Raiza Paredez

• Confer with patients via phone to provide and obtain information regarding prescription medications.

• Determine charges for requested services and provide patients with helpful education explaining prescription copays, benefits, and claims denied.

• De-escalate patient complaints and assign patients to appropriate channels, if necessary.

• SME trained new team members regarding Humana systems and helping mail order members.

• Conducted one-on-one with associates to ensure metrics are being met and/or exceeded.

• Assist Humana At Home Nurses with members' account going over benefits, placing prescription orders and providing demographic information.

• Work across Humana business units including but not limited to Clinical Service, HCPR, Benefits, Finance, Accolade, Humana At Home, Go365 and Home Office.

• Handle large volume of Spanish Inbound member calls pertaining to prescription orders, prescription billing and denied prescription claims.

• Track requests via USPS, FedEx and UPS.

• Provided exceptional customer service to patients, answering questions and addressing concerns.
• Processed payments using cash and credit cards, maintaining accurate records of transactions.
• Filed and maintained patient records in accordance with HIPAA regulations.
• Verified insurance eligibility and coverage for patients.
• Compiled and maintained patient medical records to keep information complete and up-to-date.
• Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
• Collaborated with customers to resolve disputes.
• Followed up on outstanding accounts by working provided collection reports and correspondences assisting department in lowering Accounts Receivable.
• Verified accuracy of accounts payable payments, resulting in 85-90% reduction in payment errors and check reissues.
• Reported any coding issues to management.

• Assisted customers with banking needs and inquiries.
• Established rapport with new clients to increase satisfaction and loyalty.
• Created independent tools to verify data and results of analytical systems.
• Executed wire transfers, stop payments and account transfers.
• Assisted customers with online banking navigation and Tier 1 troubleshooting of online portal errors.
• Formulated and enforced service center policies, procedures, and quality assurance measures.
• Handled various accounting transactions and highly escalated customers issues.
• Processed wide variety of retail banking transactions for personal and commercial customers