MARTHA CARDENAS MORALES
Albuquerque,NM
Summary
Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level as a Certified Peer Support Worker. Ready to help team achieve company goals. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Compiling of medical records and documenting findings.
Overview
11
11
years of professional experience
Work History
Member Connections Representative/CPSW
Centene Corporation For Western Sky Community Care
10.2018 - Current
- Provide Peer Support to certain Individuals as needed and educate people on their healthcare benefits through home and outreach contact
- Assist in projects in projects such as crisis calls, CIR Referrals, UNM CHW Referrals, mPulse Referrals, Member Connection Referrals PYX Referrals and SUD Outreach.
- Certified PED Determinate Assisting Individuals to Re-Enroll in their Medicaid Coverage for the ST of NM
- Assist in finding and connecting individuals with Community, Social Services, in Agencies, and locate providers that specialize in Behavioral Care.
- ED and Readmission Diversion and other high-Risk Member for Referrals by processing TOC with members via telephone for the purpose of providing proper resources prior to be discharge from Hospital.
- Direct Contact with CYFD Employees/Resource Parents on Assisting/Reviewing CISC Projects by Addressing HEDIS
- Attend Meetings such as MAB Meeting, and Proper Trainings
- Supported The Marketing Department for Outreach Events, and Manned out their table and providing WSCC Members with Educational Materials.
- Collected Lead Cards with member information to follow up calls regarding their covered benefits and services.
- I did a lots of assistance as a Member Connector, went above and beyond for members by discussing WSCC Value Add Services that other MCO's did not cover.
- Out in the Community by visiting several Homeless Shelters to provide Peer Support, File Housing Referral on Member's behalf, and Provide Other necessary Assistance.
- Assist Members with Activities in applicable settings and document information in their properly assigned file
Customer Service Representative
Centene Corporation For Western Sky Community Care
10.2018 - Current
- Provided Primary Customer Support to Internal Members on Covered Medical Benefit
- Provided Primary Customer Support to Internal Members on Covered Medical Benefit
- Order ID cards for Members as needed and Assisted by Correcting information in Member's Demographics
- Assisted Spanish Speaking Members with their Medical Concerns by Providing them with In -Network Providers in different Specialties and, schedule medical appointments.
- Assisted Spanish Speaking Members with their Medical Concerns by Providing them with In -Network Providers in different Specialties and, schedule medical appointments.
- Responded to calls in Contact Center Setting by Assisting Providers in their Medical Claim Denials, and Appeals Status by Reviewing and Providing them with the denial reasons, and directing them to their Medical Billing Department
- Organized Customer Information by helping Providers with Coordination of Benefits, timely filing, member's eligibility status, provider contract issues, among other necessary information for providers to send their corrected claims, and appeal
- Deescalated Calls, when Necessary, in Proper Techniques before obtaining supervisor assistance.
MSR II Customer Service
Molina Healthcare
08.2016 - 09.2018
- Responded to calls in a Contact Center Setting Facility to assist Providers in their Medical Claim Status, and Appeals status.
- Identified and responded to Provider's needs by Educating and explaining the proper reasons of their claim/appeal denials and provided them with the correct Timely Filing Limit to Submit Corrected Medical Claims
- Made Attempts to Resolve Provider's Issues by Assisting on sending Medical Claims for Review on Call Tracking System.
- Willing to inform Providers where to fax or mail Corrected Claims and Appeals
- Responded to Provider Needs by Assisting them with Medical Claim Status for Seven Different States including, CA, IL, NM, UT, FL, NY and MS Health Advisor for Members and Providers
- Deescalated Calls, when Necessary, in Proper Techniques avoiding supervisor's assistance
Customer Service Representative
Alorica Contact Center For United Healthcare
09.2015 - 08.2016
- Assisted Members and Providers with Customer Service for Medical Benefits targeting 100 or more calls per day
- Identified and responded to customer needs based on designated procedure for members/clients on their Medical Needs by assisting them with In Network Providers that will Assist them with their Medical Needs in different Specialties and Fields
- Made attempts to Resolve Customer Issues and Deescalated Problems of Irate Members and Providers Escalated calls to Team Lead or Supervisors, when Necessary, and Appropriate
- Entered Data in the Proper Software System, including Payment in account information, and call logs.
- Answered customer inquiries and provided accurate information regarding products and services.
Recruiter/Trainer Coordinator
Staffline Temporary Service
07.2013 - 07.2015
- Evaluated Strengths and Weaknesses of Candidates through effective Screening
- Recruited New Employees by processing Criminal Background Checks, and Administered Drug Test by using Saliva Drug testing, and E-verified each Employee to Verify Work Eligibility for Employment Purposes
- Set up Employee Taxes and placed Qualified Applicants with Specialized Assignments. Filed incident reports, complaints, and accidents reports on behalf of employees. Multiple Telephone Lines to Assist Employees with their Work Assignments for Several Different Warehouses
- Provided Orientations to Employees for Other Purposes in Safety and Security Purposes as well in Foster Positive Team Attitude Maintained filing system of Current, Prospective and Future Positions
- Pre-screened Resumes prior to sending to Corporate for hiring Managers for Consideration
- Provided training to other new employees on application process, among other necessary training.
Education
High School Diploma -
James Madison High School
Atlanta Georgia05.2002
Some College (No Degree) - Medical Office Specialty
Dona Ana Branch Community College
Las Cruces, NMSkills
- Certified PED Determinator with The State of NM
- Certified Peer Support Worker (CPSW)
- Excellent Communication Skills
- Knowledgeable In Most Medical Insurances, Medicaid Product, Medicare Product, and Health Exchange
- Team Player and Fast Learner
- Bilingual in Spanish
- Medical Records Keeping Electronical
- Microsoft Office/Outlook/Excell/Word & Windows 11
- Conduct Health Risk assessments, SDoH Mini Screener Assessments, Columbia Suicide Assessments, Sterling Training Assessments
- Customer Service Experience and Customer Support
- Support and Referrals in Community Resources
- Quality Assurance
- Troubleshooting
- Friendly, Positive Attitude
- Remote Office Availability
- Cultural Awareness
Timeline
Member Connections Representative/CPSW
Centene Corporation For Western Sky Community Care
10.2018 - Current
Customer Service Representative
Centene Corporation For Western Sky Community Care
10.2018 - Current
MSR II Customer Service
Molina Healthcare
08.2016 - 09.2018
Customer Service Representative
Alorica Contact Center For United Healthcare
09.2015 - 08.2016
Recruiter/Trainer Coordinator
Staffline Temporary Service
07.2013 - 07.2015
High School Diploma -
James Madison High School
Some College (No Degree) - Medical Office Specialty
Dona Ana Branch Community College
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