Aida Gaines
El Paso,Texas
Summary
Personable and dedicated Customer Service Representative with extensive experience in the Healthcare industry as well as billing. Solid team player with upbeat, positive attitude and proven skill in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to the company’s success. Articulate, enthusiastic and results-oriented with demonstrated passion for building relationships, cultivating partnerships, and growing businesses. Successful at efficiently handling client inquiries, billing and administrative tasks. Familiar with contracts and other documents affecting billing processes. Prepares professional, polished statements and business correspondence. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
8
8
years of professional experience
Work History
Billing analyst
Spectrum
08.2022 - Current
- Handle customer questions, complaints, and billing inquiries with the highest degree of courtesy and professionalism to resolve customer issues with quick and effective resolutions
- Offer alternative solutions where appropriate with the objective of retaining customers business
- Communicate with multiple customers at the same time using web-based tools and demonstrate proficiency in typing and grammar
- Promote high customer satisfaction by resolving problems with knowledgeable and friendly service
- Communicate in a clear and straightforward manner with customers, company personnel, and all levels of management
- Handle multiple projects and tasks
- Make decisions and solve problems while working under pressure while prioritizing and organizing effectively
- Work independently as well as with others to resolve problems, handle requests or situations.
Customer Service Representative
TriWest Healthcare Alliance
08.2021 - 08.2022
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service
- Fielded providers complaints and queries, fast-tracking them for problem resolution
- Reviewed documentation and accounts to gain a full picture
- Stayed current on HIPAA regulations, benefits claim processing, medical terminology, and other procedures
- Reviewed administrative guidelines whenever questions arose during processing of claims
- Checked documentation for appropriate coding, catching errors and making revisions
- Answered incoming calls and provided the highest level of professionalism and knowledgeable service to every provider
- Met or exceeded call speed, accuracy, and volume benchmarks on a consistent basis
- Documented customer correspondence in Triwest360 to track requests, problems, and solutions
- Handled more than 50 calls per day to assist providers with their claim and authorization inquiries.
Healthcare Representative
United Healthcare
04.2019 - 08.2022
- Review insurance policy to determine coverage as well as prepare insurance claim forms or related documents and review them for completeness
- Transmit claims for payment or further investigation and check to ensure that appropriate changes were made to resolve the customers' or providers' problems
- Converse daily with members and providers by telephone to provide information about the member's coverage, eligibility, bills, and billing procedures
- When needed refer unresolved customer grievances to designated departments for further investigation
- Basic knowledge of Billing and Coding is required
- Daily requirement to protect the security of medical records and member information to ensure that confidentiality is maintained under HIPAA
- Transmit correspondence or medical records by mail, e-mail, or fax and contact customers and/or providers to respond to inquiries or to notify them of claim investigation results or any planned adjustments
- The knowledge and use of de-escalation is an acquired skill obtained by this position when interacting with upset or frustrated members and providers
- Great adaptability with changes
- The fast pace of this position requires the ability to resolve the problem or provide the requested information in a quick and correct way
- Knowledge of operating a telephone switchboard to answer or forward calls to correct departments
- Leadership, teamwork, and quality are qualities I possess that allow a successful performance
- Increased and succeeded company goals
- Accomplishments: Pay raises every merit due to excellent performance and results.
Customer Sales Representative, Team Leader, Supervisor
HGS
11.2016 - 04.2019
- Take and handle escalated calls
- QA calls and give agents coaching's on errors
- Handle Payroll, reports, and scheduling
- Before receiving the team lead position, I was a Lead Operator which includes submitting coverage requests for patient's medications
- I use dual monitors as well as speak with the patients over headset
- I manage a wide variety of customer service and administrative tasks to resolve the patients' issues quickly and efficiently
- Ask open-ended questions to assess the patient's needs
- Investigate and resolve patients' inquiries and complaints in a timely and empathetic manner
- Built long-term customer relationships and advised customers of all the necessary information
- Take and handle escalated calls
- Process faxes requesting additional information for coverage determination request and Denials of Coverage
- Submit production reports using excel.
Education
Associate of Arts in Psychology -
El Paso Community College
El Paso, TX06.2022
High School Diploma -
ANDRESS HIGH SCHOOL
El Paso, TX05.2012
Skills
- Effective oral and written communication
- Team leader for university group organization
- Efficient and very knowledgeable in Microsoft and Excell applications
- Excellent at Multi-tasking, teamwork, and a fast-paced learner
- Ability to work independently in the accomplishment of a wide variety of duties, including setting priorities, and coordinating work
- Ability to successfully operate computerized programs and databases to enter, modify, and retrieve information
- Ability to communicate effectively and professionally with employees at all grade levels
- Train individuals to successfully complete job functions
- 2 years of management experience
- Coaching and training
- Exceptional Critical Thinker
Volunteer Information
- Youth city recreational teams, El Paso, TX, 2010-Current, Coaching competitive cheerleading teams ranging in ages 3-16. Proficiency in leadership, team building, and communication. Choreographing routines, ensuring the safety of all participants during both practice sessions and performances. Ability to foster a positive team environment through motivational coaching strategies and conflict resolution skills. Teaching morals, sportsmanship and helping children develop gross motor skills.
- El Paso State Supported Living Center, El Paso, TX, 1998-2016, Ministered and provided physical, mental, and emotional support to physically and mentally disabled individuals.
References
- Jessica Lopez, Supervisor, 915-231-4341
- Aarin Acosta, Coworker, 915-234-6550
- April Polk, Associate, 915-990-9148
Affiliations
- Gold Rush Xtreme Cheer
Assistant Head Coach
Coaching competitive cheerleading teams ranging in ages 3-16. Proficiency in leadership, team building, and communication. Choreographing routines, ensuring the safety of all participants during both practice sessions and performances. Ability to foster a positive team environment through motivational coaching strategies and conflict resolution skills. Teaching morals, sportsmanship and helping children develop gross motor skills.
Timeline
Billing analyst
Spectrum
08.2022 - Current
Customer Service Representative
TriWest Healthcare Alliance
08.2021 - 08.2022
Healthcare Representative
United Healthcare
04.2019 - 08.2022
Customer Sales Representative, Team Leader, Supervisor
HGS
11.2016 - 04.2019
Associate of Arts in Psychology -
El Paso Community College
High School Diploma -
ANDRESS HIGH SCHOOL