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Click here or scroll down to respond to this candidateCandidate's Name
San Antonio, TX Street Address
EMAIL AVAILABLEPHONE NUMBER AVAILABLEExcellent research, time management and problem solving skills Seasoned customer service specialist with experience working with various customer issuesAbility to handle multiple task and work under pressure Experience in leadership positionsFast learner with a passion to work as a team to achieve a common goal Proficient in Microsoft Office suite, UltiProExperience with various office/call center equipment Authorized to work in the US for any employerWork ExperienceMembership Growth ConsultantChenMed - San Antonio, TXSeptember 2023 to November 2023 Nurtures, builds and cultivates direct-to-seniors and business-to-business partnerships to generate new patient opportunities year-round. Meets with individual seniors and groups in their homes, workplaces, houses of worship, senior centers or living communities to share the ChenMed value proposition. Plans, coordinates and executes local events within the community (e.g., information tables, health fairs, doc talks, etc.) to help reach our ideal patients (i.e., medically underserved, Medicare-eligible seniors, age 55 and older). Cultivates strong relationships with health plan agents, individual insurance agents, social workers, case workers, senior housing managers, senior centers and related community providers to keep ChenMed/JenCare Medical Centers as their top provider choice for senior healthcare when referring patients to a primary care physician. Partners with community officials, businesses and senior outreach programs to develop initiatives that will appropriately drive new patient growth. Schedules one-on-one sales meetings, referral relationships with Plan agents, independent brokers and the senior community to delivers solutions on immediate customer requests. Manages vendors as related to event planning and negotiating contracts with venues where events are taking place. Ensures insurance agents and/or brokers are invited to community events to ensure timely patient assignment to ChenMed/JenCare Medical Centers. Leverages marketing and sales tools to identify solutions and sell to new customers. Maintains up-to- date client information in designated customer relationship management (CRM) tool (i.e., SalesForce). Utilizes CRM tool to document interactions with clients and ensures effective management of leads. Provides monthly activity calendar reflecting community access points and new tabletop venues. Creates penetration plans and initiatives in key target markets and channels. Recovers dormant customers via sales tools and marketing campaigns. Drives new member growth by appropriately educating potential patients on our value proposition and healthcare model. Delivers prescribed presentation in front of large audiences. Develops all distribution channels to support new patient enrollment growth. Uses all sales tools provided to ensure efficiency and collection of pertinent data. Partners with sales leadership to improve effectiveness of engagements with distributors, vendors and community partners. Builds trusting relationships with brokers/insurance agents/case workers/third party vendors associated with seniors. Develops and executes specific broker and partner strategies and plans. Engages with new patients through and beyond their first appointment. Maintains relationships with enrolled patients to positively impact retention. Helps address and resolve customer complaints and issues. Performs other related duties as assigned.Client Service Coordinator /recruiterPediatric Healthcare Connection/ AQTS / Care Options for Kids - San Antonio, TX December 2021 to September 2023 Maintains a current awareness of the abilities and limitations of each field/external staff member. Demonstrates good managerial judgment. Consistently communicate with direct care staff members to provide exceptional customer service. Demonstrates a thorough knowledge and adherence to the policies and procedures of PHC, holds nurses accountable for carrying out all non-clinical policies and procedures as outlined in the Policy and Procedure manual. Maintains an active involvement in issues of cost containment; effectively utilizes nurses when assigning cases. Demonstrates an ability to identify and solve problems; uses initiative and good judgment to reach quality decisions. Demonstrates an active and positive role in evaluating staff performance; participates with the Account Manager and Clinical Supervisor in performance management of the nursing staff Demonstrates an ability to communicate effectively and express ideas clearly and actively listens. Maintains an excellent rapport with clients and caregivers, and effectively promotes harmonious interpersonal relationships. Provides leadership through planning, organizing, coordinating, continually monitoring and thoroughly evaluating the services given to clients associated with PHC. Assist in provision of orientation for new staff members. Coordination and timely distribution of monthly scheduling. Design and implement overall recruiting strategy Develop and update job descriptions and job specifications Perform job and task analysis to document job requirements and objectives Prepare recruitment materials and post jobs to appropriate job board/newspapers/colleges etc Source and recruit candidates by using databases, social media etc Screen candidates resumes and job applications Conduct interviews using various reliable recruiting and selection tools/methods to filter candidates within schedule Assess applicants relevant knowledge, skills, soft