Experienced Customer service driver
Resume:
Ashika Lopez
Fairfield CA 94533
SUMMARY
Experienced Call Center Representative adept at providing efficient service to customers. Proven ability to manage a high volume of inbound and outbound calls, utilizing effective communication and problem-solving skills to address customer inquiries and resolve issues effectively.
EXPERIENCE
Customer Service Coloarado Medicaid Provider Services 02/01/2025- Present
Optum/United Healthcare Colorado Medicaid Program
Answer inbound calls from Colorado Medicaid providers
Assist with inquiries related to:
oClaim status
oMember eligibility
oPrior authorizations
oProvider enrollment
Follow HIPAA and contractual compliance guidelines
Accurately document call information and outcomes
Meet daily expectations for schedule adherence and attendance
Medicare Prior Authorization Pharmacy Clerk 09/2023 – 12/31/2024
Elevance Health Carelon Rx (Las Vegas, NV)
Assist Members, Groups, and Facilities with obtaining Prior Authorization from the Insurance company for Medication, IV and Infused Medication according to CMS rules and regulations:
Educate patients on their conditions and prescribed medications.
Continually update a leadership resume and hone skills by participating in various management trainings. Work with departments across the company, including marketing and project management, in developing innovative ideas, initiatives, products, and services.
Prior Authorization Representative 05/2022 – 09/2023
RDI Connect/Optum Specialty Pharmacy (Henderson, NV)
Answered calls from physician offices, hospitals, and patients using exemplary customer service skills.
Accurately enter the required information (non-clinical and structured clinical data) into a computer database.
Reviewed structured clinical data matching it against specified medical terms and diagnoses or procedure codes (without the need for interpretation) and followed established procedures for authorizing requests or referring requests for further review.
Referred callers to benefit departments of the correct claims administrator when requesting benefit information.
Maintained patient confidentiality as defined by state, federal, and company regulations.
Established effective rapport with other employees, professional support service staff, customers, clients, patients, families, and physicians.
Actively supported departmental and corporate strategic plans and ensured successful implementation.
Utilized hospital systems to monitor and report on individual patient care, including lab results, allergies, and vital signs.
Maintained a clean and safe work environment, resulting in a 30% reduction in complaints filed with management and a 15% increase in crew satisfaction.
Support Center Specialist 09/2021 – 04/2022
Robert Half Recruiters and Employment Agency (Phoenix, AZ)
Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
Adhered to company policies and scripts to consistently achieve call-time and quality standards.
Educated customers on company systems, form completion, and access to services.
Created and maintained an inpatient care log that noted patient medical history, medications, and diagnoses.
Organized approximately 10 volunteer events that raised $15k in donations.
UHC Group Services Representative- Case Installment 08/2016 – 09/2021
Total Med Staffing Solutions (Las Vegas, NV)
Provided new employees with an explanation of benefits and instructed them on enrolment and fulfillment procedures.
Administrated COBRA, LOAs, FMLA usage, and other issues as required by our in-house regulations and legal requirements.
Assisted employees with enrolling in medical, dental, and vision insurance plans. Informed employees of changes to the benefit structure
Resolved employee issues with insurance providers and other benefit administrators. Consulted with employees about eligibility and other issues.
Provided on-going support for benefits and HR teams. Processed enrolments quickly and accurately.
Cooperated with other HR professionals when required.
Utilized hospital systems to monitor and report on individual patient care, including lab results, allergies, and vital signs.
Created and maintained an inpatient care log that noted patient medical history, medications, and diagnoses.
Recruited over 25 paid staff members to assist with event management and implementation of a volunteer retention bonus program.
SKILLS
Medical Coding, Medical billing, Revenue management, Medical records, Medical terminology, EMR systems, EHR systems, HEDIS, HIPAA, Citrix, Customer service, Data entry, Insurance verification, Medical coding, Analysis skills, ICD-10, CPT coding, Microsoft Excel, Accounting, Communication skills, Medical collection, Microsoft Office, Medicare, ICD-9, Anatomy knowledge, HCPCS, ICD coding, Epic, Management, Organizational skills, Clinic, Computer skills, Typing, Succession planning, Computer literacy, English, Teaching, Microsoft Outlook, Contracts, Basic math, Phone etiquette, Microsoft Word, Medical administrative support, Leadership, Office experience, Front desk, Medical receptionist, Sales, Medical office experience, Records management, ERP systems, Accounts receivable, Quality assurance, Documentation review, Guest services, Schedule management, Clerical experience, PTSD Care, DRG, Windows, Adobe Acrobat, Revenue cycle management, Pediatrics
EDUCATION
DeVry University
Certificate- Medical Billing/Coding
West Contra Costa Adult Education – DeJean
GED
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