Cynthia Torres
Oro Valley,USA
Summary
Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Overview
23
23
years of professional experience
Work History
Medicare/Medicaid enrollment
Centauri Health Solutions
Remote
03.2023 - Current
- Achieved successful member assistance through effective handling of inbound and outbound calls related to Medicaid. Streamlined enrollment in Medicare Savings Program for eligible individuals. Enhanced benefits tracking by liaising with county offices across all 50 states. Executed authorization to represent forms for validated accounts. Confirmed accuracy of incoming correspondence notices to ensure compliance.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Worked well in a team setting, providing support and guidance.
Retention Specialist
BCBS OF ARIZONA
Remote
03.2022 - 01.2023
- Responded to member inquiries and offered support on benefits, ensuring a smooth onboarding experience.
- Resolved member service inquiries and supported providers in understanding member benefits. Handled appeals related to fraud, waste, and abuse effectively. Liaised with case managers to enhance member support and service delivery.
- Managed name change processes for members and organized efficient package delivery schedules.
- Interpreted customer feedback data to create targeted retention strategies that fostered increased satisfaction among clients.
- Developed and executed communication strategies in collaboration with cross-functional teams to improve member engagement.
Service Center Representative/Claims Processor
UAHN/ Banner University Medical Center
Remote
09.2014 - 11.2021
- Achieved timely processing of 1500 claims, consistently meeting daily goals of 200 claims. Contributed to special projects that enhanced overall workflow and productivity.
- Denied claims based on confirmed secondary insurance status and billed primary insurance accordingly.
- Employed IDX, Siebel, HPIS, and SharePoint for efficient handling of claims documentation and tracking.
- Analyzed claim information meticulously to confirm accuracy, facilitating informed approval or denial outcomes.
- Achieved accurate processing of remittance advice checks by printing and attaching remittance advice. Identified and resolved mismatches in check information, enhancing operational efficiency. Facilitated communication with providers by generating and dispatching letters concerning interest on checks.
- Achieved accurate financial records by reconciling cash payment registers with remittance advices. Addressed discrepancies through effective communication and interest verification. Streamlined return mail logging and ensured timely updates in Lawson. Facilitated prompt email delivery of checks to providers.
- Conducted thorough reviews of checks without backup, reprinting remittance advice from EOB files when discrepancies were identified.
- Managed data entry of Medicare enrollment applications to ensure accurate and timely processing for prospective Medicare Advantage plan members.
- Verify all demographic information including DOB, legal name and address.
- Verify that members have Medicare part A, Medicare part B and are enrolled in a Medicaid plan as well.
- Mail letters to members advising them of their enrollment in the Medicare Advantage program, or a denial letter if they do not qualify for the Medicare Advantage plan.
- Marketplace Plan duties include but are not limited to, receiving calls from providers and members requesting status or changes on their accounts such as PCP changes or claim status information.
- Manage, investigate and resolve 'HICS' Cases from the Federally Facilitated Marketplace (FFM).
- Investigated and resolved cases related to terminated benefits and tax credit removals, focusing on correcting misinformation.
- Coordinated communication with members and verified payment details to maintain operational accuracy.
- Coordinated interactions between members and health plan departments to streamline processes.
Customer Service Representative
AppleOne
Tucson, AZ
10.2013 - 02.2014
- Resolved employee issues at UMC Hospital by efficiently handling phone inquiries and documenting system challenges. Improved departmental operations by streamlining the ticketing process for technical problems. Enhanced overall employee satisfaction through prompt and effective support.
- Managed ticket distribution, ensuring attached documents reached correct departments for efficient resolution.
Scheduler
Radiology Ltd
Tucson, AZ
09.2012 - 01.2013
- Facilitated efficient scheduling of patient appointments for various imaging services, ensuring coverage across seven Tucson vicinity locations.
- Managed patient appointment confirmations and modifications, addressing requests up to 48 hours before procedures.
- Managed thorough review of doctor's orders and coordinated with insurance entities to confirm necessary approvals for medical procedures.
