KIMBERLY zAYAS
Suncity Center,FL
Summary
Results-driven Supervisor with experience steering and directing all aspects of operations. Practiced in orchestrating multiple projects with competing priorities involving process improvements, safety initiatives and quality control. Recognized and commended for collaborating with upper management to achieve organizational objectives.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Authorizations Supervisor
Centene Corporation
Tampa, FL
05.2024 - Current
- Directed and supervised team of 15 employees in daily operations.
- Developed and implemented operational policies and procedures to ensure efficiency and accuracy of workflows.
- Tracked progress on projects and provided timely feedback to staff members.
- Recruited, hired, trained, mentored, coached, evaluated, and terminated staff as necessary.
- Conducted weekly meetings with team members to discuss upcoming tasks and project deadlines.
- Monitored employee productivity levels on a regular basis to identify areas of improvement.
- Reviewed reports from subordinate staff members before submitting them to senior management.
- Collaborated with other departments to coordinate workflow processes between teams.
Referral specialist I
Centene Corporation
Tampa, FL
05.2020 - Current
- Assist in monitoring utilization of medical services to ensure cost-effective use of medical resources through processing prior authorizations.
- Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list.
- Route to appropriate staff when needed.
- Verify eligibility and benefits.
- Process faxes within established standards.
- Data enters authorizations into the system.
- Creating authorization request for long-term care members and skilled nursing facilities.
- Working hand in hand with all of the facilities in the state of Florida to ensure patient care.
Service Center Representative
Orthopedic Medical Group
Brandon, FL
09.2017 - Current
- Provide Customer Service and medical administrative support for six offices
- Handle a high volume of calls while properly addressing patient's needs
- Schedule new patient appointments/ post-operative appointments
- Call health insurance companies to verify benefits
- Submit referrals and authorizations into EMR
- Work directly with primary care physicians in regard to obtaining referrals and authorizations on behalf of patients
- Call in prescription medication into patients preferred pharmacy
- Adapted to dynamic changes with-in the company
Patient Account Representative
Chambers Medical Group
Brandon, FL
04.2016 - Current
- Work directly with attorney's regarding personal injury cases
- Monitor, call and collect medical debt from patients directly
- File claims using ICD-9 codes to insurance companies
- Call car insurance companies to file PIP claims on behalf of patients
- Follow through with PIP benefits for patients in the state of Kentucky
- Make new patient appointments in the system
- Negotiate full and Final agreements on patient account balances
- Collect patients account balances from accounts receivable report
- Effectively train newly incoming workers
- Answer phone calls in a busy environment
- Adapted to dynamic changes with-in the company
- Completed monthly goals on or before deadline
Patient Care Coordinator
BLOOMINGDALE MEDICAL ASSOCIATES
Riverview, FL
04.2018 - 05.2020
- Patient care Coordinator- Front desk handles and resolves patient inquiries, schedule future appointments for labs x-rays and ultrasounds
- Check in and check out patients, answer phone calls in a very busy environment
Quality Specialist Supervisor
General Dynamics Information Technology
Riverview, FL
08.2015 - 03.2017
- Evaluates recorded conversations between the agent and caller using the QA evaluation solution for the program, providing context for ratings
- Evaluates interactions with customers or consumers for all contact center channels in multiple channel programs using the appropriate QA solutions
- Provides accurate scoring per approved criteria definitions, quality standards and standard operating
- Effectively communicates results to agents both verbally and in written format, providing agents a path to appropriate reference materials for additional guidance
Customer Service Representative| Parts A & B Claims Tier
06.2015 - 08.2015
- Answering inbound calls about general questions related to the federal health insurance of Medicare
- Providing detailed reasons on denied claims related to medical services rendered
- Experience with Medical Coding and billing files
Customer service representative
07.2014 - 06.2015
- Provide resolutions to detailed inquiries from consumers
- Transfer calls to the appropriate line of business when necessary
- Follow the call management framework while assisting callers
- Maintain and provide piece of mind to upset/ frustrated callers to exceed in quality expectations
- Enrollment in Part D drug plans of Medicare
Education
High School Diploma -
Bloomingdale High School
01.2014
Associates in Arts -
Hillsborough Community College
07.2018
Associate of Science - Nursing
Rasmussen University
Tampa, FL09-2025
Skills
- Customer service
- Oral communication
- Written communication
- Bilingual (English and Spanish)
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Microsoft PowerPoint
- Flexibility
- Deadline management
- Attention to detail
- Adaptability
- Problem solving
- Attendance
- Punctuality
- Typing (40 WPM)
- Computer skills
- Online navigation
- Training
- Analytical skills
- Sales experience
- Accounts Receivable
- Staff Management
- Operations Management
- Data Analytics
- Employee Motivation
References
Provided per request
Accomplishments
- Graduated from highschool in National Honor Society with a 4.8 GPA.
- Deans List All throughout Nursing school upholding a 3.94 GPA.
Languages
English
Professional
Spanish
Professional
Certification
- BSL (Basic Life Support + CPR Certified)
Timeline
Authorizations Supervisor
Centene Corporation
05.2024 - Current
Referral specialist I
Centene Corporation
05.2020 - Current
Patient Care Coordinator
BLOOMINGDALE MEDICAL ASSOCIATES
04.2018 - 05.2020
Service Center Representative
Orthopedic Medical Group
09.2017 - Current
Patient Account Representative
Chambers Medical Group
04.2016 - Current
Quality Specialist Supervisor
General Dynamics Information Technology
08.2015 - 03.2017
Customer Service Representative| Parts A & B Claims Tier
06.2015 - 08.2015
Customer service representative
07.2014 - 06.2015
High School Diploma -
Bloomingdale High School
Associates in Arts -
Hillsborough Community College
Associate of Science - Nursing
Rasmussen University
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