Mariam Segarra
Middletown
Summary
Results-driven professional with a solid background in customer service and management. Adept at meeting organizational and client demands, utilizing expertise to ensure optimal customer satisfaction and propel business growth. Eager to leverage skills and motivation to contribute to the success of an institution.
Overview
13
13
years of professional experience
Work History
Quality Assurance Manager
Montefiore Medical Center
08.2022 - Current
- Conduct regular audits to ensure adherence to established protocols, maintaining consistency across the organization.
- Train team members on quality assurance principles, fostering a culture of accountability and high performance.
- Facilitate communications between departments regarding quality concerns, fostering collaboration towards shared goals.
- Enhanced product quality by implementing comprehensive QA processes and procedures.
- Assured consistent quality of production by implementing and enforcing automated practice systems.
- Investigate customer complaints and performed corrective actions to resolve quality issues.
- Assess performance quality by monitoring quality assurance metrics, reports and dashboards.
- Record, analyze, and distribute statistical information to all stakeholders.
- Implemented scorecard system, improving agent performance and service.
- Improved team productivity and morale by establishing clear goals and recognizing achievements.
- Applied coaching techniques and tools to support managers and team members in improving performance.
- Determined quality department standards, practices, and procedures.
- Mentor Quality Analysts in best practices for quality management, contributing to overall team growth and development.
Quality Analyst
Montefiore Medical Center
10.2015 - 08.2022
- Evaluated individual and departmental performance to assure the implementation of quality standards
- Provided performance and quality measurements to management for training needs
- Monitored agent calls for scheduling and billing lines in the Patient Access center
- Helped maximize the operational efficiency of each department by identifying areas of opportunity, Facilitate trainings, and call coaching sessions to help improve the development of liaisons
- Reported the outcome of quality trainings and call coaching sessions to management for review
- Investigated Patient/Customer complaints and non-conformance issues and handle accordingly
- Ensured liaisons are providing accurate information and following departmental guidelines while providing an exceptional customer service experience to all callers
- Performed internal audits for process improvement
- Facilitated training for all new hires
- Analyzed quality and performance data to support operational decision-making.
- Created and revised procedures, checklists and job aids to reduce errors.
- Developed and maintained quality assurance procedure documentation.
- Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
Customer Service Liaison
Montefiore Medical Center
07.2013 - 10.2015
- Handled high volume of calls in a contact center environment while exuding a professional and helpful demeanor
- Handled Patient/Provider claim and billing inquiries
- Electronically billed all facility and professional services in EPIC, IDX, and HSR billing systems
- Evaluated Insurance denials and escalated insurance claims for correct insurance payment
- Reviewed insurance explanation of benefits to determine correct payment and denial postings
- Made adjustments to Patient account balances following departmental guidelines
- Reviewed Patient statements for discrepancies or inaccurate billing
- Evaluated account balances and established budget payment plans
- Maintained strict Patient confidentiality and adhered to all HIPAA guidelines and regulations
- Verified and provided Emblem CMO benefits, claims and authorizations status to Medical Providers
- Accurately documented all verbal and written appeals received via mail and forwarded for processing
- Enhanced customer satisfaction by efficiently resolving inquiries and addressing concerns.
- Exceeded performance targets consistently by applying excellent organizational skills and attention to detail.
- Provided valuable input during process improvement discussions, contributing ideas drawn from daily client-facing experiences.
- Conducted regular quality assessments to identify areas for improvement and provide constructive feedback to colleagues.
Contract Assistant
Orthonet, LLC (United Health Care; Oxford)
08.2011 - 07.2013
- Handled high volume of calls in a call center environment
- Used CPT-4/ICD-9 coding and CPT coding for initial precertification requests
- Collected clinical information that met the medical criteria into Citrix/Pulse system for precertification
- Processed authorizations for Orthopedic, Podiatry, Pain Management, Physical Medicine & Rehab, Neurology, Hand Surgery, Durable Medical Equipment cases
- Performed routine clerical duties for Senior Management
- Prepared and completed daily action logs for appropriate follow-up and processing of requests for time sensitive cases
- Processed web requests for medical procedures
- Participated in training classes related to Confidentiality, Conflict of Interest, HIPAA, URAC, Regulatory Compliance, and department specific trainings
- Documented transactions received by phone, email or mail into multiple databases
- Coordinated with Nurse case-managers to assure that clinical information was received and entered into ECAA systems appropriately while documenting turnaround time
- Trained all new hires and developed all training materials and workflows
Education
LaGuardia CC
05.2009
Skills
- Bilingual: English/Spanish (verbal and written)
- Management skills
- Analytical skills
- EPIC
- Cisco
- NICE
- Verint
- MS Office
- QNXT
- Quality Assurance
- Training
Timeline
Quality Assurance Manager
Montefiore Medical Center
08.2022 - Current
Quality Analyst
Montefiore Medical Center
10.2015 - 08.2022
Customer Service Liaison
Montefiore Medical Center
07.2013 - 10.2015
Contract Assistant
Orthonet, LLC (United Health Care; Oxford)
08.2011 - 07.2013
LaGuardia CC
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