Summary
Overview
Work History
Education
Skills
Certification
Awards
Languages
Personal Information
Timeline
Generic

Maria Jose Molina

Plantation,FL

Summary

Proven professional with extensive experience in healthcare and customer service, notably at UnitedHealth Group. Skilled in data analysis and Microsoft Excel, I excel in streamlining processes and enhancing service quality. Demonstrated ability to lead with empathy, significantly improving patient and client relations. Achieved a consistent track record of surpassing productivity and quality standards.

20 years of experience in an office environment, including Customer service, Quality control, Compliance, and assisting Management. I have vast knowledge of HMO, PPO, and PFFS Medicare/Medicaid products. Knowledge of fraud and abuse issues related to health care and Medicare/Medicaid along with knowledge of applicable laws and regulations. Experience in Advertising, Marketing, and Public Relations.

Overview

24
24
years of professional experience
1
1
Certification

Work History

Appointment Specialist I

Cleveland Clinic Florida
Weston, FL
04.2021 - Current
  • Preregisters new patients to the Cleveland Clinic, following the specific guidelines of CCF.
  • Determines correct physician within the specified department with the correct insurance and credentialing.
  • Verifies patient insurance eligibility to procure referrals for HMO patients seeing CCF specialists.
  • Schedules appointments requested through the CCF WEB site.
  • Meets standards related to call responses, accuracy and customer service.
  • Other duties as assigned.
  • High School Diploma, college or technical training a plus.
  • Phone, Typing computer and Internet skills.
  • Excellent interpersonal skills in order to communicate effectively with internal and external personnel and strong oral and written communication skills.
  • Must be able to work with patients, physicians and interoffice personnel in a positive and productive manner. Ability to calm patients and deter patient complaints.
  • Must have ability to multi-task.
  • Must speak clearly and succinctly in order for the customer to answer questions and comprehend instructions.
  • None required.
  • All employees are expected to meet the standards of performance outlined in the Organizational-Wide Competencies listed below as applied to the position: World Class Service Orientation: Includes attitude, behavior, interpersonal skill, and problem solving that enable an employee to respond to internal and external customer needs and expectations in a positive manner.
  • Adaptability: Includes teamwork and flexibility needed to fulfill job responsibilities including adapting to changes in work environment and accepting supervisory feedback.
  • Efficiency and Effectiveness: Includes quantity and quality of desired work, as well as organization skills necessary to perform successfully.
  • Essential Job Requirements: Includes adherence to all relevant policies, procedures, and guidelines affecting the work environment, including maintenance of required competencies and communication skills.
  • Supervisory Responsibilities (if applicable): Includes overall accountability for assigned work group relative to operational goals, personnel requirements, and budgetary constraints.
  • Note: The above stated duties are intended to outline those functions typically performed by individuals assigned to this classification. This description of duties is not intended to be all inclusive nor to limit the discretionary authority of supervisors to assign other tasks of similar nature or level of responsibility.
  • Minimum of one (1) year experience in the medical field and/or 2 years of customer service.
  • Able to relate to other health care workers and develop productive work relationships with peers and physicians.
  • Projects a cooperative helping demeanor.
  • Be able to perform under stressful conditions.
  • Is flexible and able to adjust to changes in assignments. Able to work under minimal supervision, prioritizes workload and meet required deadlines.
  • Ability to sit for long periods of time, work in front of a computer monitor and use keyboard for sustained periods of time. Must be able to walk about the department and lift and carry paper, notebooks up to 10 pounds without assistant.
  • The occupant of this position spends almost 100% of his/her time in air-conditioned areas.
  • The potential for exposure to blood-borne pathogens, body fluids or potentially infectious material is minimal to none.
  • Follows Standard Precautions using personal protective equipment as required for procedures.

