Maria Rodriguez
Winter Park,FL
Summary
Goal-oriented and highly motivated professional dedicated to achieving excellence while maintaining client confidentiality and delivering exceptional customer service. Expertise in issue analysis and resolution, complemented by outstanding communication skills and a strong educational background. Proficient in QuickBooks with a typing speed of 55 words per minute, fluent in Spanish and English, and well-versed in medical terminology. Experienced in navigating Marketplace, Medicaid, and Medicare systems, including conducting appeals and grievance reviews, with a willingness to explore relocation opportunities.
Overview
14
14
years of professional experience
Work History
Lead Patient Advocate
AdventHealth MedicalGroup
Altamonte Springs, FL
01.2025 - Current
- Handled incoming phone calls, addressing inquiries and directing patients to appropriate resources.
- Maintained organized filing systems for medical records, ensuring compliance with privacy regulations.
- Assisted in training new reception staff on office procedures and software usage.
- Streamlined check-in/check-out procedures to enhance patient flow and reduce wait times.
- Collaborated with medical staff to ensure seamless communication regarding patient care needs.
- Improved patient satisfaction by efficiently managing front desk operations and addressing inquiries professionally.
- Increased office productivity by multitasking efficiently during peak hours, handling multiple responsibilities simultaneously.
- Collaborated with medical staff to ensure seamless communication and coordination of patient care.
- Maintained patient databases and updated information in alignment with HIPAA protocols.
Customer Relations Representative
Graham Field Health Inc
Griffin, GA
08.2023 - 11.2024
- Provided excellent customer care by responding to inquiries about product functionality, pricing, and availability.
- Developed rapport with customers by maintaining clear communication lines, fostering trust, and demonstrating empathy.
- Managed customer orders, including delivery scheduling and coordination.
- Strengthened customer relationships by listening to customer concerns and giving priority to service requirements.
- Entered EDI orders.
- Worked with ERP system.
Medical Program Specialist
CoPilot Provider Support Services
Orlando, FL
08.2022 - 08.2023
- Researches and obtains information regarding patient's insurance coverage and benefits request investigations submitted by MD (medical doctors) office.
- Contacts insurance companies to obtain info on patient's medical benefits.
- Obtains each case’s medical benefits for procedure/diagnosis codes for requested or prescribed medication or treatment.
- Handle benefits request investigations submitted by MD offices.
- Bilingual Provider
Molina Healthcare
08.2018 - 06.2022
- Researches and articulately communicates information's regarding member eligibility, benefits, EP services, claims status, Authorization inquiries to callers while maintaining confidentiality
- Actively listens and probes callers in a professionally and timely manner to determine purpose of the calls
- Resolves customer administrative concerns as the first line of contact- this may include claim resolutions and other expressions of dissatisfaction
- Assists in the mentoring and training of new staff
- Assumes full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions
- Educates providers on how to submit claims and when/where to submit a treatment plan
- Identifies and responds to Crisis calls and continues assistance with the clinician until the call has
- Been resolved
- Informs providers and members on Magellan's appeals process
- Perform necessarily follow up tasks to ensure member or provider needs are completely met
- Provides information regarding In-network and Out of network
- Thoroughly documents customers comments/information and forwards required information to the appropriate department.
Spanish Operator / Customer Service
Stratus Video Interpreters
05.2012 - 06.2018
- Answer Inbound and Outbound calls route outside calls to all the departments
- Place, outsource, transfer and connect conference calls
- Send invoices to appropriate Insurance Companies
- Look up referrals and assist in data entry
- Provide information, document interactions, schedule appointments
- Delivery message to patients regarding appointment schedules, cancellations and rescheduling appointments.
Education
Associate of Applied Science - Medical
Florida Technical College
Orlando, FL07-2012
High School Diploma -
Carl Schurz High School
Chicago, IL06-2008
Skills
- Capable of typing 55 wpm
- Detail-oriented
- Customer retention
- Attentiveness in verbal and written communication
- Customer Service
- CRM software
- Proficient in medical terminology
- Medical coding
- Bilingual Spanish
- Proficient in QuickBooks
- Medical office experience
- Insurance verification
- Team leader and Team player
- Proficient in Microsoft word, excel, and outlook
- ICD-10
- Care plans
- Healthcare
- Problem-solving
- Customer service
- Friendly and outgoing
Languages
Spanish
Native or Bilingual
Timeline
Lead Patient Advocate
AdventHealth MedicalGroup
01.2025 - Current
Customer Relations Representative
Graham Field Health Inc
08.2023 - 11.2024
Medical Program Specialist
CoPilot Provider Support Services
08.2022 - 08.2023
Molina Healthcare
08.2018 - 06.2022
Spanish Operator / Customer Service
Stratus Video Interpreters
05.2012 - 06.2018
High School Diploma -
Carl Schurz High School
Associate of Applied Science - Medical
Florida Technical College