Angela Cruz
Phoenix,AZ
Summary
Customer Service with 10+ years of experience responding to all types of customer inquiries for internal and external customers. Familiar with major customer service software, conflict resolution, and possess a positive attitude. Aiming to use my proven skills to effectively fill the role in your company.
Knowledgeable and dedicated customer service professional with extensive experience in [Type] industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.
Capable Patient Representative dedicated to providing superior support for patients in need of reliable information regarding insurance coverage, finance options and documentation requirements. Well-versed in scheduling and database management functions for streamlined communication and reduced correspondence backlogs. Excels at identifying client needs and concerns to improve engagement strategies and overall service.
Overview
8
8
years of professional experience
Work History
Concierge Team
Oscar Health Insurance
09.2021 - Current
- Collaborate with your team of Care Guides, a Concierge Nurse and a dedicated bridge team
- Assist in the coordination of care across a variety of settings (outpatient, ER, home care) while maintaining strict confidentiality and the highest level of professionalism
- Answer questions and resolve issues related to topics such as claims and billing
- Listen to member's comments, concerns, and suggestions, relaying that information internally, while ensuring member satisfaction
- Complete logs for metric on excel, reports forms and records to properly document medical claims
- Reject or accept documentation, determine benefit due, and start the denial or payment process to resolve medical claims
- Identifies and resolves routine and recurring problems
- Involved in fact finding, information search and data gathering
- Enter claim data accurately and timely, in alignment with departmental production and quality goals
- Experience handling Personal Health Information
- Selected as the best of the best for the new project ICHRA
- Career experience on doc triage on sorting important documents to each department and working on hold claims
Senior Customer Representative
United Health Care/ Optum Care
07.2017 - 08.2019
- Answer phones promptly, in a professional tone, and appropriately respond to member inquiries or requests while maintaining performance measures
- Completion of benefits determination notice
- Utilized notification wizard along with basic ICD-9 and CPT coding
- Monitored and maintained appropriate provider and enrollee notifications
- Provided excellent customer service to both providers and enrollees
- Constantly met established productivity, schedule adherence, and quality standards while maintaining good attendance
- Assisted with faxes containing clinical/medical patient history
- Submitted clinical information by fax or over the phone to assigned nurses
- Intake clinicals for Medicare plans
- Professional interaction with customers and business partners both internal and external
- Capacity to retain and utilize information, facts, policies, procedures, resources, and codes to ensure accurate and efficient responses
- Flexibility to support extended hours as determined by business needs to meet customer expectations
- Assist members with form completion, complaint investigations and cross-department warm transfers
- Compliance with HIPPA regulations and Medicare guidelines
- Met or exceed established goals for both the Internal Call Monitoring Audits and surveys
- Accuracy in relaying information concerning benefits according to specified benefit plans design and accurately documents content of the call
- Review the accuracy and completeness of the information requested and ensure that all supporting documents are present
- Receive requests for pre-authorizations and ensure that they are properly and closely monitored
- Consult with supervisor or nurse manager to obtain clearance that treatment regimen is considered a medical necessity
- Look through denials and submit appeals in a bid to them approved by insurance companies
- Interview patients to determine how they can be assisted in receiving authorizations for their medications and procedures
- Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
- Develop and implement prior authorization workflow, policies, and procedures
- Collaborate with other departments to assist in obtaining pre-authorizations in a cross-functional manner
Customer Service Specialist
RemX Specialty Staffing/ McKesson
11.2016 - 04.2017
- Insurance verifications to ensure Medicare patients health care benefits cover required medications
- Provide financial help/ assistance for families with medical needs
- Handling Medicare patients with questions, services, and financial needs is necessary
- Provide patients with care and knowledge
- Responsible for interfacing with customers, company sales, and/or service representatives to handle a variety of functions
- Determine the status of equipment returns, repairs, replacements, sales orders, and delivery schedules
- Manage requests for additional company materials
- Maintains records returns, schedule changes, product enhancements or product pricing
- Served as the point of contact for customer queries and resolution
- Ensures that good customer relations and seamless turnaround in problem resolution are maintained and customer claims, orders, and complaints are resolved fairly, effectively and in accordance with the consumer laws
- Develops organization-wide initiatives to proactively inform and educate customers
- Respond to basic customer inquiries regarding products, pricing, and basic order reports in a timely and professional manner
- Managing customer and product data within the system
- Communicating with cross-functional departments to coordinate customer service
Education
Medical Assistant -
Phoenix College
Phoenix, AZ01.2012
Windows/Internet -
Maricopa Skills Center
01.1997
High School -
North High School
01.1995
Skills
- Communication
- Active Listening
- Transferable
- Advanced Computer Skills in Microsoft Excel and Word
- Time Management
- Good Work Ethic
- Leadership
- Willingness to Learn
- Self-Control
- Management
- Positive Attitude
- Problem-Solving
- Interpersonal
- Empathy
- Customer Service
- Patient Scheduling Software
- Medical Terminology
- Detailed Orientated
- Computer Technology
- Accounting
- Teamwork
- Project Management
- Presentation Skills
- Administrative Skills
Timeline
Concierge Team
Oscar Health Insurance
09.2021 - Current
Senior Customer Representative
United Health Care/ Optum Care
07.2017 - 08.2019
Customer Service Specialist
RemX Specialty Staffing/ McKesson
11.2016 - 04.2017
Windows/Internet -
Maricopa Skills Center
High School -
North High School
Medical Assistant -
Phoenix College
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