Patient Relations Assistant

Memorial Regional Hospital South
Hollywood, FL
02.2019 - 02.2021
  • Oversees the Hospital's Service Recovery Program by serving as a link between patients, families, and the Hospital to respond to patient information inquiries and resolve questions
  • Responsible for interviewing patients and guests to ensure requests are accurately recorded, documented, and logged
  • Collaborates with Hospital administration and clinical staff in performance improvement efforts
  • Provides clerical and administrative support for the department
  • Answers questions and concerns about the Hospital, its policies, and patient rights
  • Enters, updates, and generates reports as needed
  • Responds to requests for information by other departments/agencies
  • Coordinates sensitivity and customer service training for the department as needed

Compliance Analyst

UnitedHealth Group
City of Sunrise, FL
04.2009 - 01.2011
  • Conducted daily audits and analysis of CMS regulatory guidance (Centers for Medicare and Medicaid Services) to prevent unethical or improper conduct in the organization
  • Worked with the Compliance Officer to coordinate audit activities across the organization
  • Performed post audit activities involving follow-up in preparing for final report packages
  • Assisted with preparation of CMS site visits and reports on CMS audits
  • Assisted with monitoring activities involving the effective execution of corrective action requirements imposed by CMS for Medicare/Medicaid contract deficiencies
  • Interacted with people from other areas to communicate issues that are related to Compliance
  • Performed special projects and other duties as assigned

Quality Specialist

UnitedHealth Group
Sunrise, FL
11.2006 - 04.2009
  • Presented Quality training material to UnitedHealth Care employees, including Supervisors
  • Participated in weekly Calibration sessions with other UnitedHealth Care sites to ensure consistency
  • Assisted Management with weekly and monthly reports
  • Constantly reported findings to Management staff in order to improve service and collaborated on process improvement initiatives
  • Provided face to face coaching to Customer Service representatives to help them improve on their Quality scores
  • Listened to and evaluated recorded and live calls from Customer Service representatives to verify that members received World Class Service
  • In charge of distributing and assigning teams among Quality Professionals (QP) to ensure a fair allocation of people for each QP to evaluate

Customer Service Representative

UnitedHealth Group
City of Sunrise, FL
10.2004 - 11.2006
  • Researched and resolved simple and complex customer service inquiries including: claim status, claim explanation, claim adjustments, benefits, eligibility, and authorizations
  • Consistently met established productivity, scheduled adherence, and quality standards
  • Consistently learned new skills and retained large amount of information, facts, codes, rules, and claim procedures

Counter and Reservations Agent

Grupo Taca Airlines
03.2001 - 10.2003
  • Office duties included coordinating meetings and training staff, in addition to maintaining reports and statistical analysis of different local company resources
  • Answered inquires such as schedules, fares and flight information using SABRE System
  • Trained new employees in order for them to meet the necessary requirements to complete their jobs
  • In charge of Travel Agencies Account Management, paying Travel Agencies commissions, and selecting top Travel Agencies according to sales reports

Education

Bachelor of Communications and Advertising - Marketing and Graphic Design

Universidad de Especialidades Espíritu Santo

Associates - Advertising

Universidad Casa Grande

Associates - Information Systems

Instituto Técnico Superior

Skills

  • EXCEL
  • MS EXCEL
  • OUTLOOK
  • PIVOT TABLES
  • POWERPOINT
  • SORTING
  • WORD
  • Microsoft Office
  • Microsoft Excel
  • MS Office
  • Typing
  • Data Analysis
  • CPR
  • EPIC
  • Follow-up skills
  • Client relationship building
  • Client-specific scheduling
  • Schedule verification
  • Customer service
  • Goal oriented
  • Data entry proficiency
  • Client relations
  • Production schedules
  • Strong work ethic
  • Teamwork and collaboration

Certification

BLS for Healthcare Providers, 06/01/19, 06/01/21

Awards

Highest GPA, 06/01/00

Languages

English
Native/ Bilingual
Spanish
Native/ Bilingual

Personal Information

Authorized To Work: US

Timeline

Appointment Specialist I

Cleveland Clinic Florida
04.2021 - Current

Patient Relations Assistant

Memorial Regional Hospital South
02.2019 - 02.2021

Compliance Analyst

UnitedHealth Group
04.2009 - 01.2011

Quality Specialist

UnitedHealth Group
11.2006 - 04.2009

Customer Service Representative

UnitedHealth Group
10.2004 - 11.2006

Counter and Reservations Agent

Grupo Taca Airlines
03.2001 - 10.2003

Bachelor of Communications and Advertising - Marketing and Graphic Design

Universidad de Especialidades Espíritu Santo

Associates - Advertising

Universidad Casa Grande

Associates - Information Systems

Instituto Técnico Superior

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Maria Jose Molina