUDGE GROUP - CAL-OPTIMA HEALTHCARE/MEMBER SERVICES/PROVIDER REP.

04/24 (With The Judge Group Staffing)

Addresses provider inquiries, questions, and concerns in all areas, including enrollment, claims submission and payment, benefit interpretation, and referrals/authorizations for medical care.

Verifies member eligibility, claims, and authorization status for providers.

Ensures thorough follow-up and completion of all provider inquiries or requests.

Taking inbound/outbound calls from providers, hospitals, and billing offices.

Assisting members with calls about their insurance, provider change, and updating members’ records profile.

01/23 to

01/24 SPARKS ADVISORS – PATIENT OUTREACH SPECIALIST – CALL CENTER – CLAIMS PROCESSING/REMOTE (With Robert Half, Inc.)

Taking incoming calls, and assisting Medicare members with their doctor’s appointments;

Answer 60-70 Inbound Calls daily

Process electronic Claims from the hospital, billing.; familiar with all claim forms.

Resolve Member/Provider Inquiries

Provide Claims disposition

Provide Authorization status

Master internal department workflow processes

Ability to demonstrate Empathy/Compassion

Responsible for making 100+ outbound calls daily.

Outbound calls are to existing patients and asking if they’re ready to schedule their first doctor’s appointment for the year and if so… transfer the call to the scheduling department, if no…. ask why or leave a voicemail.

Data entry and proper verification of patient and documentation

Ask patients if they want to participate in a 3-question survey after your call.

Software: Google Docs, Slack, and Ring Voice.

12/21 to ROBERT HALF STAFFING/ LOS ANGELES REGISTRAR’S RECORDER – CALL CENTER

01/23 (Seasonal/Temporary Employment)

Assisting in the election process, call center, and answering incoming calls for voter inquiries. Troubleshooting the Marking Ballot Device unit,

Being an election-workers assist and prepare all registered voters for checking in.

Assists voters, especially ADA with disability, with pre-registration and how to navigate the use of the marking ballot device.

Do sanitation after each voter on the marking ballot device unit.

Maintains proper sanitation, follows the guidelines, and provides the safest voting centers possible.

02/21to

12/21 CALIFORNIA RENTAL ASSISTANCE – HOUSING IS KEY WEBSITE –CALL CENTER

(With LA Business Personnel, Inc. Temp. Staffing)

Assist callers and provide CA COVID-19 Rent Relief program assistance for both landlords and tenants.

Routing each call to the appropriate departments.

Landlords and renters are both encouraged to apply.

The program provides free financial assistance is available to landlords and renters who need help with unpaid or future rent or utilities.

notified of next steps.

All applicant information is kept private and will not be shared.

Once an application has been successfully processed, both the landlord and renter will get paid

01/21 to UCI CONTACT TRACER FOR COVID-19 RESPONSE CALL CENTER REPRESENTATIVE

02/21 (TES –Temporary Employment Services at UCI)

Calling students/employees daily within UCI Campus to follow up with the potentially exposed employees/students with COVID-19 and their health status by asking questions in the survey.

Processes assessment and metric-measure guidelines for the survey.

Doing home assessments and following up on all test results.

Educating and giving advice to all employees/students within the UCI Campus about Covid-19.

Updating notes and records to all cases.

01/20 to LOS ANGELES COUNTY REGISTRAR/MULTILINGUAL CLERK FOR ELECTIONS YR. 2020

01/21 (Contracted with L.A. Business Personnel, Inc. Temporary Staffing)

Assist in using the voting machines to help language minority voters better understand and feel more comfortable.

To determine which areas should receive translated material and poll-worker assistance in a certain language, the Department has developed a comprehensive language-targeting database system

The Department records audio ballots in ten languages to provide an alternative means of voting for those with disabilities and language assistance needs.

To provide residents with the opportunity to fully engage in the electoral process, the Department transliterates candidate names and provides translated election materials in the covered languages to those who request it.

Poll workers answer questions at the polls, explain the ballot and voting procedures, and assist in using the voting machines to help language minority voters better understand and feel more comfortable with the process.

11/19 to OPTUM RX / UNITED HEALTHCARE GROUP (Contracted with Healthcare Support Staffing)

01/20 Customer Service Advocate I

Answer incoming calls from our customers on issues related to benefit eligibility questions and prescription status inquiries

Help guide and educate customers on their prescription benefits, use of plan, formulary, premiums and status of orders, and claims or inquiries

Ask appropriate questions and listen actively to identify any questions or issues while documenting required information in computer systems

Identify issues and communicate solutions and steps to customers, pharmacies, and physicians with prescription orders and reorders

Escalate drug-related calls as appropriate to licensed pharmacists for resolution

Coordinate internal resolution of claims exceptions and other issues including determining the appropriateness of overriding pharmacy claims edits and error messages

Make outbound calls to customers on prescriptions withhold orders and payment issue

May also assist with entering new prescription orders into the system

Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first-call resolution, and attendance

06/19 to RICOH of America /Irvine

11/19 Field Service Representative (FSR)

Performs and assists with ensuring services are completed according to Ricoh Service Excellence requirements

Flexible with travel within a geographic territory

Works with a flexible schedule to cover time off requests for contracted customers' onsite staff, which may include managerial duties.

