Cristina Vento
Lake Jackson
Summary
Detail-oriented and highly organized professional with extensive experience in healthcare administration and customer service. Adept at processing care reviews, verifying benefits, and coordinating patient care with precision and efficiency. Strong problem-solving abilities, excellent communication skills, and a track record of ensuring seamless healthcare operations. Bilingual in English and Spanish.
Overview
16
16
years of professional experience
Work History
Case Review Specialist
Molina Healthcare
01.2022 - Current
- Provide telephone, clerical, and data entry support for the Care Review team
- Process authorization requests and inquiries related to benefits, provider contracting, and treatment approvals
- Professionally respond through electronic referral platforms within the specified time requirements.
- Collaborate with physician offices to request and verify missing documentation
- Review and document patient prior authorizations to home health services through electronic referral systems, ensuring compliance with applicable coverage criteria.
- Provide the appropriate information from the electronic system (availity/eportal) to the Care Review Clinican to ensure complete referral information.
Pharmacy Care Coordinator
SSG
03.2021 - 01.2022
- Serve as the first line of customer service for external and internal customers.
- Assist patients with medication delivery scheduling and compliance
- Reported adverse events related to drug therapy
- Maintain accurate patient records in the database
- Meet assigned KPIs to ensure high service standards
- Communicate and follow up with Business Development regarding pending patient assistance programs.
Benefits Verification Specialist
SSG
11.2020 - 01.2021
- Verify patient insurance benefits
- Initiate prior authorization and claims appeals
- Collect and maintain patient information in the system
- Receive and document patient referrals to home health services through electronic referral systems, ensuring compliance with applicable coverage criteria.
- Obtain prior authorization for home health services and skilled nursing/custodial requests.
Program Support Specialist
WorkForce Solutions
12.2019 - 10.2020
- Assist in pre-screening customers for required documentation
- Managed telephone inquiries and data entry into TWIST systems
- Coordinate schedules and meeting deadlines
- Ensured smooth mail processing and office coordination
- Provide technical assistance to staff, government agencies, and the public
- Monitor compliance with laws, regulations, and policies
Customer Service Advocate
UnitedHealthcare
09.2016 - 12.2019
- Assist members with benefits, claims, and provider searches
- Assist members with scheduling appointments
- Process payments and transactions efficiently
- Maintain accurate patient data for effective healthcare management
- Receive and process; expedite stat and at-risk referrals.
Customer Service Representative
Fred Loya Insurance
02.2015 - 10.2015
- Manage policy renewals, quotes, and customer inquiries
- Process transactions and maintain accurate customer records
- Follow up with customers on quotes, renewals, and cancellations
- Involved in marketing initiatives for new business development on an as needed basis
- FNOL’s (vehicle inspections)
- Bank run deposits
Customer Service Representative
Dish Network
09.2011 - 05.2014
- Assist customers with billing inquiries, technical troubleshooting, and account management
- Process payments and recommended appropriate service packages
- Effectively engage with customers, address their needs, and provide assistance in a manner that ensures a positive experience and builds lasting relationships
- Efficiently handle multiple tasks, inquiries, or issues simultaneously without compromising the quality of service
Clerk
San Benito C.I.S.D
06.2009 - 08.2009
- Managed office tasks, answered phone inquiries, and organized records
- Type, format, or edit routine memos or other reports
- Provide general information to staff, clients, or the public
- Schedule appointments and receive customers or visitors.
Education
A.A - Psychology
South Texas College
01.2019
High School Diploma -
San Benito High School
01.2011
Skills
- Healthcare Administration
- Medical Authorizations
- Benefits Verification
- Insurance Coordination
- Patient Support
- Customer Service
- Electronic Medical Records (EMR)
- Data Entry
- Microsoft Office Suite
- Word
- Excel
- Outlook
- Teams
- Bilingual
- Problem-Solving
- Multitasking
- Remote Work
- Home Health Services
- Team Collaboration
Timeline
Case Review Specialist
Molina Healthcare
01.2022 - Current
Pharmacy Care Coordinator
SSG
03.2021 - 01.2022
Benefits Verification Specialist
SSG
11.2020 - 01.2021
Program Support Specialist
WorkForce Solutions
12.2019 - 10.2020
Customer Service Advocate
UnitedHealthcare
09.2016 - 12.2019
Customer Service Representative
Fred Loya Insurance
02.2015 - 10.2015
Customer Service Representative
Dish Network
09.2011 - 05.2014
Clerk
San Benito C.I.S.D
06.2009 - 08.2009
A.A - Psychology
South Texas College
High School Diploma -
San Benito High School
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