Summary
Overview
Work History
Education
Skills
Personal Information
Assessments
Timeline
AdministrativeAssistant
Dawn Rich

Dawn Rich

Portales,NM

Summary

Medical Claim Processor Authorized to work in the US for any employer

Professional hospitality worker with extensive experience in delivering high-quality service in busy dining settings. Known for strong focus on teamwork and achieving customer satisfaction. Versatile and reliable, adapting to changing needs and ensuring smooth operations through excellent communication and problem-solving skills.

Overview

30
30
years of professional experience

Work History

Advisor II Transaction Processor

Concentrix-Aetna-New Mexico
07.2022 - Current
  • Receive and review medical and hospital claims checking for completeness and compliance with established policies and procedure
  • Review claims for authorization and member eligibility as necessary
  • Complete all claims processing functions within the regulated timeframe of 30 days to deny and 45 days to pay
  • System and correct any discrepancies as necessary
  • Work EDE electronic claim queues to correct, modify
  • Maintain CPH daily and monthly basis

Customer Service Representative

Faneuil
10.2020 - 03.2022
  • Anticipate member needs processes and dispenses or directly supports the processing and dispensing traditional and over the counter medicines
  • Personalize their experience
  • While placing members prescription refills that are to be mailed to patients' homes and handles complex and/or escalated issues
  • Promptly responded to inquiries regarding prescription drug plan coverage and ordering prescriptions through the mail order pharmacy
  • Educated members to handle their healthcare needs
  • Responsible for center calls and directly respond to questions, handle issues and provide guidance to both internal and external customers
  • Responsible for releasing prescription refill medication
  • Responsible for sending requests to physicians office to renew expired prescriptions
  • Provided assistance to clients

Scheduler II

Lovelace Medical Group
11.2019 - 10.2020
  • Scheduled for Lovelace Medical Group, a multispecialty provider group
  • Scheduled patient appointments and coordinated with staff to ensure patient care
  • Provided a positive patient experience through phone, chat, and email

Administrative Scheduler

Vitalant/UBS
09.2018 - 02.2019
  • Responsible for tele-recruiting donor platelets every day basis
  • Had to maintain statistics on a daily basis
  • Informed platelet donors, on how often they would be able to donate platelets are needed the most for cancer patients, general surgery patients

Administrative Assistant

Harmony Home Health and Hospice
06.2016 - 03.2017
  • Ensured operation of equipment by completing preventive maintenance requirements; calling for repairs, maintaining equipment log
  • Maintains an excellent relationship with the medical staff and other Professional and Supervisory staff
  • Completed operational requirements scheduling supervisory visits with hospice nurse, in conjunction with home health aide assigned to hospice patients
  • Completed operational requirements scheduling supervisory visits with hospice nurse, in conjunction with home health aide assigned to hospice patients
  • Responsible for regularly maintaining filing system for medically fragile pediatric nursing documentation
  • Administrative Assistant position has been eliminated from Harmony home health and hospice Albuquerque office

Staffing Coordinator

Westways Staffing
07.2012 - 12.2014
  • Daily staffing over 100 nurses both locally and nationally
  • Recruiting and credentialing for all nurses
  • Generating monthly reports as well as payroll and billing
  • Managing New Mexico and Arizona per diem healthcare offices
  • Distributing paychecks on a daily basis, answered multiple phone lines
  • Obtaining healthcare facility contracts, as well as vendor mgt
  • Contracts
  • Responsible for Albuquerque, NM office passing JACHO, hospital standards

Staffing Assistant

Onward Health Care
05.2008 - 10.2010
  • Managed over 263 technicians, staff
  • Distribute pay checks daily basis
  • Answered multiple phone lines
  • Certified WFX pro lucent broadlane staffing system

Administrative Assistant

University of New Mexico
01.1995 - 12.2004
  • Worked for The University of New Mexico Anesthesiology Division , Multiple Divisions of ACC offices within hospital , as well as University of New Mexico English Department as many other departments within the University
  • Will explain at time of interview

Education

High school diploma or GED - Basic

Freedom High School
Albuquerque, NM
05.1987

Skills

  • Clerical experience
  • Medical scheduling
  • Microsoft Excel
  • Typing
  • Word
  • Administrative support
  • Database
  • Customer service
  • Medical office experience
  • Organizational management
  • Multi-line Phone Systems
  • Microsoft Office
  • Windows
  • Computer skills
  • Microsoft Outlook
  • Data Entry
  • Administrative experience
  • Microsoft Word
  • Word processing
  • Computer literacy
  • Recruiting
  • Upselling
  • Written communication
  • Relationship building
  • Critical thinking
  • Time management

Personal Information

Work Permit: Authorized to work in the US for any employer

Assessments

  • Customer focus & orientation, Proficient, 01/22
  • Customer service, Completed, 01/22
  • Scheduling, Proficient, 07/22
  • Call center customer service, Proficient, 03/22

Timeline

Advisor II Transaction Processor

Concentrix-Aetna-New Mexico
07.2022 - Current

Customer Service Representative

Faneuil
10.2020 - 03.2022

Scheduler II

Lovelace Medical Group
11.2019 - 10.2020

Administrative Scheduler

Vitalant/UBS
09.2018 - 02.2019

Administrative Assistant

Harmony Home Health and Hospice
06.2016 - 03.2017

Staffing Coordinator

Westways Staffing
07.2012 - 12.2014

Staffing Assistant

Onward Health Care
05.2008 - 10.2010

Administrative Assistant

University of New Mexico
01.1995 - 12.2004

High school diploma or GED - Basic

Freedom High School

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