Embraces the diverse customer environment and maintains excellent customer focus while performing on site duties.

Responsible for customer satisfaction by engaging end-user feedback and escalating concerns to the account manager and helping support resolution.

Works to learn and manage all aspects of the RICOH Service Center in the absence of the Site Manager or Supervisor.

Assists in the coordination of work assignments to meet specific deadlines and service deliverables.

Assists in copy/print production center and performs all functions required to complete and deliver all copy requests. This may include the usage of all finishing equipment such as binding, folders, laminators, etc.

Filing and labeling of documents and other materials for storage and retrieval.

Processes all incoming and outgoing mail and packages. This includes sorting, delivery, packaging, shipping, and receiving.

Provides courier service for the pickup and delivery of mail and copy jobs, on campus and offsite.

Other duties as assigned

03/19 to SEDGWICK CMS-TPA-Third Party Administrator (Contracted with PRG Recruiters Staffing)

06/19 Office Claims Assistant Coordinator

Process mail, separating and distributing claims to the different departments;

All RFA’s (Request for Authorizations) Claims go to specific assigned examiners

Date-stamp all claims received with the use of a perforated machine daily,

Collecting faxed documents, claims daily,

Creating and typing form letters.

Sets up, maintains, and locates claim files.

Processes packets daily

10/18 to MOLINA HEALTH CARE (Contracted with Healthcare Support Staffing)

03/19 HEDIS Coordinator Representative

Assisting with project management by coordinating the identification, pursuit, and collection of medical records and other data in collaboration with other Medical Record staff

Assists the Manager and Supervisor(s) and/or performs the coordination and preparation of the medical record collection process that includes the pursuit via phone call, fax, mail, electronic medical record system retrieval, and direct onsite pick-up

Participates in meetings with vendors for the medical record collection process

Collects medical records and reports from provider offices, and loads data into the Medical Record application

Performs administrative and office support activities.

Answers and transfers incoming telephone calls.

Receives and directs visitors.

Performs word processing, filing, and email/faxing

Medical Records Collector will work collaboratively in reaching to providers to pursue medical records via phone call, fax, mail, electronic medical record system retrieval and direct onsite pick up, for Medical Record projects.

Under the direction of the national and/or regional lead, the Medical Records Collector supports the annual audit and other Medical Record-like audits by organizing provider outreach, pursuit, collection, and upload of provider medical records into the internal database.

04/18 to BEACON HEALTH OPTIONS

10/18 Clinical Schedule Coordinator (Contracted through Konnect Resources Staffing)

First-line responders at a busy Call Center, providing guidance, support, and information to the community, plan members, providers, or other service agencies

Verifies member eligibility for services through state and county information systems

Enters relevant call notes and information in the Flex-Care program

Coordinate with the team (Utilization Review Clinicians, Care Coordinator II) in accommodating member’s needs

Consistently provides members, providers, and internal staff with exceptional customer service

Provides community-based and other needed resources to members

Processing and doing data entry on member’s profile & information

11/17 to NDS-NEXT DAY SERVICES (NORCO)

04/18 Mail Courier

Delivering a wide variety of items

Following delivery driving routes and time schedules

Pick up mail on businesses and drop them off at the post office, complete log/reports

10/17 to SCAN HEALTH PLAN

11/17 Member Service Advocate, (Contracted through The Judge Group Staffing)

Provide quality for SCAN members and input information and do data entry on member's updates and profiles.

Educates members, family, friends, providers, and caregivers regarding benefits and plan options

Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer

Familiarity with CPT and ICD-10 Coding.

Provides follow-up with customers (providers) by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution.

Escalates appropriate issues to management or other departments as required.

Provides claim status and support for submission of claims.

Consistently meets and/or exceeds the departmental standards, including, but not limited to: quality, productivity, and adherence to schedule and attendance.

Responds appropriately and in a timely fashion to customers (internal staff/providers) by answering telephonic inquiries concerning benefits, eligibility, referrals, claims, and all other issues while following departmental policies and procedures and job aids.

08/13 to ANSAFONE CONTACT CENTERS

10/17 Customer Service Representative

After an hour of answering service, taking inbound calls from different of clients/providers.

Taking incoming messages and calls from different companies.

Inbound call center assisting with health insurance needs for customers.

Contact this candidate