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Click here or scroll down to respond to this candidateCandidate's Name
EMAIL AVAILABLEStreet Address
Contact: PHONE NUMBER AVAILABLEProfessional Summary: Highly organized, ambitious, hard-working and dedicated team player with experience excelling in multiple roles. Over 5 years of experience in health care, Insurance Billing and leadership roles in projects, training and 10+ years of exceptional customer service.Objective: To join a growing organization as an Appeal specialist or Administrator with the opportunity to display my ability to perform under pressure, excel in new responsibilities and roles within the organization.Key Skills and Strengths:Bilingual- Spanish (Speak, Read & Write)Outstanding team player with Success in leadershipAbility to convey important information correctly and effectivelyAbility to listen to and convey detailsProven aptitude in problem-solvingOutstanding communication skills ability to convince while maintaining professionalismAll Microsoft ApplicationsData entry, Ramco, Win team Expert, Highmark, beacon, InsinqProfessional Experience:Independence Blue Cross Blue Shield (Philadelphia, Pa) 03/2019-PresentProvider Appeal Specialist & New hire TrainerResearch history relevant to a case; eligibility, benefit plan and circumstances surrounding a denial of services.Communicate with members and providers verbally and in writing according to unit policy and within established timeframes.Document all communication in relevant systems used within the department.Communication, effectively and professionally with internal and external resources to coordinate and investigate information as it relates to the member or provider appeal.Ensure case files documents are filed and secured accordingly to guidelines and submitted timely for Q/A purposes.Organize case files for external review per regulatory guidelines and other duties as assigned.Training new hires on the multiple systems used, policy and procedures, protocols, guideline and the timely sensitivity to each case.Security Resources Inc, Philadelphia, PA 03/2013 03/2019Dispatcher Supervisor (Philadelphia & South NJ)Answered telephone calls to answer questions and provide information during non-business hours.Trained new dispatch hires. Produced detailed daily dispatch logDispatched and scheduled workers to certain locations depending on the requests of the client.Recorded and maintained files on expenses, services, inventory, charges, customer requests and other dispatch information.Document all activity in daily log while making notifications to superiors regarding escalated situations.Multi-task while answering phones, dispatching runs, and working the window to the office.Data entry and scheduling using Ramco System.ESJ Auto Detailing, Philadelphia, PA 06/2012 01/2013ReceptionistGreet and welcome guests in person and on phone; answer high volume calls and direct inquiries to designated department.Calculated bills for services rendered and collected and processed customer payments.Balanced monthly vendor statements and closed monthly sales invoices.Maintain log books, including sign-in/out logs, front desk expenditures, and calls received.Pick up and sort daily incoming correspondence and deliver sorted mail to addressees.References available upon Request |
