Summary
Overview
Work History
Education
Skills
References
Recognition
Timeline
Generic

Diana Ramirez

Hobbs,NM

Summary

Proven Patient Service Representative with a track record of excellence at Centene Corporation, adept in medical billing and demonstrating exceptional communication skills. Bilingual in English and Spanish, I excel in customer care, consistently recognized for outstanding service and a positive attitude. Achieved top performer status, reflecting my commitment to productivity and willingness to learn. Knowledgeable Desired Position with solid background in processing and verifying authorizations. Proven experience in ensuring compliance with regulations and maintaining accurate records. Demonstrated ability to handle sensitive information and collaborate effectively with team members. Detail-oriented worker with knowledge of account management and collaborating with other departments. Talented at data entry and analysis with exceptional knowledge of Area of expertise. Cooperative Correspondence Clerk with Number years of Area of expertise experience. Adept at customer service and staying client focused through conflict resolution. Exceptional customer service skills and accurate typing ability. Authorization professional with proven track record in processing and managing authorizations, ensuring compliance with regulations. Known for strong attention to detail and ability to handle confidential information with discretion. Highly reliable team player focused on achieving results and adapting to changing needs with ease. Experienced with processing and managing authorizations, ensuring compliance with industry standards. Utilizes attention to detail and problem-solving skills to maintain accurate records and resolve discrepancies. Knowledge of regulatory requirements and effective communication with team members. Professional with robust background in administrative support and client services, ready to excel in managing authorization processes. Skilled in data entry, document management, and customer communication. Strong team collaborator, adaptable to changing needs, and focused on achieving results. Highly dependable, ensuring accuracy and efficiency in all tasks. Pursuing full-time role that presents professional challenges and leverages interpersonal skills, effective time management, and problem-solving expertise. Results-oriented achiever with proven ability to exceed targets and drive success in fast-paced environments. Combines strategic thinking with hands-on experience to deliver impactful solutions and enhance organizational performance. Innovative technology professional with several years of diverse experience. Skilled in enhancing systems and aligning technical solutions with business objectives. Proven success in leading projects from start to finish and contributing to organizational growth and success. Tech-savvy innovator with hands-on experience in emerging technologies and passion for continuous improvement. Skilled in identifying opportunities for technological enhancements and implementing effective solutions. Adept at leveraging new tools and methods to solve problems and enhance productivity. Excels in adapting to fast-paced environments and driving technological advancements. Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth. Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives. Recent graduate with foundational knowledge in Area of study and hands-on experience gained through academic projects and internships. Demonstrates strong teamwork, problem-solving, and time-management skills. Prepared to start career and make meaningful contributions with commitment and drive. Possesses versatile skills in project management, problem-solving, and collaboration. Brings fresh perspective and strong commitment to quality and success. Recognized for adaptability and proactive approach in delivering effective solutions. Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level Job Title position. Ready to help team achieve company goals. Dynamic individual with hands-on experience in Area of expertise and talent for navigating challenges. Brings strong problem-solving skills and proactive approach to new tasks. Known for adaptability, creativity, and results-oriented mindset. Committed to making meaningful contributions and advancing organizational goals. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth. Thorough team contributor with strong organizational capabilities. Experienced in handling numerous projects at once while ensuring accuracy. Effective at prioritizing tasks and meeting deadlines. Experienced leader with strong background in guiding teams, managing complex projects, and achieving strategic objectives. Excels in developing efficient processes, ensuring high standards, and aligning efforts with organizational goals. Known for collaborative approach and commitment to excellence. Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.

Overview

13
13
years of professional experience

Work History

Patient Authorization Clerk

Nor Lea Hospital
07.2024 - 10.2024
  • Supported timely patient care by diligently obtaining pre-authorizations for necessary medical procedures and tests.
  • Submitted for prior authorization with required documentation to appropriate funding source.
  • Maintained consistent follow-up on status of prior authorization requests.
  • Collaborated with multidisciplinary teams to ensure timely submission of documentation required for insurance approval.

