CRYSTAL MEDINA
Summary
Reliable individual bringing 6 years of experience in healthcare environments. Maintains positive relationships with members and providers. Remains polished and calm under extreme stress.
Overview
11
11
years of professional experience
Work History
Utilization Management Representative
Anthem, Inc
11.2017 - Current
- Submitted cases for prior authorization review of services requiring notification.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Tracked referral submission during facilitation of prior authorization issuance.
- Input all patient data regarding claims and prior authorizations into system accurately.
Cashier/Customer Service
K-Mart Retails
05.2019 - 11.2020
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Self-motivated, with a strong sense of personal responsibility.
- Proven ability to learn quickly and adapt to new situations.
- Excellent communication skills, both verbal and written.
- Handled customer inquiries and suggestions courteously and professionally.
- Greeted customers and helped with product questions, selections, and purchases.
- Maintained clean sales floor and straightened and faced merchandise.
- Stocked merchandise, clearly labeling items, and arranging according to size or color.
- Helped customers complete purchases, locate items, and join reward programs.
- Used POS system to process sales, returns, online orders, and gift card activations.
- Checked pricing, scanned items, applied discounts, and printed receipts to ring up customers.
Account Manager
Refuse Specialists
10.2014 - 07.2017
- Facilitated client satisfaction and renewed customer relations to drive growth.
- Addressed problems with accounting, billing, and service delivery to maintain and enhance client satisfaction.
- Evaluated client needs and developed tailored solutions to increase positive customer ratings.
- Built relationships with customers and community to promote long term business growth.
- Contributed to team objectives in fast-paced environment.
- Recorded accurate and efficient records in customer database.
- Monitored service after sale and implemented quick and effective problem resolutions.
Customer Service Associate
Sears
10.2012 - 11.2015
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Operated cash register for cash, check, and credit card transactions with excellent accuracy levels.
- Worked flexible schedule and extra shifts to meet business needs.
- Welcomed customers and helped determine their needs.
- Helped customers complete purchases, locate items, and join reward programs.
- Restocked and organized merchandise in front lanes.
- Greeted customers entering store and responded promptly to customer needs.
- Counted money in cash drawers at beginning and end of shifts to maintain accuracy.
- Stocked, tagged and displayed merchandise as required.
Education
High school diploma -
Rio Mesa High School
Oxnard, CASkills
- Receptionist
- Customer Service
- Prior Authorization
- Call Center
- CPT coding
- Microsoft Outlook
- Medical terminology
- Cash handling
- Cash register
- Merchandising
- ICD-10
- Account Reconciliation
Additional Information
- work in the US for any employer, Willing to relocate: Anywhere, Authorized to work in the US for any employer
Languages
English
Timeline
Cashier/Customer Service
K-Mart Retails
05.2019 - 11.2020
Utilization Management Representative
Anthem, Inc
11.2017 - Current
Account Manager
Refuse Specialists
10.2014 - 07.2017
Customer Service Associate
Sears
10.2012 - 11.2015
High school diploma -
Rio Mesa High School
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