Customer Service Specialist and Administrator

Raquel Torres

Ph: 559-***-****/Email: **********@****.***

Capable team leader and player who is known to be a self-starter. My aim is to attain a position in a growth-oriented company where I can use my strong organizational and technical skills to contribute to the company's success. I am also seeking a position that will allow me to continue developing my abilities while contributing to the goals of the organization.

Top Skills:

●Customer Service

●Microsoft Office, Word, Excel, Power point

●Communication

●Computers

●Bilingual (English/Spanish) (Verbally/Read/Write)

●Typing (65 wpm)

●Data Entry

●10 Key by touch

Experience:

Innovative Integrated Health (PACE FRESNO)

Guest Service Representative 9/2024 – 9/2025

Ensure the daily activities and administration functions of the front desk are completed in a sensitive, highly visible and dynamic environment, requiring management of multiple and rapidly changing priorities

Proper phone etiquette, greetings of participants and visitors, and monitoring the flow of reception area

Highly collaborative with demonstrated ability to work in a global setting across a variety of cultures and styles

Demonstrate highly professional demeanor; meet the highest standards of integrity

Demonstrate a strong passion for and strong record of delivery high-quality results

Strong communication, process, and project management skills, collaboration and influence management at all levels.

Express information to individuals or groups effectively and accurately

Consider the audience and nature of information (for example, technical, sensitive controversial), always uphold HIPAA regulations.

Make clear and convincing oral presentations

Listen to others, attend to nonverbal cues, and respond appropriately.

Accept assigned duties in a cooperative manner; and perform all other related duties as assigned

Provide sound guidance to management process (including technical) issues

Maintaining knowledge and utilization of the current versions and future software and documentation system

Strong interpersonal skills and ability to build relationships with stakeholders, including staff

Attend and participate in staff meetings, in-services, projects, and committees as assigned

Adhere to

Flexible schedule of hours worked

Provide support to the Authorization department in reviewing medical record charts, visit notes, and entering data accordingly.

Medical Record data entry, chart and visit notes

E-fax authorization and patient medication list to provider’s office when necessary

Innovative Integrated Health (PACE FRESNO)

Community Health Advisor 5/2023 – 9/2024

Support the IIH Business Development department’s recruitment efforts and enrollment assistance for IIH’s PACE program

Participate in community health events, education activities, and PACE-sponsored events, as assigned.

Develop meaningful, relevant relationships with community organizations including but not limited to, senior and cultural centers, churches, doctors’ offices, and/or housing communities.

Engage in mandatory and ongoing training and skill-building activities to effectively achieve intake, enrollment, and program goals.

Provide PACE referral and community health resource information to PACE-eligible seniors, their families/caregivers, and/or community members in designated service area(s).

Conduct preliminary enrollment screening interviews to determine eligibility for PACE program services.

Assist with the set-up of health education and PACE information booths.

Responsible for adding to and reviewing annual Community Outreach and Marketing calendar to ensure readiness and timely preparation.

Track outreach activity in the Enrollment Activity Tracker

Submit promotional material requests and reports utilization figures to the VP of Business Development and the Marketing Manager.

Attend and participate in staff meetings, in-services, projects, and committees as assigned.

Adhere to and support the center’s practices, procedures, and policies including assigned break times and attendance.

Assigned duties in a cooperative manner; and perform all other related duties as assigned.

Kings View Community Services. 8/2017 – 4/2023

DUI Record Specialist I

●Answer phones, schedule appointments, receipts and post payments

●Prepare and print all program rosters (for each counselor)

●Pull chart daily

●Client billing (monthly)

●Create schedules for clients at time of orientation

●Entering incoming referrals into office program

●Process referrals for failing to enroll

●Maintain files for storage

●Process new clients, send letters to either DMV, Court or probation as proof of enrollment, and or if client has been terminated or completed

●Maintain professionalism and work with other staff to ensure timely completion assigned duties.