- Managed scheduling of emergency appointments, ensuring timely responses to calls from medical offices.
Customer Service Rep
DES/DERS
Tucson, AZ
10.2010 - 07.2012
- Achieved efficient claim processing by managing claimant calls and inquiries. Streamlined the filing of new and additional claims, enhancing access to emergency unemployment compensation. Conducted thorough wage checks in other states via SIDI, ensuring accurate eligibility assessments. Provided critical updates to claimants on their claims, fostering transparency and trust. Processed weekly certifications and monitored benefit issuance, contributing to timely support. Collaborated with adjudicators to resolve past due issues, improving overall claim resolution times. Maintained accurate records of employer information and proactively addressed any discrepancies.
Customer Service Rep
Sears Holdings
Tempe, AZ
04.2008 - 09.2010
- Achieved high customer satisfaction by efficiently processing phone orders and resolving inquiries. Delivered accurate product information by liaising with other stores for item availability. Enhanced service quality by addressing customer needs in both English and Spanish.
- Reviewed and updated order status information for all completed purchases.
- Achieved timely warranty verification for purchased products, enhancing customer satisfaction. Optimized merchandise pickup and repair scheduling, resulting in improved operational flow. Enhanced data entry accuracy, contributing to effective tracking of product status.
Sales Associate
Macys
Tucson, AZ
11.2007 - 02.2008
- Addressed customer needs and concerns to ensure a positive service experience.
- Conducted regular checks of fitting rooms to uphold hygiene standards and enhance customer experience.
- Facilitated engagement and support for families in children's department.
- Achieved high customer satisfaction through effective communication and support. Streamlined cash handling processes to minimize discrepancies. Successfully completed nightly register close-outs, ensuring financial integrity.
Teacher
Cosy casa daycare
Tucson, AZ
02.2003 - 02.2007
- Created a nurturing classroom environment to support social and cognitive growth in two-year-old students.
- Managed diaper changes and trainer adjustments to ensure comfort and hygiene during activities.
- Organized and managed nap periods to enhance children's well-being and focus.
- Collaborated with teams at different facilities, including Desert Skies, to address operational requirements and maintain service continuity.
Education
Diploma - Billing And Coding
Apollo College
Mesa, AZ01-2010
High School Diploma -
Flowing Wells High School
Tucson, AZ05-2002
Skills
- Skilled in formatting and editing with Microsoft Word
- Excel data analysis
- Clinical coding proficiency
- Experience with ICD-9 documentation
- Insurance billing management
- Experience with HIPAA standards
- Friendly, positive attitude
- Teamwork and collaboration
- Customer service
- Problem-solving
Additional Information
Bilingual in English and Spanish, Keyboarding 45 wpm, Competent, flexible and can multi-task, Enjoy helping others and can adapt quickly to any new environment, Experience in HIPAA, ICD-9, CPT, prescription medications, billing, coding, medical terminology
Covid Vaccine Status
I do not have the covid vaccine
Personal Information
- Title: Service Center Representative/Claims Processor
- Work Permit: Authorized to work in the US for any employer
- Visa Status: Authorized to work in the US for any employer
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
Timeline
Medicare/Medicaid enrollment
Centauri Health Solutions
03.2023 - Current
Retention Specialist
BCBS OF ARIZONA
03.2022 - 01.2023
Service Center Representative/Claims Processor
UAHN/ Banner University Medical Center
09.2014 - 11.2021
Customer Service Representative
AppleOne
10.2013 - 02.2014
Scheduler
Radiology Ltd
09.2012 - 01.2013
Customer Service Rep
DES/DERS
10.2010 - 07.2012
Customer Service Rep
Sears Holdings
04.2008 - 09.2010
Sales Associate
Macys
11.2007 - 02.2008
Teacher
Cosy casa daycare
02.2003 - 02.2007
Diploma - Billing And Coding
Apollo College
High School Diploma -
Flowing Wells High School