Patient Service Representative

Centene Corporation
06.2021 - 01.2024
  • Speak to members with health insurance verifying benefits, such as deductibles, co payments for primary provider visit and speciality provider visit if they need referral or authorizations for certain medical procedures
  • Help members find providers in the network with the health plan that the members have
  • Call providers and assist members with scheduling medical appointments
  • Speak to providers and verify eligibility for members with different health plans, assist providers with authorizations, referrals if members need one
  • CPT codes if the health plan covers it and if the members need authorization if providers need help website or provider portal I can assist providers
  • If the provider is calling for claim status and how much did the insurance pay for the claim, as well as if a check was issued or if check was cashed already if the claim got rejected, what is the process' timely filing limit and if certain claim lines were denied or not paid explain the reason to providers
  • Explain to providers how to submit a medical claim
  • What status the claim is on when we received the claim if members had coverage at the time of service

Patient Service Representative

Triwest
11.2017 - 04.2021
  • Assisting Veterans, with their health insurance outside the VA, help veterans with medical authorizations and referrals to schedule appointments with providers
  • Call veterans and assess with MRI questions CT scan questions and mammograms
  • Speak and assist providers about authorizations referrals on file what the authorization covers when it starts and when it ends anything they need to know about veteran history

Alorica
02.2012 - 10.2017
  • Great customer care and communication skills, Worked at AT&T answered phones, assisted customers with discounts for their phones, and offered plans for phone services
  • Did a lot of Data entry for AT&T, entered customer's information faxed to correct departments, Always on top of everything to give the best customer satisfaction
  • Excellent customer service and great communication skills, I was and still am a Bilingual agent
  • Assisted with bank information such as checking and savings accounts as well as all types of loans
  • Submitted applications for Credit cards
  • Submitted line of increase for customers, manage customers' accounts if they were going to travel and how long the trip would be
  • Explain to them how credit cards worked, type of percentage each transaction would have when using the credit card
  • Recognized for always being one of the top performers at AT&T, Bank of America met all metrics surveys, always 9 or 10
  • Always recognized for such great customer service I would give
  • Veterans always wanted to speak to management to let them know how amazing I was with a great and positive attitude and to let them know how much I cared for our veterans overall always recognize for my work and example to other employees

Education

Community College - Anatomy 1&2, Medical Terminology, Pharmacology, English 1&2, Speech, Psychology 1&2, History

Medical Office Specialist -

International Business College
01.1997

High School -

Del Valle High School
01.1995

Skills

  • Bilingual English and Spanish
  • General office duties
  • Typing
  • Telephones
  • Customer service
  • Medical knowledge
  • CPT codes
  • Diagnosis codes
  • Medical billing
  • Positive attitude
  • Willingness to learn
  • Productivity
  • Customer care
  • Communication skills
  • Bilingual agent

References

  • Oshma Raje, Supervisor at Centene Corporation, 512-299-2454
  • Kenny Lockridge, Supervisor veteran at TriWest Healthcare Alliance, 575-640-2550, 915-702-1479
  • Rene Melendez, Supervisor at Alorica, 915-691-3649
  • Mathew Pineda, Team Lead at TriWest Healthcare Alliance, 915-599-7628

Recognition

  • Top performer at AT&T and Bank of America
  • Met all metrics surveys with scores of 9 or 10
  • Recognized for great customer service by veterans

Timeline

Patient Authorization Clerk

Nor Lea Hospital
07.2024 - 10.2024

Patient Service Representative

Centene Corporation
06.2021 - 01.2024

Patient Service Representative

Triwest
11.2017 - 04.2021

Alorica
02.2012 - 10.2017

Community College - Anatomy 1&2, Medical Terminology, Pharmacology, English 1&2, Speech, Psychology 1&2, History

Medical Office Specialist -

International Business College

High School -

Del Valle High School
Diana Ramirez