Overview
Work History
Education
Skills
HEALTHCARE ADMINISTRATION | INSURANCE PROFESSIONAL | CUSTOMER SUCCESS SPECIALIST
Timeline
Generic

STEPHANIE RAZA

Overview

3
3
years of professional experience

Work History

Operations Support Coordinator

NY Maximus
11.2023 - Current
  • Communicated over 20 consumers daily via MAXeb system to schedule, reschedule or cancel assessment appointments for consumers regarding the New York Independent Assessor Program's next steps to receive services for Managed Long Term Care
  • Conducted over 20 outbound calls daily to consumers for the New York Independent Assessor Program post-assessment surveys and incorporated consumer complaints via MAXeb upon request
  • Verified consumer MLTC case information via RL forms, No Show, Interrupted appointments using MAXeb platform to make outreach as needed
  • Utilizing UAS & MAXeb systems to authenticate consumer MLTC information and document in excel spreadsheets to alleviate top 20% of back office workloads for clinicians and nurse assessors

Physician Support Unit Representative I

Evicore Healthcare
07.2022 - 06.2023
  • Served over 70 facilities, patients and providers daily via Cisco finesse system and ISAAC platforms to provide post-decision options for denied cases on commercial & Medicare programs to accomplish top 10% of PSU department goals
  • Collaborated with a call center team of 25, exceeding service levels 40-70 calls daily completed in < 3 minutes

Customer Service Representative

Evolent Health
07.2021 - 07.2022
  • Utilized available resources to assist over 60 Medicare Advantage general inquiries daily via NICE inContact telephone system for Bright Health & MoreCare members including providers, medical institutions, other medical professionals, and seniors
  • Communicated with over 50 members and providers weekly to verify billing information, payment, and answer questions or resolve concerns about plan benefits, claims statuses (UB & CMS 1500), eligibility, prior authorization (CPT) procedures, and coverage networks via Identifi CS, Wi Pro and UPC/MPX systems
  • Assisted Morecare & Bright Health special projects to achieve top 20% of performance goals established in the areas of efficiency, accuracy, quality, and member satisfaction
  • Incorporated member complaints/grievances to de-escalate complex member situations to determine appropriate course of action for resolution to improve member satisfaction to meet top 20% of organization aims

Education

Master of Science - Health Care Systems

St. John's University
Jamaica
05.2021

Bachelor of Arts -

Queens College
Flushing, NY
01.2019

Skills

  • Preferral Scheduling Appointment System, MAXeb scheduling system
  • UB, CMS 1500 claim forms, SDS Quick Claims, (CPT , ICD-10 codes) Prior Authorizations
  • EMR: Identifi CS (Customer Relationship Manager), Identifi Review, Identifi Ops Intel, ISAAC 360, MAXeb (NYS medicaid platform)
  • Wi Pro360, Panviva & Uniform Assessment System for New York (NYS Health Commerce System)
  • Over-The-Counter (OTC) systems
  • Universal Printing Company (UPC), MPX
  • Cisco Finesse General, WFM IEX, Amazon WorkSpace (AWS), NICE inContact & Genesys Cloud Application
  • Google's G Suite, MS Office Suite (Word, PowerPoint, Excel, Outlook, Publisher, OneNote) & MS SharePoint
  • Cisco Finesse General, WFM IEX, Amazon WorkSpace (AWS), NICE inContact & Genesys Cloud Application
  • Google's G Suite, MS Office Suite (Word, PowerPoint, Excel, Outlook, Publisher, OneNote) & MS SharePoint
  • Bilingual in Spanish

HEALTHCARE ADMINISTRATION | INSURANCE PROFESSIONAL | CUSTOMER SUCCESS SPECIALIST

.

Timeline

Operations Support Coordinator

NY Maximus
11.2023 - Current

Physician Support Unit Representative I

Evicore Healthcare
07.2022 - 06.2023

Customer Service Representative

Evolent Health
07.2021 - 07.2022

Master of Science - Health Care Systems

St. John's University

Bachelor of Arts -

Queens College

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STEPHANIE RAZA