Juliana Maldonado
San Diego,CA
Summary
Seeking a challenging but fulfilling role as a health care professional,I am skilled at coordinating busy offices and maintaining professionalism in stressful situations. Dedicated to learning, growing, and succeeding in Health Care. A person who is open to new ideas; and a creative and flexible individual who is comfortable working in a large, complex organization. Reliable employee offering excellent communication and good judgment.
Overview
7
7
years of professional experience
Work History
Customer Service Rep|Billing and Claims Rep
Sharp Healthcare PFS
05.2022 - Current
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Answered constant flow of customer calls with minimal wait times.
- Participated in team meetings and training sessions to stay informed about product updates and changes.
- Handled customer inquiries and suggestions courteously and professionally.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Served as a subject matter expert on specialized claims, providing guidance and support to other team members when needed.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
Clinical Services Liaison|UM Clinical Services
Physicians Data Trust
01.2019 - 01.2022
- Verify eligibility & benefits for each submitted physician referral Process and complete authorization request forms into the company's in-house system Create denial letters in timely manner to ensure TAT is met Answering phone calls coming into the UM department Collaborate with the CM to ensure all members are assisted with the coordination of care
- Served as the primary point of contact, fostering strong relationships between internal teams and external partners.
- Provided detailed progress reports to stakeholders throughout project lifecycles, ensuring transparency regarding status and outcomes.
- Liaised between internal departments and external partners to promote efficient communication and collaboration.
- Coordinated multiple projects simultaneously, ensuring timely completion and alignment with organizational objectives.
- Collected and analyzed data and feedback to identify opportunities to improve relationship between other entities and business.
CMC-SNP Coordinator|UM Clinical Services
Physicians Data Trust
01.2018 - 01.2019
- Assist updating Health Risk Assessments (HRA) Follow up with patients after doctor appointments Assisting with member cover letters Assisting CMC/SNP nurses with contacting patients via phone call Obtained medical records from primary care physicians
- Improved team productivity with regular communication and progress updates, fostering a collaborative work environment.
- Entered data, generated reports, and produced tracking documents.
- Enhanced customer satisfaction by responding promptly to inquiries and addressing concerns professionally.
- Used job-related software to draft and finalize written correspondence and documentation.
Dental assistant-Dental receptionist
West Coast Smiles
01.2017 - 01.2018
- Welcome patients in Insurance verification Chair assist Dr
- Sanitize any tools/ clean rooms Help clients with any paperwork Scheduling Help Dr
- With anything needed Take incoming calls Treatment planning
- Documented patient dental health information, medical history, and vital signs for future reference.
- Scheduled appointments for new and existing customers, factoring in provider availability and scheduling loads.
- Reduced appointment cancellations by implementing reminder calls and text messaging services, resulting in improved scheduling efficiency.
- Promoted ongoing professional development by attending industry conferences, seminars, workshops.
Education
Orange Glen High School
01.2016
Skills
- Bilingual English/Spanish Speaker
- Centricity/HER/EPIC
- Effective Communicator
- Outstanding Customer Service Skills
- Varied Computer skills ( Word, Excel, Access, Outlook
- Team Player
- Problem-solving abilities
- Self-Starter
- Knowledgeable with IPA management
- Claims Processing Managed Care setting
References
- Laura Saavedra, (760) 481-4355
- Marioly Ramos, (760) 580-2340
- Camille Arredondo, (760) 994-3001
Timeline
Customer Service Rep|Billing and Claims Rep
Sharp Healthcare PFS
05.2022 - Current
Clinical Services Liaison|UM Clinical Services
Physicians Data Trust
01.2019 - 01.2022
CMC-SNP Coordinator|UM Clinical Services
Physicians Data Trust
01.2018 - 01.2019
Dental assistant-Dental receptionist
West Coast Smiles
01.2017 - 01.2018
Orange Glen High School
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