Patient Service Representative
Optum
03.2023 - 09.2023
Hi, I’m
Isabel Mendez
McMinnville,US
Summary
Results-oriented and client-centric professional with meaningful experience delivering best-in-class customer/patient service and support within healthcare industry. Proven success securing optimal client satisfaction and long-term retention, creating positive experience, resolving complex problems, and exceeding organizational targets such as metrics and production. Well-built initiative to deliver compassionate healthcare to patients/clients, passionate at educating patients on benefits, pre-determinations, and balances, adhering to HIPAA laws, and managing medical insurance claims. Bilingual communicator, interpreter, and problem-solver with distinctive ability to build enduring relationships within company senior management, supervisors, families, patients and external entities medical providers, clinics/hospitals and pharmacies. Enthusiastic about helping patients get necessary medical support by obtaining authorizations, scheduling procedures and coordinating paperwork. Detail-oriented and proactive with good relationship-building skills, a hardworking nature and an adaptable approach. Demonstrated Proficiency learning any new Software used by each company and for diverse use.
Work History
Optum
Patient Service Representative
03.2023 - 09.2023
Job overview
- During my time in the healthcare industry, I provided exceptional customer service to patients by answering their questions and addressing their concerns. I also verified insurance eligibility and coverage for patients, and entered their demographic and insurance data into the electronic medical record system. To ensure confidentiality, I filed and maintained patient records in accordance with HIPAA regulations. I applied my administrative knowledge and courtesy to explain procedures and services to patients. Additionally, I was able to learn different software to schedule appointments and find client information.
Quest Diagnostics
Life Insurance Risk Interviewer
09.2022 - 02.2023
Job overview
- Risk interviewers at Quest Diagnostics have the primary purpose of completing life insurance medical and/or financial interviews via telephone through outbound calls for multiple client companies, each with their Script and internal questionnaire.
- Succeeded at placing the required quota of outbound calls with the purpose of contacting life insurance applicants for several Insurance agencies like Farm Bureau and State Farm, among others.
- Complete interviews with applicants, always verifying identity and gathering medical, financial, occupational, and recreational histories.
Evolent Health for Bright Health Plan
Customer Service Representative (Remote Contract with Talent Burst)
09.2021 - 08.2022
Job overview
- Our team works together to develop effective solutions for complex problems and issues. Resolve complex problems and issues by developing appropriate solutions within our team.
- Guide Spanish-speaking members in finding providers with Spanish-speaking services and selection of male or female providers.
- Enable members to use Hub independently by supporting in the successful creation and management of member HUB.
- Increased productivity from 80% to 87% - 90%, achieving bottom line success
- Equipped Bright members with deep understanding of their insurance benefits through expert-level guidance and support as well as branding greeting in a professional and polite manner
- Maintained accuracy on coinsurance %, member copays, and effective and termed dates by providing information to providers’ offices on member benefits.
NASPO: AK
Case Investigator (Remote Contract with Rose International)
12.2020 - 02.2021
Job overview
- Oversee cases and contacts by collaborating with contact tracers on a daily basis
- My best accomplishment was building rapport among Native population of Alaska providing excellent patient services, educating patients on Covid Protocol to be followed with public health guidelines on COVID, promoting social distancing to defeat pandemic
- Hold the responsibility for documenting all information via CommCare
- Pivotal in referring COVID contact patients for testing in line with the set protocols as well as escalating cases to Team Lead/Supervisor
- Recognized for collecting accurately the required data to provide an overview of statistics on Covid-19
- Successfully documented all interactions between patients that tested positive, any family member authorized to received information, and supervisors.
Bedford County Health Department
COVID-19 Contact Tracer
07.2020 - 09.2020
Job overview
- Notified patients of their positive Covid-19 test, collecting data such as symptoms and family and community contacts by conducting brief interviews
- Assumed accountable for maintaining information for statistics data-based programs such as Red Cap
- Delivered consultative support and guidance to patients/families on isolation, invited household members to isolate, maintained any necessary measures, and promoted disinfecting and hand washing
- Assured the patients with utmost data confidentiality to patients by explaining HIPAA rights and ensuring considerable use of discretion, tact, and excellent judgment.
Lincare Holdings Inc.
Medical Customer Service Representative
06.2019 - 07.2020
Job overview
- Responsible for attending to patients’ prescriptions and referrals from PCP and specialist providers to dispense DME plus oxygen mainly as emergency set-up
- It resolved administrative department inquiries by managing inbound and outbound calls as a liaison among doctors’ offices, clinics, and pharmacies.
- They created Certificates of Medical Necessities per insurance guidelines to receive payment by leveraging excellent knowledge and management of HIPAA law.
- Supported patients in improving their lives by matching medical diagnoses to DME
- Conducted ICD coding prior authorizations while developing strong collaborations between sleep study centers, providers, and DME companies
- Identified and exceeded patients’ needs as per diagnosis and medical approaches or plans of treatments.
Warren County Health Department
Bilingual Public Health Office Assistant
11.2017 - 05.2019
Job overview
- Proved multitasking on all set-out endeavors from clerical to medical tasks, interviewing patients for medical and administrative services and scheduling patient appointments for different clinics Primary Care, Family Planning, WIC, Dental, Physicals
- Maintained and released of medical information following all protocols per state and HIPAA law.
- Credited with interpreting 100% Spanish/English between provider and patient, driving complete understanding of medical information and medical terminology between doctors, nurses, medical staff, and patients.
- Explained treatment plan, setting goals to be evaluated every three months, guiding patients towards treatment options.
- Organized classes for Spanish-speaking patients on topics such as breastfeeding, educating pregnant patients who qualified for WIC program explaining certifications, different food packages provided by WIC according to mother’s preference on breast feeding or formula
- Interpreted during diabetic workshops.
Education
Humberto Lopez Y Lopez High SchoolTegucigalpa, Honduras
High School Degree
11.2001
Universidad Pedagógica Nacional De HondurasTegucigalpa, Honduras
Educational Administration
Skills
- Excellent at providing Customer Service by building rapport in each and every call
- Team Leadership/Coordination
- Customer Guidance & Support
- Patient/Client Need Assessments
- Customer Satisfaction & Retention
- Patients & Family Care/Advocacy
- Customer Experience Enhancement
- Exceptional Patient/Customer Service
- Revenue & Business Growth
- Problems & Issues Resolution
- HIPAA Compliance
Languages
English
Spanish
Timeline
Life Insurance Risk Interviewer
Quest Diagnostics
09.2022 - 02.2023
Customer Service Representative (Remote Contract with Talent Burst)
Evolent Health for Bright Health Plan
09.2021 - 08.2022
Case Investigator (Remote Contract with Rose International)
NASPO: AK
12.2020 - 02.2021
COVID-19 Contact Tracer
Bedford County Health Department
07.2020 - 09.2020
Medical Customer Service Representative
Lincare Holdings Inc.
06.2019 - 07.2020
Bilingual Public Health Office Assistant
Warren County Health Department
11.2017 - 05.2019
Humberto Lopez Y Lopez High School
High School Degree
Universidad Pedagógica Nacional De Honduras
Educational Administration
Overview
6
years of professional experience
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