Maria Juarez
Eloy ,AZ
Summary
Knowledgeable and dedicated customer service professional with extensive experience in medical benefit industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Medical Benefits Coordinator
CVS Aetna
05.2022 - Current
- Enhanced employee satisfaction by efficiently administering and managing benefits programs.
- Developed comprehensive benefits communications materials, resulting in increased employee understanding of available offerings.
- Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
- Provided training to new staff members on the intricacies of various insurance plans and their specific prior authorization requirements.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
- Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
- Optimized billing processes by implementing efficient invoicing and payment tracking systems.
- Increased accuracy of claims submissions with thorough understanding of ICD-10, CPT, and HCPCS coding systems.
Collection Escalations Specialist
CVS Omnicare
07.2021 - 05.2022
- Developed customized payment plans for clients experiencing financial difficulties to minimize losses.
- Established performance metrics to evaluate team success and identify areas for improvement.
- Managed escalated customer issues, providing resolutions that balanced both company interests and customer needs.
- Maintained accurate records of customer communications, payments, and account status for optimal reporting and analysis purposes.
- Demonstrated strong problem-solving skills by effectively resolving complex customer issues related to billing disputes and account discrepancies, leading to improved customer satisfaction levels and reduced resolution times.
Pharmacy Benefits Manager
CVS Caremark
07.2018 - 07.2021
- Improved patient outcomes by efficiently managing pharmacy benefit programs and optimizing medication therapy.
- Collaborated with pharmacists to resolve drug therapy issues, optimizing patients'' overall health outcomes.
- Improved patient adherence to medication regimens by offering personalized counseling on proper usage and potential side effects.
- Delivered exceptional service during high-volume periods, maintaining composure under pressure while managing multiple tasks simultaneously.
- Processed incoming drug orders by checking deliveries against paperwork and updating computer system.
- Cross-trained and provided backup support for organizational leadership.
Education
Associate of Applied Science - Nursing Administration
Central Arizona College
Coolidge, AZNo Degree - Dental Assisting
Carrington College - Phoenix
Phoenix, AZ03.2017
Skills
- Benefits Administration
- Benefits Explanation
- Medicaid Knowledge
- Prior Authorization Processing
- Coordination and Scheduling
- Insurance Coverage Verification
- Patient Education
- Pharmaceutical Knowledge
- De-Escalation Techniques
- Team Collaboration
Certification
Radiation health & Safety certification - Dental Assisting National Board 2017
Certified Pharmacy benefits manager, Rio Salado 2019
References
References available upon request.
Timeline
Medical Benefits Coordinator
CVS Aetna
05.2022 - Current
Collection Escalations Specialist
CVS Omnicare
07.2021 - 05.2022
Pharmacy Benefits Manager
CVS Caremark
07.2018 - 07.2021
Associate of Applied Science - Nursing Administration
Central Arizona College
No Degree - Dental Assisting
Carrington College - Phoenix