Initiative-taking professional having interest in personal growth and willing to become a member of the growing team. Bilingual English/Spanish) professional with extensive experience in administrative roles supporting medical providers and member services. Proven ability to manage complex issues, provide accurate information, and maintain high standards of quality and productivity. Skilled in managing member and provider inquiries, resolving complaints, and facilitating communication between members and healthcare providers. Proficient in Microsoft Office and various healthcare management systems, with a strong commitment to improving customer satisfaction and operational efficiency.
Skills:
• High diligence with respect to documentation and task management.
• In-depth knowledge and understanding of IDX and availity medi-cal and Medicare
• Ability to work well under pressure with minimal supervision within a large team or individually.
• Typing speed at 40 words per minute • Strong computer and Microsoft Office365 program skills.
• Bilingual, English/Spanish
Experience:
PROSPECT MEDICAL GROUP- CUSTOMER SERVICE REPRESENTATIVE
NOVEMBER 2023-CURRENT,ORANGE,CA
• Answered incoming calls involving multiple issues from members, health plans, and providers.
• Maintain or exceed quality and productivity standards.
• Process member demographic changes and in the resolution of complaints and other service-related issues.
• Assist Providers with eligibility, DOFR, claims and Authorization status
REGAL MEDICAL GROUP - MEMBER SERVICES REPRESENTATIVE
JANUARY 2023 – NOVEMBER 2023, NORTHRIDGE,CA
• Receive incoming calls involving multiple issues from members, health plans, and providers.
• Maintain or exceed quality and productivity standards.
• Research and resolve routine or complex issues related to services provided by gcmg, including eligibility, referral status, provider availability.
• Process member address and phone number changes.
IMPERIAL HEALTH PLAN OF CA - MEMBER SERVICES COORDINATOR
MAY 2020 – SEPTEMBER 2022, PASADENA, CA
• Provide information on LEP fees, policies, processes, benefits, products, and services.
• Actively listen to members Land identify their needs.
• Investigate ...
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