Maria Rodriguez
Griffin,GA
Summary
Goal-oriented, highly motivated professional dedicated to achieving excellence, maintaining client confidentiality, and delivering exceptional customer service. Skilled in analyzing and resolving issues, utilizing outstanding communication skills, and leveraging my education. Possess a high level of proficiency in both written and oral communication. Experienced in utilizing QuickBooks and capable of typing at a speed of 55 words per minute. Fluent in both Spanish and English, with a strong command of medical terminology. Proficient in navigating Marketplace, Medicaid, and Medicare systems, as well as conducting appeals and grievance reviews. Open to relocation opportunities.
Overview
13
13
years of professional experience
Work History
Customer Relations Representative
Graham Field Health Inc
08.2023 - 11.2024
- Provided excellent customer care by responding to inquiries about product functionality, pricing, and availability.
- Developed rapport with customers by maintaining clear communication lines, fostering trust, and demonstrating empathy.
- Managed customer orders, including delivery scheduling and coordination.
- Strengthened customer relationships by listening to customer concerns and giving priority to service requirements.
- Entered EDI orders.
- Worked with ERP system.
Medical Program Specialist
CoPilot Provider Support Services
08.2022 - 08.2023
- Researches and obtains information regarding patient's insurance coverage and benefits request investigations submitted by MD (medical doctors) office.
- Contacts insurance companies to obtain info on patient's medical benefits.
- Obtains each case’s medical benefits for procedure/diagnosis codes for requested or prescribed medication or treatment.
- Handle benefits request investigations submitted by MD offices.
- Bilingual Provider
Molina Healthcare
08.2018 - 06.2022
- Researches and articulately communicates information's regarding member eligibility, benefits, EP services, claims status, Authorization inquiries to callers while maintaining confidentiality
- Actively listens and probes callers in a professionally and timely manner to determine purpose of the calls
- Resolves customer administrative concerns as the first line of contact- this may include claim resolutions and other expressions of dissatisfaction
- Assists in the mentoring and training of new staff
- Assumes full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions
- Educates providers on how to submit claims and when/where to submit a treatment plan
- Identifies and responds to Crisis calls and continues assistance with the clinician until the call has
- Been resolved
- Informs providers and members on Magellan's appeals process
- Perform necessarily follow up tasks to ensure member or provider needs are completely met
- Provides information regarding In-network and Out of network
- Thoroughly documents customers comments/information and forwards required information to the appropriate department.
Spanish Operator / Customer Service
Stratus Video Interpreters
05.2012 - 06.2018
- Answer Inbound and Outbound calls route outside calls to all the departments
- Place, outsource, transfer and connect conference calls
- Send invoices to appropriate Insurance Companies
- Look up referrals and assist in data entry
- Provide information, document interactions, schedule appointments
- Delivery message to patients regarding appointment schedules, cancellations and rescheduling appointments.
Education
Associate of Applied Science - Medical
Florida Technical College
07.2012
High School Diploma -
Carl Schurz High School
06.2008
Skills
- Capable of typing 55 wpm
- Detail-oriented
- Customer retention
- Attentiveness in verbal and written communication
- Customer Service
- CRM software
- Proficient in medical terminology
- Medical coding
- Bilingual Spanish
- Proficient in QuickBooks
- Medical office experience
- Insurance verification
- Team leader and Team player
- Proficient in Microsoft word, excel, and outlook
- ICD-10
- Care plans
Languages
Spanish
Native or Bilingual
Timeline
Customer Relations Representative
Graham Field Health Inc
08.2023 - 11.2024
Medical Program Specialist
CoPilot Provider Support Services
08.2022 - 08.2023
Molina Healthcare
08.2018 - 06.2022
Spanish Operator / Customer Service
Stratus Video Interpreters
05.2012 - 06.2018
High School Diploma -
Carl Schurz High School
Associate of Applied Science - Medical
Florida Technical College
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