Daisy Perez

• Educated members on no show visits for well checks submitted responses to the provider dismissal department. Provide member education on appointment compliance or the issues that caused dismissal for star and chip members.
• Assisted members on follow up calls for ADHD such as obtaining members health status with medication as well as a follow up visit with prescribing provider.
• Face to Face Interpreter Assistance for medical appointments. Locate interpreter in specified language via email through vendors tracked on Interpreter Log in Share Point for billing/finance.
• Member outreach requests for Texas Eligibility contact members to provide eligibility updates and enrollment. Address any urgent access to care barriers for members also with name, dob update.
• Responded to member inquiries for provider search referral assistance for specialist on locating specific providers in area.
• Obtained authorization status for speech , occupational , physical therapy with home health agency logged and document on compliance log.
• Established and maintained effective communication with staff, physicians and community organizations to promote high quality member care.

CSR1 (2017-2019)

• Inbound calls for member services and providers for the plans contracted with Cook Children’s Health Plan & Parkland star/chip/ star-kids.

• Verified eligibility and benefits for members and providers.
• Supported the department of Mental Health & Substance Abuse Services by providing members referrals for mental health providers such as psychiatrist, psychologist, counseling etc. Submitted out of network request for provider who were not credentialed with insurance.
• Assist members on guiding step by step to website for beacon health options for more referrals.

CSR2 (2019-2020)

• Evaluate problems and complaints of the callers and provide proper escalations.

• Communicate with clinicians as needed to obtain additional information to process complaints.
• Coordinated with senior specialist to compose appeal responses. Created composed and maintained appeal response templates.
• Generated, posted and attached information to claim files.
• Researched and resolved written complaints submitted by members and physicians or providers.
• Completed documentation of final appeals or grievance determination using appropriate templates. Investigated and resolved customer inquiries and complaints quickly

CSR3 (2020-Current)

• For provider’s calls assisted by providing claim status for billing and submit insurance claims and follow up on unpaid, rejected or denied claims toresolve and resubmit when required.

• Verified behavioral health billing such as cpt codes , diagnoses codes, revenue, plan procedure. Provided check reconciliation, outstanding check status.
• Researched claims and incident information to deliver solutions and resolve problems.
• Coding in ICD-9/10, CPT, HCPCS coding based on CMS and AMA guidelines and are certified by the American Academy of Professional Coders (AAPC).
• Submitted tickets to have eligibility updated verified with health plan for verification.
• Submitted authorizations for providers for high levels of care such as inpatient , intensive outpatient , detox for facilities.

• Greeting and welcoming patient to the practice
• Scheduling, rescheduling, or canceling appointments as needed
• Assisting patients to fill out information forms & phi
• Preparing patients charts and daily schedules for the dental staff
• Updating patient records and documenting recent treatments and procedures
• Scheduling follow-up appointments and providing telephonic reminders
• Communicating with medical insurance providers to determine if patients are required to make co-payments
• Performing general office duties such as answering telephones, photocopying, filing and faxing cleaning out exam rooms.

• Involves the testing of new drugs or delivery methods to determine safety and effectiveness
• Assisted with analysis of research data in collaboration with research department.
• Performed ECG’s, urine collection, vital signs, phlebotomy, safety monitor, urine collections.
• Collecting blood samples from patients, labeling them, dispatching them for analysis, and testing
• Tracked collected specimens by initialing, dating and noting times of collection.
• Glucometer testing, finger sticks, Clinical urine collections, Urine Drug screens, assisted with physical exams and ethanol breath test.
• Collected blood samples using vacutainer tubes, tourniquets, syringes, butterfly needles, and straight needles.
• Completed proper sanitation and cleaning of equipment and work areas between patients.

• Created and followed call scripts and flows to maximize effectiveness.
• Managed applications, demographics and participant information of health education programs.
• Communicated details about available classes, materials and services.
• Communicated with prospective members and other individuals to disseminate and explain information regarding enrollment in health plans
• Promoted available resources and connected individuals with services.
• Responsible for managing the overall eligibility and enrollment strategy and operations for Texas Health Steps for STAR & Chip plans.

• Customer service agent tier I answering inbound coming calls in regards of recall notices, file complaints over vehicle issues in regards of recalls.
• Advised warranty questions on vehicle with VIN number .
• Set up appointments for test drives according to customers location.
• Provided excellent internal and external customer service via phone request focusing on first contact resolutions
• Provided service requests and gathered complaints to locate dealers for customers near area.
• Gather chief complaints in regards of recalls and when parts would not be available.
• Subordinate customers with any technical issues experienced and escalate any issues to management appropriately.