Sealeta Bates

Service oriented achiever with excellent interpersonal communication skills. Team worker, who likes to solve problems and is well organized and works independently or with others.

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

Certificate - Business/Office Administration - Los Angeles Valley College

Certificate - Paralegal Studies - L.A. Mission College (2018)