Mireille Fernandez
Miami,FL
Summary
Compassionate Healthcare Specialist known for productive and efficient task completion. Skilled in patient care management, medical terminology, and healthcare policy comprehension. Excel in communication, empathy, and problem-solving to enhance patient outcomes and team collaboration.
Overview
12
12
years of professional experience
Work History
Sales Manager
Macys Department Store
Miami, FL
02.2023 - Current
- Analyzed customer data to identify trends, preferences, and opportunities for growth.
- Performed sales consultations and educated clients on products and services.
- Trained, coached, and mentored junior sales personnel to ensure success in their roles.
- Collaborated with marketing team to create promotional materials for target customers.
- Resolved customer complaints regarding sales and service.
- Led sales planning, development and account management to grow existing accounts and establish new sales accounts.
- Coached, developed and motivated team to achieve revenue goals.
Utilization Management Coordinator
Humana
Miami, FL
10.2016 - 02.2023
- Collaborated with multi-disciplinary staff to improve overall patient care and response times.
- Maintained knowledge of current standards related to care delivery including regulatory requirements, emerging trends, best practices.
- Coordinated with internal departments such as pharmacy, nursing and provider relations.
- Communicated with patients with compassion while keeping medical information private.
- Collaborated with providers and health plans to ensure quality of care and accuracy of claims processing.
- Explained policies, procedures and services to patients.
- Ensured compliance with all state and federal regulations pertaining to utilization management activities.
- Developed case summaries detailing rationale for authorization decisions along with supporting documentation.
- Conducted utilization reviews for members to ensure services are medically necessary, appropriate and cost effective.
- Assessed member eligibility status prior to authorizing services using available resources.
- Monitored post-service activity for appropriateness of care delivered according to authorized plan of care.
United Healthcare
Member Service Coordinator
Miami, FL
03.2015 - 10.2016
- Worked with cross-functional teams to achieve goals.
- Answered member questions about products and services.
- Ensured compliance with applicable laws and regulations related to banking operations.
- Provided support to members regarding account inquiries, processing transactions, and resolving issues.
- Supported sales team members to drive growth and development.
- Helped members resolve account problems and navigate internal systems to handle routine needs.
Provider Relations Specialist
Lifesolutions EAP /PsyCare
Miami, FL
01.2013 - 03.2015
- Researched and resolved issues related to provider contracts, credentialing requirements, and reimbursement claims.
- Assisted in the development of new provider programs and initiatives.
- Provided training sessions to providers regarding billing procedures, coding standards, and other administrative topics.
- Monitored industry developments related to managed care plans, government regulations.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Identified needs of customers promptly and efficiently.
- Exceeded customer satisfaction by finding creative solutions to problems.
Education
Bachelor of Arts - Applied Psychology
Universidad Catolica De Santo Domingo
Santo Domingo Republica Dominicana08-1998
Skills
- Key account development
- Sales operation
- Strategic account development
- KPI analysis
- National account management
- Sales presentation
- Excellent communication skills
- Training and development
- Product knowledge
- Relationship building
- Verbal and written communication
Timeline
Sales Manager
Macys Department Store
02.2023 - Current
Utilization Management Coordinator
Humana
10.2016 - 02.2023
United Healthcare
Member Service Coordinator
03.2015 - 10.2016
Provider Relations Specialist
Lifesolutions EAP /PsyCare
01.2013 - 03.2015
Bachelor of Arts - Applied Psychology
Universidad Catolica De Santo Domingo