Denise Fernandez
Summary
Proactive Quality Analyst with 15 years of customer service experience in Healthcare management with 5 + years of Quality assurance background. Extensive work history showing a record of efficiency and accuracy. Proven ability to meet deadlines and assist peers when needed. Leadership role helping others with ensuring the highest quality care and customer service.
Overview
18
18
years of professional experience
Work History
Analyst Specialist
OptumHealth
01.2017 - Current
- Conduct monthly phone call evaluations for assigned agents to ensure proper phone etiquette while adhering to company guidelines.
- Provide findings and recommendations to ensure the employee uses proper phone etiquette and adheres to scripts and MMS documentation.
- Provide one-on-one coaching sessions to review staff performance.
- Identify trends and patterns, and make recommendations for improvement in customer service.
- Conduct monthly Collaborations with peers to ensure staff is aligned with the monitoring process.
- Conduct monthly audits to ensure assigned agents are returning member calls and properly assisting with questions and concerns.
- Provide feedback to assigned agents with recommendations to ensure proper customer service.
Case Reviewer
OptumHealth
01.2015 - 01.2017
- Received and reviewed all incoming correspondence from members to determine completion of package.
- Utilized proprietary systems to alert and request missing information for MSP case completion.
- Ensured MSP application and any related forms comply with state regulations.
- Documented MMS and Alert assigned Case Coordinator with findings to ensure case completeness based on state guidelines.
- Reviewed and prepared MSP application with required documents for final review for state submission.
- Maintained a 98% acceptance rate every month.
- Maintained an awareness of regulatory and processing guidelines changes.
Case Coordinator
OptumHealth
01.2009 - 01.2015
- Conducted in-depth telephonic outreach services for Medicare members who have been pre-screened by an advocate as potentially eligible for the Medicare Savings Program.
- Followed up with members weekly to ensure they have returned their completed application with the required documents for state eligibility.
- Managed between 80-100 customer service calls per day, including conference calls.
- Maintained current knowledge of state and federal regulatory requirements.
Golden Touch
OptumHealth
03.2006 - 01.2009
- Made outbound telephone calls and handled inbound calls to assist health plan members to complete applications for community programs offered in their area
- Completed three-way calls with the member and provider to ensure the member received the Community Link program they were eligible for
- Conducted follow-ups to complete program enrollment.
- Maintained accurate and complete records to document program activities and outcomes.
- Complied with legal and ethical standards to meet regulatory requirements.
Education
Broward College
06.2028
Technical School -
Hollywood Institute of Beauty Careers
Hollywood, FL08.2022
High School Diploma -
Miami Coral Park Senior High School
Miami, FL06.2005
Skills
- MSP Regulations
- Analytical skills
- Microsoft Word
- Microsoft Excel
- Problem-solving
- Data entry
- MMS workflow
- Decision making
- Time management
- Rapport building and listening
- Reliability
Languages
English
Professional Working
Spanish
Native or Bilingual
Timeline
Analyst Specialist
OptumHealth
01.2017 - Current
Case Reviewer
OptumHealth
01.2015 - 01.2017
Case Coordinator
OptumHealth
01.2009 - 01.2015
Golden Touch
OptumHealth
03.2006 - 01.2009
Broward College
Technical School -
Hollywood Institute of Beauty Careers
High School Diploma -
Miami Coral Park Senior High School