GISELL CHAVEZAMES
San Benardino,CA
Summary
A Call Center Senior with 6 years of providing accurate and quick resolutions never wagering quality customer service to assist team members in a Healthcare industry Assisted leadership in identifying areas of improvement in customer service processes and implementing new strategies to enhance Provider satisfaction. Self-motivated problem-solver.
Overview
14
14
years of professional experience
Work History
Provider Call Center Senior
Inland Empire Health Plan
2016.11 - Current
- Assist our Provider call center representatives in a timely, friendly, knowledgeable and efficient manner by utilizing Various systems : Network Development Database, MediTrac/ HSP, SuperSearch, MedHok, DataNet, & Edifecs
- Verify if Provider demographics are updated by confirming in Network Development Database & Meditrac under the Provider & Vendor Profile
- Review Provider[s] contract in Network Development
- Assist Team Members with Provider claim inquiries ( Professional & Institutional) using the claims data, adjudication summary, Edi files tab in MediTrac to identify how claims were processed
- Assist Team Members with claims Inquiries ( Professional & Institutional) using the Claims desktop Reference guide and the Medical/ Medicare website to identify how claims were adjudicated.
- Take escalated calls from Providers requesting to speak with management
- Oversee daily operations of the call center, including staffing, training for MDI huddles.
- Identify trends that may be impacting the Service Level Agreement of the call center and effectively communicating any countermeasures to our management team
- Identify process improvement opportunities to enhance operational effectiveness and improve team productivity
- Actively coordinate and support our department facilitator and scribe to lead the LEAN tiered huddles to identify process gaps and develop solutions in area of opportunities.
Provider Call Center Representative
Inland Empire Health Plan
2016.03 - 2016.11
- Assist Providers with the following type of phone inquiries: claim, behavioral health, outpatient utilization, inpatient utilization, Provider portal technical support, and general questions related to but not limited to members whom are part of the managed medi-Cal/Medicare HMO Plan
- Following up with Providers resulting in building rapport and showing customer service
- Identify process improvement opportunities to enhance operational effectiveness and improve team productivity.
Biller/Front Desk Receptionist
Mission Speech and Language Center
Loma Linda
2009.12 - 2015.07
- Reviewed patient insurance information to ensure accuracy and completeness of claims submission.
- Verified medical codes for diagnosis, treatments, procedures and supplies using ICD-10 coding system.
- Greeted visitors and provided them with assistance.
- Scheduled appointments for patients
Education
High School Diploma -
San Gorgonio Highschool
06.2008
Skills
- Team Culture
- Great verbal and written communicator
- Great research knowledge in Claims Desk Top Reference
- Great at Problem Solving/ Issue Identifier
- Teamwork
- Interpersonal
- Work Ethic
- Meditac/ HSP
- SuperSearch
- DataNet
- Edifecs
- Network Development
Personal Information
Title: Provider Call Center Senior
Timeline
Provider Call Center Senior
Inland Empire Health Plan
2016.11 - Current
Provider Call Center Representative
Inland Empire Health Plan
2016.03 - 2016.11
Biller/Front Desk Receptionist
Mission Speech and Language Center
2009.12 - 2015.07
High School Diploma -
San Gorgonio Highschool
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