Jacqueline M Babin
Gulfport,MS
Summary
To obtain a position in which I can demonstrate my capabilities to the fullest and continuously strive to better, not only myself, but my employing company. Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
14
14
years of professional experience
Work History
Care Review Processor - Utilization Management
Molina Healthcare
, VA
05.2022 - Current
- Reviewed medical records to ensure compliance with state and federal regulations.
- Conducted initial review of all care requests to determine if they meet criteria for approval or denial.
- Compiled data from multiple sources to assess patient's health needs and eligibility for services.
- Documented findings, decisions and recommendations in a timely manner.
- Evaluated claims for accuracy and completeness prior to submission for payment processing.
- Identified discrepancies or errors in documentation or coding that might affect reimbursement levels.
- Collaborated with other departments on complex cases involving multiple providers or services.
- Interpreted insurance policies and government regulations related to healthcare coverage requirements.
- Provided assistance in resolving billing issues between providers, patients and insurance companies.
- Maintained accurate records of all reviews conducted according to established guidelines.
- Participated in training sessions regarding changes in policies and regulations impacting care review processes.
- Attended meetings with management staff to discuss best practices related to care reviews.
- Provided customer service support by responding promptly to inquiries from providers, payers and other stakeholders.
- Utilized computer software programs designed specifically for reviewing medical claims and records.
- Monitored performance metrics such as turnaround time, accuracy rate., and made adjustments as needed.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Answered telephones and directed calls to appropriate medical or administrative staff.
- Communicated with patients with compassion while keeping medical information private.
- Managed front office customer service, appointment management, billing and administration tasks to streamline workflow.
- Transmitted medical records and other correspondence by mail, e-mail, or fax.
- Completed relevant insurance and other claim forms.
Community Connector/Mentor
211 San Diego
San Diego
04.2020 - Current
- Assist supervisor with developing improvement strategies, making recommendations, suggesting training programs, and offering advice and guidance
- Assist with onboarding of new agents or any agent to our department
- Provides empathic, responsive, and relevant telephonic responses to calls made to 2-1-1 San Diego or other specialty lines
- Performs in-depth screenings and assessments, collects client information, and sends information via direct referral (if applicable) to most appropriate community service
- Conducts outreach and education regarding programs that may offer additional assistance to clients, which may include public benefit programs, discount programs, and the Community Information Exchange (CIE)
- Provides application assistance for community services
- Receives referrals of complex cases from various sources, conducts outbound outreach campaigns, and offers follow-up services and/or enrollment in resource navigation
- Collaborates with other team members to develop individualized care plans for high-needs clients.
Child Care Director
Heavenly Care Child Care
03.2018 - 01.2019
- Responsible for the daily operations of a daycare center
- Manage teaching staff, develop curricula in coordination with teachers, communicate with parents, and uphold the center's reputation
- Supervise and monitor the safety of children in their care
- Prepare meals and organize mealtimes and snacks for children
- Help children keep good hygiene
- Change the diapers of infants and toddlers
- Organize activities or implement a curriculum that allow children to learn about the world and explore interests
- Develop schedules and routines to ensure that children have enough physical activity, rest, and playtime
- Watch for signs of emotional or developmental problems in children and bring the problems to the attention of parents
- Keep records of children's progress, routines, and interest.
Inside Sales Representative Call Center
Curves Jenny Craig Inc.
06.2015 - 06.2017
- Accountable for membership Sales, and food sales
- Meet personal/team qualitative and quantitative targets
- Conduct all Inbound calls and proactively make outbound calls with sales script
- Responsible for seeking self development through call recording to expand knowledge and salesmanship
- Consistently meet weekly performances expectations
- Build sustainable relationships and engage customers by taking the extra mile
- Adhering to changes in sales scripts, entering all leads, booking center appointments, pre selling corporate center memberships
- Oversee any customer service issues that may come though sales line and communicate all workflow issue to supervisors
- Maintain records of daily sales through tracking method provided by the company and in charge of submitting appropriately.
Business Development Manager
Curves Jenny Craig Inc.
03.2016 - 01.2017
- Keep current Franchise Owners on target with marketing materials, and pursuing leads
- Understand the market, including industry, company, project, company contacts and which market strategies can be used to attract clients
- Possess a strong understanding of company products, and our competition in the industry and position
- Close renewal deals by coordinating requirements; developing and negotiating contracts; integrating contract requirements with business operations
- Developing a strategy with franchise owners and have them focus on both on financial gain and customer satisfaction
- Encourage franchise owners to attend company workshops
- Review and process franchise agreements to ensure adherence to law- establish rules and guidelines
- Promote the company's products/services addressing or predicting profit and loss and member retention.
Customer Service Representative
Curves Jenny Craig Inc.
06.2015 - 03.2016
- Determines requirements by working with customers
- Answers inquiries by clarifying desired information; researching, locating, and providing information
- Resolves problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems
- Fulfills requests by clarifying desired information; completing transactions; forwarding requests
- Placing and refunding food orders
- Processing and scheduling reshipment's
- Recognizing opportunities to up-sell accounts; explaining new features
- Keeping equipment operational by following established procedures; reporting malfunctions
- Managing large amounts of inbound and outbound calls in a timely manner
- Keep records of all conversations in our call center database in a comprehensible way.
B-kid's activities coordinator/service manager's assistant/childcare attendant
B2be Sports and Wellness
08.2010 - 05.2013
- Check facility to make sure that it's up and running for the day, and make sure everything is organized
- Provide a daily class roster for all instructors and b-kids attendants
- Supervise, plan and organize projects for children
- Consult, money handling and process billing for swim team, stroke school, child and adult swim classes, b-kids fitness programs and child care
- Heavy customer service
- Supervise member's children while maintaining a safe and fun environment throughout their stay
- Implement arts and crafts with the children
- Supervise fitness class rosters and attendance.
Education
Associate of Science - Business Administration And Management
Mississippi Gulf Coast Community College
Gulfport, MS06-2025
A Behavioral Science for children and special needs -
Grand Canyon University
05.2024
Skills
- Bilingual Spanish: Verbal communication, comprehension, reading and writing
- Healthcare knowledge
- HIPAA Compliance
- Computer literate; Microsoft Office, Excel
- Compliance Monitoring
- Policy Interpretation
- Insurance knowledge
- Documentation Review
- Insurance Verification
- Medical Terminology
- Medical Coding -CPT Coding
References
References are available upon request. Thank you.
Languages
Spanish
Professional
Timeline
Care Review Processor - Utilization Management
Molina Healthcare
05.2022 - Current
Community Connector/Mentor
211 San Diego
04.2020 - Current
Child Care Director
Heavenly Care Child Care
03.2018 - 01.2019
Business Development Manager
Curves Jenny Craig Inc.
03.2016 - 01.2017
Inside Sales Representative Call Center
Curves Jenny Craig Inc.
06.2015 - 06.2017
Customer Service Representative
Curves Jenny Craig Inc.
06.2015 - 03.2016
B-kid's activities coordinator/service manager's assistant/childcare attendant
B2be Sports and Wellness
08.2010 - 05.2013
Associate of Science - Business Administration And Management
Mississippi Gulf Coast Community College
A Behavioral Science for children and special needs -
Grand Canyon University