Senior Customer Service Representative - CONIFER HEALTH SOLUTIONS - Encino, CA
(2021-06 - 2025-02)
- Answering incoming phone calls via ACD phone system
- Retrieve Voice Mails
- Provide eligibility, benefits, claim, and referral status depending on the queue on which they served.
- Assist in resolving issues for providers as they relate to claims, authorization, and eligibility inquiries.
- Appointments Verifier
- Handled billing and claim issues/ Familiar with HCPC codes/ICD 10 codes/diagnosis codes
- Handled and answered questions for HMO/Medicare and Medi-Cal members.
- Medical terminology
Patient Communication Representative - UCLA NEUROSURGERY DEPARTMENT - Agoura Hills, CA
(2018-06 - 2021-06)
- Assist in Initial Registrations for existing and new patients to see Neurosurgeons and Neurologists.
- Intake Coordinator
- Verify Insurance benefits for HMO, PPO, EPO, Medi-and Medicare patients.
- Send internal messages to Neurosurgeons and Neurology offices.
- Make appointments for new and existence patients.
- Verify diagnosis codes before making an appointment for new patients.
- Knowledge CPT, HCPCS, and ICD 10 codes/diagnosis codes
- Medical terminology
- EPIC CareConnect/ EZCAP, Outlook
Patient Communication Representative - UCLA / PCC-MEDGRP-EIMG CALL CENTER - Agoura Hills, CA
(2015-09 - 2018-06)
- Heavy inbound patients, providers, and pharmacy calls
- Light outgoing
- Problem Solving with Primary Care Physicians
- Schedule appointments for patients to see Primary Care Physicians, Specialists. and nurses/pharmacists
- Schedule patients for pre-op / post-ops, physicals, and hospital care
- Handle and book appointments for forty plus medical doctors through 5 medical groups.
- Medical terminology
- EPIC CareConnect/ EZCAP, Outlook
- Handle insurances for the entertainment industry such as /Screen Actors Guild/ Motion Pictures Network, Directors Guild, Writers Guild / and Producers Guild
- Handled Patient complaints.
- Responsible for checking patient's enrollments, Eligibility, and benefits.
- Knowledge CPT, HCPCS, and ICD 9 codes/diagnosis codes.
- EPIC/Care connect / Common Eligibility/Cerecons/Availability/ Greenway experience.
- Senior Age Well Program Assist with making doctors' appointments and ordering patients' medication.
- Core Training
Administration Analyst Assistant per Diem - UCLA / MPTF FPG-EIMG - Woodland Hills, CA
(2015-05 - 2015-07)
- Heavy inbound patients, providers, and pharmacy calls
- Light outgoing calls
- Problem Solving Primary Care Physicians
- Heavy Interaction with Primary Care
- Schedule appointments for patients to see Primary Care Physicians, Specialists. and nurses
- Schedule patients for pre-op / post-ops, physicals, and hospital care
- Handle and book appointments for forty plus medical doctors through 5 medical groups
- Assist motion picture Guilds.
- Handle insurances for the entertainment industry/Aftra/Cigna, Motion Pictures Network, Directors Guild, Writers Guild / plus commercial insurance
- Handled Patient complaints.
- Responsible for checking patient's enrollments, Eligibility, and benefits/Claims.
- Knowledge CPT, HCPCS, EZCAP, Outlook, and ICD9 codes
- EPIC/Care connect / Common Eligibility/Cerecons/Availability/experience.
- Medical terminology
Case Compliance Representative - KELLY TEMP SERVICES/WELLPOINT, INC. - Woodland Hills, CA 91367
(2014-10 - 2015-03)
Current experience in CMS, HICS ISG, MAINFRAME, WEM/ISG systems and Client Console System for the Affordable Healthcare Act Programs.
- Responsible for checking eligible, health, and dental benefits through the healthcare reform act in eight states through Obama Care.
- Handled consumers complaints,
- Checked enrollments and updated enrollment applications.
- Temporary contract through Kelly Services Temp agency.
- Medical terminology
Prior Authorization Coordinator/Appeals & Grievances - REGAL MEDICAL GROUP - Northridge, CA 91325
(2013-09 - 2014-06)
- Heavy Incoming/Outgoing calls.
- Handle Referral Authorizations.
- Check eligibility/benefits/Claims Processing/knowledge (CPT, HCPCS, ICD9, DRG)
- Close contact with inpatient and outpatient nurses.
- EZ-CAP experience
- Medical terminology
Vital Care/ Coordinator/Medical Management Department - REGAL MEDICAL GROUP - Simi Valley, CA 93063
(2010-07 - 2013-09)
- Heavy incoming/outgoing calls
- Handle authorization / referrals for senior and commercial patients
- Fax authorizations and denial referrals to hospitals, patients, and facilities
- Check Eligibility
- Work close with Medical Director.
- Scheduled appointments for patients to come in for yearly physical exam.
- Close contact with PCP's and Specialists
- EZ-CAP experience
- Medical terminology
Customer Service Team Lead/ Utilization Management Coordinator - REGAL MEDICAL GROUP - Northridge, CA 91324
(2004-05 - 2010-07)
Handled Incoming/Outgoing Inquiries for Job Duties Listed Below:
- Heavy ACD QUE.
- Handle Authorization/Referrals/Update Referrals/Provider Changes
- Close Contact/Medical Director
- Check Eligibility
- Customer Service Training for new hires
- Work special projects.
- Assist Members & providers with claim issues.
- Appeals and grievances.
- EZ-CAP experience
- Heavy Incoming/Outgoing calls.
- Handle Referral Authorizations.
- Close contact with medical directors, QM reps and UM reps.
- Close contact with inpatient and outpatient nurses.
- EZ Cap Experience Processing Claims.
- Medical terminology
Appeals and Grievance Coordinator - KELLY TEMP SERVICES/WELLPOINT, INC. - Woodland Hills, CA 91367
(2003-06 - 2004-05)
- Close contact with medical directors, QM reps and UM reps.
- Fax Authorizations and denial Referrals to members/provider.
- Check eligibility.
- Close contact with inpatient and outpatient nurses.
- Handled and filed/researched complaints/grievances/appeals.
- Interaction with IPA's/hospitals/members
- Medical terminology
