Dejah Burgos
Apex,USA
Summary
Patient-focused customer service professional equipped with case-management and client relation experience. Helps keep healthcare services proceeding smoothly by optimizing administrative resources with integrity an efficiency. Talented in finding balanced solutions and resolving escalated conflicts.
Overview
6
6
years of professional experience
Work History
Program Supervisor
Mercalis
12.2024 - Current
- Supervise and mentor a team of data entry and reimbursement agents, ensuring accurate and efficient completion of patient enrollment, benefit verification, prior authorizations, and appeals.
- Foster a positive and collaborative team environment by guiding agents through the document intake and insurance coverage processes, analyzing performance metrics, and implementing corrective actions as needed.
- Act as the first line of escalation for complex reimbursement and intake-related issues, addressing client concerns and providing timely resolutions to maintain client satisfaction.
- Participate in regular meetings with the Program Manager and other stakeholders to review performance metrics, identify challenges, and implement improvements.
- Manage special projects and ad-hoc tasks to support the goals of the intake, reimbursement, and patient advocacy teams.
Support Coordinator
Mercalis
09.2023 - 12.2024
- Promoted to S.W.A.T Escalation Team within 3 months of hire
- Utilized Salesforce, Microsoft Office, Excel, and Quickpath software
- Delivered personalized case management, guiding patient program enrollment, reimbursement support, and financial assistance
- Developed strong relationships with healthcare providers and pharmacies to streamline benefit investigations, prior authorizations, and claims support
- Ensured accurate medication dispensing by verifying doses and resolving discrepancies, collaborating with pharmacists to address errors
- Led training sessions for new agents, focusing on best practices and standard operating procedures to ensure readiness and compliance
- Managed quality assurance, researching and resolving escalated cases, and providing weekly updates to identify challenges and areas for improvement
Program Specialist
Labcorp Drug Development
10.2020 - 09.2023
- Provided program services on the escalation team through inbound and outbound communications, assisting patients and healthcare providers with program enrollment, benefit investigation, prior authorization, appeal, and claims support, and financial assistance to eliminate nonclinical barriers to therapy
- Trained new agents to follow Standard Operating Procedures (SOP) through call assessment and data entry evaluation
- Collaborated with external providers, including insurance companies and third-party administrators, to address and resolve escalated patient discrepancies regarding eligibility, reimbursement, and claims processing
- Provided feedback on patient and provider experience trends for enhancing the quality of service
Optometric Technician
The Eye Center
06.2019 - 06.2020
- Streamlined clinic operations by conducting patient registration, verification of medical and vision insurance coverage, handling incoming and outgoing communications, preparing patients' charts and consent documents, facilitating ophthalmologist referrals, and managing appointment schedules across multiple sites
- Updated and maintained comprehensive electronic medical records to reflect accurate details of patient care, condition, progress, concerns, and medical history
- Administered comprehensive diagnostic tests and preliminary screenings to include visual acuity testing, auto-refraction, ophthalmoscopy, tonometry, and retinal imaging for the purpose of delivering high-quality patient care
- Educated patients in contact lens care, insertion, removal, and hygiene practices
- Prepare exam room for use and address abnormalities observed during preliminary examinations with physicians to develop and implement personalized care plans
- Assisted optometrist in minor surgical procedures, such as corneal foreign body removal
- Trained new staff on optometric testing procedures and clinic protocols
Donor Recruiter
The Blood Connection
04.2019 - 07.2019
- Drove successful donor engagement by strategically planning outreach efforts and executing well-attended blood donation events through various channels including in-person meetings, telephone conversations, and email exchanges
- Managed relationships with existing donors through regular communication and follow-up activities
- Organized and attended job fairs and recruiting events to promote employment opportunities
- Maintained compliance with HIPAA protocols to safeguard patient privacy
- Analyzed recruitment metrics and reports to identify trends, challenges, and opportunities for process improvement
- Coordinated with external vendors and partners to facilitate effective donor outreach activities
Customer Service Representative
Aetna
10.2018 - 01.2019
- Managed high-volume inbound and outbound calls to promptly address and resolve customer inquiries, complex claims, payment processing for premiums and renewals, and billing disputes
- Utilized CRM software to track and record customer interactions, feedback, and resolutions
- Educated customers on new insurance products and services relevant to their healthcare needs
- Informed and educated customers about their health coverage by providing detailed explanations of eligibility requirements, benefits, and policy limitations
Education
No Degree - Health Science
Spelman College
Atlanta, GA10-2018
High School Diploma -
W.G. Enloe High School
06.2017
Skills
- Registration and Scheduling
- Client Relations
- Medical Billing and coding
- Insurance Verification
- Accounts Receivable
- Triaging
- HIPAA Compliance
- Patient Confidentiality and Data Security
- Microsoft Office
- Microsoft Excel
- Quickbooks
- Customer service
- Data entry
- Quality Assurance
- Training Coordination
- Account Auditing
- Case Management
Websites
Timeline
Program Supervisor
Mercalis
12.2024 - Current
Support Coordinator
Mercalis
09.2023 - 12.2024
Program Specialist
Labcorp Drug Development
10.2020 - 09.2023
Optometric Technician
The Eye Center
06.2019 - 06.2020
Donor Recruiter
The Blood Connection
04.2019 - 07.2019
Customer Service Representative
Aetna
10.2018 - 01.2019
High School Diploma -
W.G. Enloe High School
No Degree - Health Science
Spelman College
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