Prior Authorization & Insurance Verification Specialist (Client: SuperCare Health) - IND Consulting | Call Center
(2021-04 - 2026-04)
- Managed Prior Authorizations: Spearheaded end-to-end prior authorization processes for U.S. insurance companies, successfully minimizing claim denials.
- Customer Service Excellence: Handled high-volume inbound patient calls regarding inquiries and medical refills, resolving issues on first contact or routing them efficiently.
- Portal & Platform Expertise: Utilized major medical networks and web engines (Availity, UnitedHealthcare, Astrana, MedPOINT) to submit requests, verify medical necessity, and track utilization status.
- Data Integrity & CRM Management: Navigated DocuFlow to verify demographics and updated the HDMS CRM daily to maintain accurate patient records and insurance approvals.
- Documentation Auditing: Audited medical charts and physician prescriptions to ensure strict validity and compliance before insurance submission.
- Provider & Patient Outreach: Conducted proactive outbound outreach via phone, email, and digital fax to clinics and patients to resolve expired documents and collect updated primary care physician (PCP) info.
Bilingual Customer Service Representative - Onelink (Volaris)
(2020-07 - 2021-04)
- Bilingual Support: Delivered high-quality customer service in English, resolving passenger inquiries, booking issues, and flight changes.
- Issue Resolution: Handled real-time problem-solving under pressure to maintain customer satisfaction and loyalty.
Restaurant Owner & Operator - Comidas y Desayunos Aileen
(2018-02 - 2021-01)
- Business Management: Managed daily operations, supply chain, budgeting, and customer service for an independent food service establishment.
- Inventory & Sales: Controlled food costs, negotiated with local vendors, and implemented marketing strategies to drive revenue.
Production Planner - HFI México
(2014-11 - 2017-07)
- Production Scheduling: Developed and distributed daily production programs using ERP systems (MACOLA) and MRP downloads.
- Performance Tracking: Monitored production lines, recorded delay days, and collaborated with supervisors to ensure shipment priorities and deadlines were met.
- Data Analysis: Generated daily scrap graphs, performed root-cause analyses, and presented operational metrics during unit meetings.
- Logistics & Inventory Control: Managed weekly packaging material inventories, coordinated truck shipment statuses, and processed sales and service orders.
Data Entry & Inventory Analyst - HFI México
(2012-12 - 2014-10)
- Inventory Accuracy: Tracked and audited raw materials and finished goods to ensure stock integrity.
- Database Maintenance: Input precise operational data into company systems to support the logistics team.
Production Operator (Cutting Area) - HFI México
(2012-02 - 2012-11)
- Quality & Execution: Handled materials and operated cutting machinery according to strict manufacturing standards and safety guidelines.