skills, experience and aptitudes Onboard new employees in order to become fully integrated Monitor and apply HR recruiting best practices Provide analytical and well documented recruiting reports to the rest of the team Act as a point of contact and build influential candidate relationships during the selection process Promote companys reputation as best place to work Clinical Review TechnicianPrime Therapeutics - San Antonio, TXOctober 2020 to December 2021Process prescription exceptions which may include: resolving claim rejects and member and physician outreach. Enter member demographics and prescription information into the data processing system. Research and resolve rejected insurance billing issues and/or escalated member issues. Escalate questions regarding prescription to a Pharmacist for interpretation or provide direction on processing. Assist with inbound and/or outbound patient or physician calls. Insurance verificationMedicareMedical terminologyCustomer Call Center Representative IIQTCMay 2019 to September 2019 Provides clients with customer service by determining call requirements, responding to inquiries, resolving customer issues and fulfilling customer requests Triages customer needs to include verification of demographics, and mileage check inquires Assisted veterans with rescheduling their medical appointments, verify their medical claim status Promotes electronic communication services by recognizing opportunities to utilize advanced case management technology Accurately documents all call information in case management system according to standard operating procedures Efficiently utilizes tools and available resources such as: ECW, UCM, and examinee portal Customer Engagement Team Lead/ WorkforceCarenetJanuary 2018 to March 2019 Provide exceptional service via telephone by ensuring customer satisfaction with providing quality service, identifying customer needs and assisting them with Health and Insurance issues/concerns. Utilize scheduling software and Ulti Pro to determine the proper shift coverage to accommodate changes in call volume/service. Monitor real-time adherence and call statistics and communicate with supervisor to ensure on-phone and off-phone activity is managed efficiently throughout the day Monitor/track sick calls, tardiness etc., entering real-time exceptions into eWorkforce Management(absence, tardiness, meetings, overtime, etc.)DFAC Work LeaderLackland Air Force BaseApril 2017 to August 2017 Lead will work closely with the Air Force Force Support Squadron on Food Service programs and functions. The DFAC Shift Lead shall be responsible for the performance of the work of the personnel within the Dining Facility relating to the daily operation of this contract. The DFAC Shift Lead shall oversee the contracted operations within the Dining Facility and shall be able to effectively communicate and use technical manuals and references. September 2014- February 2017 CVS HealthPrior Authorization/ Customer Service Review orders for payment issues and updating the systems with accurate information, and complete mail order prescriptions. Ability to research and investigate orders using Peoplesafe and LINKS. Effectively manage work volume by handling inbound calls/fax requests utilizing appropriate courteous and professional behavior based upon established standards Provide professional over the phone assistance with prior authorization forms, Insurance verification, and Explanation of benefits.Prior Authorization RepresentativeCVS Health - San Antonio, TXSeptember 2014 to February 2017Provide professional over the phone assistance to customers completing prior authorization forms, insurance verification and explanation of benefits Review orders for payment issues and update system with accurate information Complete mail order prescription requestHandle inbound calls/fax request using established standards Phone BankerWells FargoMarch 2013 to August 2014 Customer service focus with experience handling complex transactions across multiple systems Experience working with others on a team to meet customer needs and follow policies and Procedures. Ability to identify potential fraud/risky accounts and take appropriate action to prevent loss Relevant military experience including working with military protocol and instructions, enlisted evaluations, officer/leadership reportingEducationWarren High SchoolAugust 2008 to June 2012Skills Excellent with research, time management and problem solving skills. Seasoned customer service specialist with a background in providing advice on diverse customer situations. Excellent at balancing multiple task and working under pressure, I also have great leadership attributes as I'm a fast learner and enjoy helping others on any topic to achieve a common goal. Computer proficient in; Microsoft Word, Excel, Publisher, Outlook, Power Point, and Ulti Pro. Ability to operate scanner, copier, and multi-line phones. Insurance Verification Medical Scheduling Medical Billing HIPAA Medical Records Triage Hospitality ICD-10 Medical Terminology Time management Customer service Management Human Resources HR Sourcing Performance Management Employee Orientation EMR Systems Medical Office Experience ICD-9 Interviewing Recruiting Talent acquisition Marketing Customer relationship management Human resources Customer service Salesforce Healthcare management HIPAA Pediatrics Medical terminology ICD-10 Sourcing Negotiation Medical records HR sourcing Microsoft Access ATS Training & development Relationship management Communication skills Sales Teaching Cash handling Leadership Long term care Geriatrics Microsoft Office Analysis skills Team managementCertifications and LicensesDriver's License |
