Rachel S. Arellano
Rancho Cucamonga,US
Summary
Results-driven Operator Dispatch Agent with a proven track record of ensuring customer satisfaction and timely response. Proficient in multi-line telephone systems, dispatch call tracking, and incident reporting. Years of experince with salesforce / epic and meditrac working in the medical / dental industry.
Qualified Member Services Representative with many years in fast-paced customer service and call center environments. Personable and professional under pressure.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Member Service Representative
Hoag Memorial Hospital Presbyterian
Costa Mesa, California
05.2024 - 12.2024
- Organized timely and accurate referrals to help patients obtain health care services and access available resources.
- Supported hospital and clinic operations using customer service skills and detailed system knowledge.
- Reviewed eligibility responses to assess patient benefit level and prepare estimates.
- Scheduled patient appointments and procedures.
- Accessed patient information through various software applications, maintaining strict confidentiality to remain compliant with HIPAA regulations.
- Guided patients through the completion of consent and other required medical forms.
- Verified demographics and insurance information to register patients in computer system.
- Collaborated with insurance companies to resolve billing discrepancies and pre-certification issues.
- Answered incoming calls in a professional manner.
- Explained to patients different speciality groups provided in clinic
- Assisted with outbound calls/ follow up appointments such as confirming or rescheduling
Allied Universal Security Services - Operations Dispatch Center
06.2022 - 06.2024
- Provide discovery on cases and submit RFIs
- Responsible for customer satisfaction on projects
- Operated multi-line telephone system, prioritized calls and initiated appropriate action based on incident type and importance
- Tracked dispatch call activity to verify timely response and document assistance provided or task completed
- Prepared detailed incident reports to facilitate appropriate follow-up
- Answered customer telephone calls promptly to avoid on-hold wait times
- Met customer call guidelines for service levels, handle time and productivity
- Contacted police, fire and ambulance in emergency situations to coordinate proper response
- Enhanced communication between first responders and callers by providing clear, concise information during high-stress situations
- Reduced errors in dispatch procedures by maintaining accurate records of all emergency calls, resource allocations, and incident outcomes
- Managed multiple communication channels simultaneously, including telephone lines, radio frequencies, and computer-aided dispatch systems for effective coordination among emergency units
- Contributed to improved overall call center performance by consistently meeting or exceeding key performance metrics in areas such as response time and accuracy rates
LIBERTY Dental Plan - Member Services
06.2019 - 04.2022
- Handled sensitive and confidential information with discretion to maintain department security
- Created, maintained, and updated patient records in accordance with HIPAA regulations
- Worked with patients to evaluate personal financial information and make determination for insurance program
- Educated healthcare providers on proper documentation
- Familiarize myself with Medical, Medicaid plans ; HMO , PPO Plans practices, reducing denials significantly
- Provide office listing to patients
- Provide benefit breakdowns
- Schedule patients according to scheduling guidlines
- Conducted training sessions for new employees on company policies and procedures related to Member Services
- Successfully managed multiple projects simultaneously, meeting critical deadlines and maintaining quality standards
- Managed customer accounts using Salesforce CRM software, updating contact information as needed
- Handled escalated calls professionally by listening carefully to the needs of each individual customer before offering appropriate solutions
- Navigated multiple computer systems and applications and utilized search tools to find information
AltaMed - Patient Service (Seasonal)
Anaheim
01.2018 - 06.2019
- Participated in ongoing training programs related to HIPAA compliance, maintaining up-to-date knowledge on regulatory requirements
- Verified insurance eligibility and coverage for patients
- Improved patient satisfaction by providing exceptional customer service during check-in and check-out processes
- Managed patient registration process, confirming data accuracy and completeness
- Used Software to schedule appointments
- Assisted patients in filling out check-in and payment paperwork
- Took copayments and compiled daily financial records
- Balanced deposits and credit card payments each day
- Reduced no-show rates through consistent appointment reminder calls, leading to improved clinic productivity
- Streamlined communication between patients and healthcare providers, ensuring timely responses to inquiries and concerns
- Communicated with insurance companies to verify coverage and obtain authorizations for medical treatments and procedures
- Acted as a knowledgeable resource for patients seeking information about community resources and support services available to them in their healthcare journey
- Monitored patient health records for accuracy to meet compliance with healthcare guidelines
- Coordinated transportation to get patients to and from medical appointments
Pushinnovation - Call Center Supervisor
01.2016 - 02.2018
- Built relationships with customers and community to establish long-term business
- Collaborated with upper management to implement continuous improvements and exceed team goals
- One on one meetings with representative to assure business needs are being met
- High volume setting with inbound / outbound calls per day
- Achieve daily call quota of70 calls per day
- Determined quality assurance benchmarks and set standards for improvement
- Established and oversaw performance targets for call center associates
- Assisted in organizing and overseeing assignments, planning and coordinating in-house and outsourced resources
- Implemented new quality assurance and customer service standards
- Prepared and collection production reports
- Applied coaching techniques and tools to support managers and team members in improving performance
- Analyzed data trends in order to anticipate future challenges or opportunities within the market segment
- Collaborated with team members to achieve branch sales targets consistently
- Maintained confidentiality of private banking information with discretion, diplomacy and professionalism
MedXM medical - Member Services (agency TEMP)
05.2015 - 01.2016
- Helped large volume of inbound calls with positive services
- Assisted members with correcting account, service and educating patients on required forms and benefits
- Educated patients at-home healthcare tools
- Followed document protocols to safeguard confidentiality of patient records
- Checked documentation for accuracy and validity on updated systems
- Maintained confidentiality HIPPA of patient finances, records and health statuses
- Applied administrative knowledge and courtesy to explain procedures and services to patients
- Enhanced overall patient experience with empathetic communication and thorough explanations of insurance benefits and coverage
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record
- Verify patient insurance and eligibility
Education
High School / GED -
Cesar Chavez High School
Santa Ana, CA06.2013
Criminal Justice
Golden west college
USSkills
- Strong Telephone Etiquette
- Efficient and Detail-Oriented
- High-Volume Environments
- Microsoft Word
- Medical terminology
- Medical / Medicare trained
- Team-Oriented and Cooperative
- Call Volume and Quality Metrics
- Inbound and Outbound Calling
- Microsoft Excel
- Salesforce CRM
- EPIC trained
- CCTV Monitoring
- RFI Investigations
- Health plan insurance
- HIPAA and Confidentiality Compliance
- Training and mentoring
- CAD
Certification
California POST
Languages
Spanish Fluent
Timeline
Member Service Representative
Hoag Memorial Hospital Presbyterian
05.2024 - 12.2024
Allied Universal Security Services - Operations Dispatch Center
06.2022 - 06.2024
LIBERTY Dental Plan - Member Services
06.2019 - 04.2022
AltaMed - Patient Service (Seasonal)
01.2018 - 06.2019
Pushinnovation - Call Center Supervisor
01.2016 - 02.2018
MedXM medical - Member Services (agency TEMP)
05.2015 - 01.2016
High School / GED -
Cesar Chavez High School
Criminal Justice
Golden west college