Summary
Overview
Work History
Education
Skills
Timeline
Generic

Johanna Reyna Meraz

Phoenix,AZ

Summary

Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

Overview

8
8
years of professional experience

Work History

Care Navigation Specialist

Oscar Health
Tempe , AZ
02.2018 - Current
  • Perform and complete escalations from Care Navigation Guides.
  • Plug in and collaborate in cross-departmental meetings acting as a liaison for Care Navigation.
  • Act as Subject Matter Experts (SME’s) to help answer content questions from the team
  • Identify, track and communicate trends with escalations.
  • Review searches to ensure quality work is being produced
  • Provide feedback and mentorship to Care Navigation Guides
  • Garner departmental feedback and present to Experts and Managers
  • Be available for special projects as necessary

Bilingual Care Guide

Oscar Health
Phoenix, Az
03.2017 - 02.2018


  • Provide relevant, refined and impactful personalized options that address the members' specific care requests while staying within SLA and meeting access standards.
  • Collaborate with RNs to effectively route care
  • Discover and communicate trends in order to improve processes and the member experience.
  • Effectively utilize all resources to navigate complex cases.
  • Confirm and update provider data.
  • Properly document tickets.
  • Stay current on all information, updates, processes, and workflows.
  • Explanation of Plan Coverage in detail
  • Explanation of Medical and Prescription Claims
  • Process Payments
  • First Call Resolution
  • De-escalate supervisor calls
  • Technical Support
  • Assist Members with Online Account
  • Assisted in Training/Shadowing
  • Appointment Setting
  • Publication Orders

Sales/ Mass Health Representative

Optum Health, UHG, Medicare
Phoenix, Az
09.2016 - 02.2017
  • MAPD/PDP Enrollments
  • Explanation of Group Plan Benefits
  • Plan Comparison
  • Publication Orders
  • Appointment Setting
  • Transfers/Referrals
  • Check Applications for Accuracy
  • Submit Paper Applications Online
  • Close/Open Cases
  • Process Sent Verifications
  • Assistance with Special Projects
  • Notate/Return Incorrect Applications

Bilingual Customer Service Representative

McKesson Specialty Health
Scottsdale, Az
11.2015 - 08.2016
  • Enroll patients into Enbrel Support
  • Medicare Screenings
  • Insurance Verifications
  • SSA LIS Application Assistance
  • Activate/Renew Support Cards
  • Send Fulfillment items
  • Problem Solving/De-Escalate Issues
  • Nurse Partner Program Enrollments
  • Relay Insurance Benefits
  • Report Patient Adverse Events
  • Enroll Patients into Reimbursement
  • Escalate issues not resolved in call
  • Medicare Solutions Consultation
  • Transferring Patients to RN Line
  • Conferencing Patients/Pharmacies for Claim Resolution

Bilingual

General Dynamics
Phoenix, Az
08.2014 - 10.2015
  • Medicare CSR
  • Prescription Plan Enrollments
  • Plan Consultations/ Comparison
  • Creating Escalations
  • Submitting Fraud Complaints
  • Prescription Plan Complaints
  • Claim Assistance
  • Publication Orders
  • Problem Solving
  • Referrals to SSA and Medicaid
  • Assisted Supervisors with Quality
  • Reviews
  • Submitted Patient Feedback
  • Tenured CSR during Training
  • Assisted in Nesting

Cashier

Glendale Drive-Ins
Glendale, Az
02.2014 - 07.2014
  • Customer Service
  • Cashier
  • Food Preparation

Medical Assistant Externship

Scottsdale Family Health
Scottsdale, Az
02.2014 - 03.2014
  • Prior Authorizations
  • Call in Lab Results
  • Patient Data Entry
  • Scanning/Faxing
  • Record Patient Vitals
  • Insurance Verification
  • Front office
  • Charting
  • Back office


Education

Medical Assisting

Sanford Brown College
Phoenix, AZ
03.2014

High School Diploma -

Alhambra High School
Phoenix, Az
05.2009

Skills

  • Medical Terminology Knowledge
  • HIPAA Compliance Training
  • Multi-task 6 Computer Systems/
  • Microsoft Word/ Outlook & Excel
  • Computer skills with 45 wpm
  • Easy to Adapt
  • Work Well Under Pressure
  • Fast learner, Self-Starter,
  • Responsible, Dedicated, Punctual,
  • Reliable, Detail Oriented, Over
  • Achiever and Hard-worker

Timeline

Care Navigation Specialist

Oscar Health
02.2018 - Current

Bilingual Care Guide

Oscar Health
03.2017 - 02.2018

Sales/ Mass Health Representative

Optum Health, UHG, Medicare
09.2016 - 02.2017

Bilingual Customer Service Representative

McKesson Specialty Health
11.2015 - 08.2016

Bilingual

General Dynamics
08.2014 - 10.2015

Cashier

Glendale Drive-Ins
02.2014 - 07.2014

Medical Assistant Externship

Scottsdale Family Health
02.2014 - 03.2014

Medical Assisting

Sanford Brown College

High School Diploma -

Alhambra High School

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