Liza Mary Garcia Cardona
Providence,RI
Summary
Personable and dedicated Customer Service Representative with extensive experience in Health industry. Solid team player with upbeat, positive attitude and proven skill in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Articulate, enthusiastic and results-oriented with demonstrated passion for building relationships, cultivating partnerships and growing businesses.
Overview
27
27
years of professional experience
1
1
Certification
Work History
Associate Medicare Costumer Services
Blue Cross Blue Shield Of Rhode Island
Providence, RI
01.2018 - 09.2023
- Respond to Medicare members written or telephone inquiries
- Educate members and clearly respond to inquiries concerning products, benefits and eligibility or billing
- Ensure compliance in all aspects of activities with internal policies as well as all regulatory agencies
- Identify cross-sell opportunities for ancillary products such as dental insurance; Maintain records of customer interactions process changes to members account, record inquiry details and actions and refer unresolved issue to appropriate internal department for additional research.
Customer Services Representative
Automated Health System
East Providence, RI
07.2017 - 01.2018
- Respond to inquiries which include, but are not limited to: billing\payment, notices renewals, enrollment, coverage issues, benefit questions, health plan selection, technical assistance, changes in circumstance, account update, tax credit questions, 1095 inquiries, policy, complex case resolutions and referrals to other agencies or programs
- Assists consumers to navigate through the Medicaid Expansion program (based on Modified Adjusted Gross Income parameters- MAGI), Advanced Premium Tax Credit(APTC), Small Business Health Option Program (SHOP), and the non-subsidized uninsured seeking services related to Qualified Health Plans(HPS) Present plans/carrier in a manner that does not provide any recommendations or preferences for one plan/carrier over another and instead solely provides fact-based information, explanations and guidance
Pharmacy Specialist
MMM Holding
San Juan, PR
03.2015 - 06.2017
- Receive inbound phone calls from members and providers regarding clinical medication evaluations
- Applied policy of HIPPA
- Assess pharmacy situations on an individual basis, using your analytical and pharmacy skills, document your solutions, and ensure that the arrangements you have decided upon are consistently adhered
- Knowledge of Medical Terminology
- Knowledge of Pharmacy claims processing
- Document case information according to decision made
- Manage member and/or provider issues related to a clinical decision
Pharmacy Specialist
Triple SSS
Hato Rey, PR
10.2013 - 03.2015
- Receive inbound phone calls from members and providers regarding clinical medication evaluations
- Applied policy of HIPPA
- Assess pharmacy situations on an individual basis, using your analytical and pharmacy skills, document your solutions, and ensure that the arrangements you have decided upon are consistently adhered t
- Knowledge of Medical Terminology
- Knowledge of Pharmacy claims processing
- Document case information according to decision made
- Manage member and/or provider issues related to a clinical decision
Pharmacy Specialist
Humana INC
Hato Rey, PR
10.2011 - 10.2013
- Receive inbound phone calls from members and providers regarding clinical medication evaluations
- Applied policy of HIPPA
- Assess pharmacy situations on an individual basis, using your analytical and pharmacy skills, document your solutions, and ensure that the arrangements you have decided upon are consistently adhered t
- Knowledge of Medical Terminology
- Knowledge of Pharmacy claims processing
- Document case information according to decision made
- Manage member and/or provider issues related to a clinical decision
Pharmacy Technician
Farmacia Caridad
Caguas, P.R.
01.2011 - 11.2011
Pharmacy Technician
Drogueria Castillo
Guaynabo, P.R.
09.2007 - 10.2010
Customer Service Representative
Maximus
Rancho Cordova, CA
02.2006 - 08.2007
- Assisted incoming calls, Responds to 800-line calls
- Maintains updated knowledge to this job position
- Provides beneficiaries with status of enrollment/disenrollment, medical exemptions and waivers
- Meets Production and Quality Assurance goals as defined in policy for this position
- Maintains an acceptable attendance record as outlined in the Employee Manual
- Performs other duties as may be assigned by management
Pharmacy Technician
Farmacia Caridad
Luquillo, P.R.
10.1996 - 01.2002
- Reviewed and processed prior authorization request from physicians and pharmacies
- Applied medical policy criteria authorization request
- Assigned entered and document claim processing system
- Maintain Inventory; Responsible for client service
Sales Costumer Services
- Costumer Services
- Assisted incoming calls
- Sales pharmaceutical drugs
Education
Certificate - Chef
Instituto de Banca y Comercio
08.2002
Associate - Pharmacy Technician
Centro de Estudio Multidisciplinario Humacao
06.1995
Additional Information
Skills, Bilingual Spanish and English, Proficient in Word, Excel, Power Point, Outlook, PA Hub, Provider Maintenance, SXC, RXCLAIM, RX 30, SAP; Typing ten key; Basic of Yellow Belt, Proficiency in Argus, CCMS, PHMS Environment Selection, Citrix, Sales Forces , soft phone Five 9
Certification
- Pharmacy Technician in P.R.
Timeline
Associate Medicare Costumer Services
Blue Cross Blue Shield Of Rhode Island
01.2018 - 09.2023
Customer Services Representative
Automated Health System
07.2017 - 01.2018
Pharmacy Specialist
MMM Holding
03.2015 - 06.2017
Pharmacy Specialist
Triple SSS
10.2013 - 03.2015
Pharmacy Specialist
Humana INC
10.2011 - 10.2013
Pharmacy Technician
Farmacia Caridad
01.2011 - 11.2011
Pharmacy Technician
Drogueria Castillo
09.2007 - 10.2010
Customer Service Representative
Maximus
02.2006 - 08.2007
Pharmacy Technician
Farmacia Caridad
10.1996 - 01.2002
Sales Costumer Services
Certificate - Chef
Instituto de Banca y Comercio
Associate - Pharmacy Technician
Centro de Estudio Multidisciplinario Humacao
- Pharmacy Technician in P.R.
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