Claudia Ramirez
El Paso
Summary
Congenial and enthusiastic contributor and supporter of team goals Knowledge of medical office practices and procedures Strong attention to detail, task oriented with excellent problem solving skills Excellent analytical, organizational and communication skills Proven ability to prioritize and handle multiple tasks in a challenging environment Excellent customer service skills: communication, empathy, & patience
Overview
15
15
years of professional experience
Work History
Prior Authorizations Coordinator
Advanced Home Healthcare
EL Paso
07.2024 - Current
- Responsible for all aspects of the prior authorization process
- Responsibilities include collecting all the necessary documentation, contacting the client for additional information and completion of the required prior authorization in order to proceed with testing
- Complete, timely, and accurate identification and submission of prior and retro authorization requests to the payors
- Interacts with clients, insurance companies, patients, and sales representatives, as necessary, to request for prior authorizations
- Responsible for documenting account activity, updating patient and claim information
- Collaborated with providers to obtain missing information required for authorization submissions.
- Answered telephones and directed calls to appropriate medical or adminstrative staff.
- Coordinated resolutions for issues and appealed denied authorizations.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Collaborated with insurance companies to clarify coverage details and resolve issues related to prior authorization.
- Followed up on pending prior authorization requests to ensure timely processing.
- Ensured compliance with HIPAA regulations by properly handling confidential patient information.
- Coordinated the intake process, ensuring all required documentation was collected and processed.
- Performed data entry tasks such as entering demographic information into computer system accurately.
Lead Customer Service Representative
Unifirst
El Paso
07.2019 - 06.2024
- Handle telephone inquiries and taking orders over the phone
- Data entry
- Provide inside support to sales representatives
- Help resolve any customer issues regarding their account
- Process credits and exchanges
- Collection of Accounts Receivables
- Receive 'walk-in' customers, i.e
- Show samples, measure, take orders
- Presented existing and prospective customers with valuable service or product information to aid in decision-making.
- Developed customer service policies, procedures and standards.
- Collected deposits or payments and arranged for billing.
- Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
- Answered customers' questions and addressed complaints in-person or by phone to immediately rectify issues.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
Customer Service
Capgemini
El Paso
09.2018 - 04.2019
- Company Overview: General Electric’s Life Sciences Customer Service
- Handle calls on a daily basis, with duties including creation of service calls, complaints, questions regarding service, warranty dates, contract dates
- Handle 20+ emails daily, with duties including service request, complaints, questions regarding service, warranty dates, contract dates, attachment of payment methods
- Received an average of 90% customer satisfaction rating
- Monthly testing of knowledge regarding process, received 100% on knowledge tests
- General Electric’s Life Sciences Customer Service
Mailroom Processor
Capgemini
El Paso
09.2016 - 09.2018
- Accurately match backup paperwork generated invoices
- Use generated reports to classify mail out and file invoices
- Sort and consolidate debtor paperwork into stacks of single invoices and multiple invoices
- Scan paperwork into the corresponding system
- Fold and stuff invoices into envelopes, label envelopes, and mail out the invoices
- Monitor and use mail room equipment to facilitate the billing process
- Ensure that all mail is delivered to the proper recipient
Data Entry
Capgemini
El Paso
03.2016 - 09.2016
- Insert customer and account data by inputting text based and numerical information from source documents within time limits
- Keep information confidential
- Review data for deficiencies or errors, correct any incompatibilities if possible and check output
Extern
P M & R Associates of El Paso
El Paso
07.2015 - 09.2015
- Answered phones
- Verified multiple insurances (Medicare, Medicaid, Blue Cross Blue Shield, AETNA, TriCare)
- Schedule appointments
- File patient information
- Call in referrals
- Ya-9 coding for various conditions
Cashier
Wal-Mart
El Paso
10.2013 - 04.2014
- High volume retail facility
- Took cash and card payments
- Assisted customers with purchases
Crew Trainer
McDonalds
El Paso
02.2013 - 10.2013
- Worked closely with a team in a high volume food service environment
- Adhered to strict company policies and procedures
- Trained new hires
- Took cash and card payments
- Inventory stock and materials
Crew Member
Castro Enterprises (McDonalds)
El Paso
07.2010 - 12.2012
- Cash and card payments
- Inventories stock and materials
- Took customer orders
Education
Medical Office Specialist -
Kaplan College
El Paso, TX01.2015
Basics -
University of Texas El Paso
EL Paso, TX01.2012
High School Equivalency -
Colegio de Bachilleres Del Estado De Chihuahua
Ciudad Juarez, Chih., MXSkills
- Windows 10
- Windows 8
- Windows XP
- Mac
- Excel
- PowerPoint
- Word
- Avid
- DAQbilling
- IMed
- Medcin
- Insurance verification
- Data entry
- Customer service
- Problem resolution
- Attention to detail
- Time management
- Critical thinking
- Effective communication skills
- Typing speed
- Professionalism
- Organization and time management
- Team leadership
- Problem solving
- Sales support
- MS office suite
- Inventory control
- Adaptability
- Time management abilities
- Teamwork
- Phone and email etiquette
Additional Information
Fluent in Spanish and English, Types 40 WPM and excellent 10 key calculator skills, HIPAA & CPR Certified, Yellow Belt in Six Sigma
Training
Extern, P M & R Associates of El Paso, El Paso, TX, 07/15 - 09/15, Answered phones., Verified multiple insurances (Medicare, Medicaid, Blue Cross Blue Shield, AETNA, TriCare)., Schedule appointments., File patient information., Call in referrals., ya-9 coding for various conditions.
Timeline
Prior Authorizations Coordinator
Advanced Home Healthcare
07.2024 - Current
Lead Customer Service Representative
Unifirst
07.2019 - 06.2024
Customer Service
Capgemini
09.2018 - 04.2019
Mailroom Processor
Capgemini
09.2016 - 09.2018
Data Entry
Capgemini
03.2016 - 09.2016
Extern
P M & R Associates of El Paso
07.2015 - 09.2015
Cashier
Wal-Mart
10.2013 - 04.2014
Crew Trainer
McDonalds
02.2013 - 10.2013
Crew Member
Castro Enterprises (McDonalds)
07.2010 - 12.2012
Medical Office Specialist -
Kaplan College
Basics -
University of Texas El Paso
High School Equivalency -
Colegio de Bachilleres Del Estado De Chihuahua