Magdalena Pimentel Martinez
Summary
To succeed in an environment of growth and excellence and earn a job which provide me job satisfaction and self development and help me achieve personal as well as organizational goals. Authorized to work in the US for any employer
Overview
2023
2023
years of professional experience
Work History
Insurance Verification Specialist
Walgreens
- Respond to all levels of inbound Pharmacy Benefit Manager (PBM) and major medical insurance related phone calls
- Resolves questions and problems submitted by customers and Pharmacy Benefit Manager (PBM) following established guidelines and standard SOPs and procedures
- Utilizes all available information to choose the best solution and resolve customer and PBM concerns
- Process all PBM rejections which may include rejections for plan limits, coverage termed or prior authorization
- Facilitate of reimbursement windshields for PBM major medical claims
- Request and load insurance plans and process medical insurance referrals
- Identifies and assesses individual customer or patient needs and provide education on or assist with grant applications and complex funding needs along with appropriate action to satisfy those needs
- Provide primary support and expertise for specialized programs such as the patient assistance program or special handling
- Document contact interactions, records details, complaints, comments, and actions taken
- Will participate in special projects and perform all other responsibilities as deemed necessary
Customer Service Representative
Gainwell Technologies, Medi
03.2021 - 08.2022
- Performs standard, recurring processing and quality tasks in support of outsourced services within a specific industry and functional area
- Demonstrates knowledge and skill in assigned work processes
- Develops understanding of the client's business and applies knowledge to support efficient procedures and adherence to service level agreements
- Contributes to problem identification and resolution
- Interprets, audits and reconciles reports for accuracy or completeness
- Prepares and maintains standard reports for management and clients
- Handles company confidential data according to policy and guidelines
- Adheres to existing security policies and procedures.
Customer Service Representative
Medcore
05.2019 - 03.2021
- Communicate with a diverse customer (member/provider/health plans) base, regarding individual questions and concerns specific to plan benefits, coverage determinations, event information, claims and complaints, conducts inquiries and research related to questions and concerns, including claims status and related information
- Coordinates with others within and outside the organization to facilitate timely resolution of member, provider and health plan issues
- Data entry of professional claims
- Data entry of facility claims, Check source documents for accuracy
- Verify data and correct data where necessary
- Assist with daily provider correction reports
- Maintains the confidentiality of patient and organization information at all times.
Enrollment
BROOKSIDE OPTOMETRIC GROUP
06.2017 - 05.2019
- Greeting patients, checking in patients, faxing documents, answering multiple phone lines, scheduling patients, insurance verification and patient care coordination,using Microsoft,making charts, filing.
Education
High school diploma - General business occupation
Central Valley Opportunity Center
Modesto, CA2015
Skills
- Customer Service
- Fast learner
- Attention to Detail
- Multi-Tasker
- Bilingual (english/spanish)
- Insurance Verification (3 years)
- Data Entry
- Medical office experience
- Analytical Thinking
- Understanding of Medical Terms
- Prior Authorization Processing
- Medicaid Knowledge
- Medical Terminology
- Data Entry and Review
- Coordination and Scheduling
- Telephone Etiquette
- Critical Thinking
- Claims Processing
- Insurance Knowledge
- Problem Solving
- Time Management
- Insurance Verification
Timeline
Customer Service Representative
Gainwell Technologies, Medi
03.2021 - 08.2022
Customer Service Representative
Medcore
05.2019 - 03.2021
Enrollment
BROOKSIDE OPTOMETRIC GROUP
06.2017 - 05.2019
High school diploma - General business occupation
Central Valley Opportunity Center
Insurance Verification Specialist
Walgreens
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