Good Health Good Jobs for California (SEIU-UHW) 11/2014 – 9/2016

Data Entry Associate

●Compiled and sorted documents before it is entered

●Entered data by alphabetic & numeric information according to the required format

●Compared and verified with source document by reviewing, correcting, deleting, or reentering information to detect duplication

●Maintained and updated files as necessary

●Performed other work as required or assigned

Catholic Charities Diocese of Fresno 09/2013 – 5/2015

Certified Enrollment Counselor, for Covered California

●Screening of children and families eligible for available health coverage programs.

●Scheduling appointments and assisting families with the application process renewals and troubleshooting any enrollment issues through the online CALHEERS/CALWIN app

●Helping link families to primary care physicians within their selected health plans.

●Follow-up calls to families to ensure utilization and maintenance of coverage.

●Assisting families in troubleshooting and navigating health system and related issues.

●Encouraging prevention services and referring families to health-related programs as needed.

●Community outreach efforts to identify uninsured children and create awareness of Catholic Charities Services

●Data entry of client’s information used in office program

●Assisting clients with receiving other services which Catholic Charities offer

McKesson Corporation 01/2012 – 08/2013

CSR/Medical Biller

●Experienced billing for Radiologist

●Ensure claims are entered into and submitted electronically within 48 hours of receipt

●Research and resolve incorrect payments, EOB rejections, and other issues with outstanding accounts

●Send secondary claims upon processing primary insurance

●Monthly processing of patient statements. Answer and resolve billing inquiries from incoming patient daily telephone calls

●Follow up with multiple health insurances to resolve denial and aging of claims. Re-submit claims if necessary or negotiate to re-process claim on file for approval

●Knowledgeable in timely filling restrictions and appeals

●Accepting and assisting patients with payments within the office secure payment protocol

●Data entry patient’s information with office software

●Perform essential clerical tasks like faxing, coping and data entry

●Ensure office practices are following HIPPA regulations

24/7 Urgent Care Clinic 08/2011 – 09/2011

Extern for Medical Billing and Insurance Coder & Front Office

●Coding medical records with ICD-9-CM and CPT-4

●Registered patients by following office protocols

●Organizing and maintaining medical forms

●Verifying medical record and insurance information

●Preparing and maintaining patient's medical charts

●Collecting and postings patient payments

●Data entry patient’s information with office software

●Perform essential clerical tasks like faxing, coping, and data entry

Central California Legal Services 11/2000 - 05/2009

Legal Assistance and Certified Application Assistor

●Telephone advice about health care options and rights; Overcoming barriers to health care.

●Unlawful medical debt collection actions by hospitals, health care providers, and collection agencies; navigate the Health Care System.

●Writing letters or filling grievances; Resolve problems with health care plans.

●Representation with appeal process; Case management.

●Educated families utilize and understand their benefit package.

●Provided individual training to community partner Certified Application Assistor.

●Conduct Educational presentations regarding all State Health Care Programs (Medi-Cal, Healthy Families, Kaiser Child Health Plan, Access for Infant and Mothers, Healthy Kids and Breast Cancer); Provided written material about services and rights available.

●organize a filing system for open and closed cases.

●Create spreadsheets and forms for monthly reporting, utilizing Professional Microsoft Office 2003-2007.

●Other Clerical (answering phones, filling, faxing, coping, etc)

Volunteer:

Have been and present active community volunteer for Catholic Charities

Diocese of Fresno since 2015. Recently volunteering in warehouse, thrift

store, intake, USDA, and Healthy Markets.

Education

UEI College, Fresno, Ca

1/2011 – 9/2011

Medical Billing and Insurance Coder

●Majoring in Medical Billing and Insurance Coding (ICD-9, CPT 4 and HCPCS manually)

●Trained in several aspects of professionalism for front and back medical office

●Mentor for MBIC class and UEI College

●Honor Roll with 3.5 – 4.0 GPA

●Diploma of completion for Medical Billing and Insurance Coder

Reference:

Upon request

Contact this candidate