Christina Suarez
Poinciana,FL
Summary
Skilled and dedicated professional of 15 years experienced in health care settings providing premium patient care. Excellent customer service skills, able to assess client & office needs while making timely decision. Organized Operations Lead with background motivating, coaching and overseeing teams by employing excellent interpersonal and multitasking skills. Seasoned expert at establishing and implementing goals and objectives, identifying and managing risks and developing business potential. Strong independent judgment and critical-thinking abilities.
Overview
23
23
years of professional experience
Work History
Operation Lead
WellCare
06.2022 - Current
- Primary Contact for escalated issues in which special care is required
- Mentor to agents giving them real time feedback
- Delegate work assignments and monitor work buckets to ensure proper processing within contractual turnaround times
- Train associates one on one and in group settings to ensure accurate procedures are followed.
- Assist associates by serving as subject matter expert for all intake related issues and questions.
- Respond to member, providers and regulatory agencies inquiries and escalation via phone, written or walk in
- Coaching and guiding agents
- Training are new team members
- Log, tracks, resolve and responds to state regulators and market inquiries
- Assist or coordinate projects and duties
- Lead on Team meetings
- Create Announcements for the team regarding new changes or process updates
- Assigned daily duties to agents
- Keep track of production daily and send every morning to upper management
- Work together with supervisor to ensure Centene policies and procedure.
- Managed and allocated staff and material resources to meet production goals.
- Performed quality control and monitored production efforts.
- Oversaw problem resolution to address barriers to operational efficiency.
- Planned operations and activities, and led projects.
- Coordinated internal assignments, scheduling and communications to extend informational transparency and workforce management.
- Recommended actionable changes, lead provisioning and draft plans to maintain operational status.
- Motivated and trained employees to maximize team productivity.
- Evaluated team member performance and productivity, provided feedback and implemented corrective actions.
- Managed internal operational standards and productivity targets.
- Analyzed department metrics and performance and reported findings to management.
- Compiled training materials for new employees and tracked skill development.
Sr. Intake Escalation Specialist
WellCare, WellCare Health Plans, Inc
02.2018 - 06.2022
- Skilled on all authorization types within our various platform
- Trained in Miscellaneous Triage Bucket, Intake Manager Buckets, Failed Fax Report in
- Emma/Care Central
- Skilled on creating coaching and assist with dispute/overturn requests from all sites
- Provided detail assistance to agents and providers
- Received and completed the BayCare Census
- Created job aid for Failed Fax for Care Central
- Completed various projects to get the authorization done when we went live with several LOB
- Assisted with OT for Claims/Appeals
- Assisted with OT for are department to make sure TAT is on task
- Received thankful responses from providers and other teams, including WellCare award recognition
- Certificate of WellCare Compliance, completed On the Job Training
- Highly trained resolving escalation for Health Help, Evicore
- Assisted resolving issues with UAM, Arizona.
DME/Medical Intake Coordinator
WellCare
06.2014 - 02.2018
- Conducts intake to process Medical and Durable Medical Equipment prior authorizations via fax and occasional phone calls within 2-Hour Turn-around time
- Research CPT/Procedure codes and compare them to the CMS Medicare/Medicaid Fee
- Schedule to ensure accurate approval/denials
- Responsible for training new hires on processing Authorizations for DME
- Worked escalated inquiries from providers looking to receive Authorizations
- Special task as assigned by Management
- Nominated for Core Value Award 2016-Accountability
- Selected as one of the first agents to pilot Work-At-Home in the Intake Department due to high metrics
- Effectively prioritize and organize workloads in a constantly changing environment to meet daily and weekly schedules
- Solely responsible for KY DME 2HR TAT bucket
- Top production on DME Team
- Process authorization for Evicore, work Invalid spread sheet for DVT, DVL and CCN.
Senior Client Care Specialist
ADVOCATE MEDICAL SERVICES
01.2007 - 06.2014
- Effectively prioritize and organize workloads in a constantly changing environment to meet daily and weekly schedules
- Direct contact with customers, responsible for organizing and renewing medical orders
- Prioritize and escalate projects to technical support
- Responsible to verify various types of insurance including Medicare, Medicaid, and private insurance
- Prioritize and escalate projects to technical support and administration
- Handle overflow of customer service and technical support calls
- Allocate Prescription orders
- Receive and process customer orders by phone, fax and e-mail
- Process accounting functions including account payable and receivable.
Quality Auditor
Proper International Incorporated, Cabo Rojo
01.2001 - 01.2006
- Supervised staff on production line
- Diligently generated reports for all U.S
- And foreign business operations
- Managed quality control for internal audit and consulting related risk management projects
- TECHNICAL EXPERIENCE
- Quick self-taught learner with varying experience in the following software:
- MS Excel
- Medisoft
- MS PowerPoint
- MS Access
- MS Project
- MS Outlook
- Lotus Notes
- Portico
- SharePoint
- MS Office
- Amysis
- Cenpas
- Omni-Page
- Central Point
- MicroStrategy
Education
Medical Billing Mayaguez -
Colegio Univer Del Este Leonidas Morales Rodriguez
Puerto Rico2004
High School Diploma -
Leonides Morales Rodriguez
Lajas, Puerto Rico1994
Skills
- Team player with positive
- Attitude
- Strong organizational skills
- Exercises good judgment
- Self-motivate
- Time management
- Active listening skills
- Analytical reasoning
- File insurance forms
- Electronic Medical Record
- Software
- Customer service-oriented
- Invoice processing
- Account reconciliations
- Insurance eligibility verifications
- Customer Needs Acknowledgement
- People Management Proficiency
- Employee Engagement
- Lead Generation
- Corrective Actions
- Operational Standards
- Team Meetings
- Microsoft PowerPoint
- Professional Relationships
- Performance Monitoring and Evaluation
- Improve Performance
- Policy Development and Enforcement
Languages
English
Full Professional
Spanish
Full Professional
Timeline
Operation Lead
WellCare
06.2022 - Current
Sr. Intake Escalation Specialist
WellCare, WellCare Health Plans, Inc
02.2018 - 06.2022
DME/Medical Intake Coordinator
WellCare
06.2014 - 02.2018
Senior Client Care Specialist
ADVOCATE MEDICAL SERVICES
01.2007 - 06.2014
Quality Auditor
Proper International Incorporated, Cabo Rojo
01.2001 - 01.2006
Medical Billing Mayaguez -
Colegio Univer Del Este Leonidas Morales Rodriguez
High School Diploma -
Leonides Morales Rodriguez
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