Rebecca Escarsega
San Antonio,TX
Summary
To use my experience and training to find an occupation that will advance my current skill set, to provide a variety of job opportunities. Passionate about promoting lasting customer satisfaction by delivering quality service and unparalleled support. Proficient in customer service best practices and related options. Customer Service Representative bringing top-notch skills in oral and written communication, active listening and analytical problem-solving skills. Enhances customer experiences by employing service-oriented behaviors, understanding customer desires, ad providing customized solutions to build loyalty. Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
7
7
years of professional experience
Work History
Remote Customer Service Representative
Helpmates Staffing
10.2023 - Current
- Make outbound calls to provider offices to inform them about audit selection
- Provide the office with the required medical record documents needed for the audit
- Perform follow-up calls to ensure they have the required information
- Monitor the status of audit requests and provide timely updates
- Deliver exceptional customer service with professionalism and courtesy
- Collaborate with team members to ensure audit processes run smoothly
- Maintain detailed records of all interactions and audit progress
- Uphold a professional attitude and demeanor in all communications.
Precertification Specialist
The START center for Cancer Care
04.2023 - 08.2023
- Review chart documentation to ensure patient meets medical policy guidelines
- Prioritize incoming authorization requests according to urgency
- Obtain authorization via payer website or by phone and follow up regularly on pending cases
- Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
- Initiate appeals for denied authorizations
- Respond to clinic questions regarding payer medical policy guidelines
- Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
- Contact patients to discuss authorization status
- Other duties as assigned.
Admissions Coordinator
Innova Recovery Center
01.2023 - 03.2023
- Provide information about all Innova's programs to potential and current clients
- Communicate details about Innova's RTC/PHP program
- Connect clients with the appropriate department as needed
- Collect patient information and create client profiles
- Check insurance benefits and communicate coverage to clients
- Establish deposit amount and payment plan arrangements
- Schedule Level of Care Assessments
- Ensure all required documentation is obtained and accurate
- Keep census records up to date
- Process all deposits and any necessary payment plans
- Give tours of the facility as needed
- Coordinate arrival times and transportation arrangements for admissions
- Notify all appropriate departments of admissions
- Collaborate with Director of Admissions on various case consults
- Assist with various tasks and projects.
Service Coordinator
Superior HealthPlan
09.2019 - 12.2022
- Identify special needs members through the completion of health screenings and other resources
- Conduct screening and develop interventions per program guidelines
- Collaborate with various departments to coordinate member care and referrals to and community support systems, such as Centers for Independent Living, Area Agencies on Aging, Local IDD Authorities, and LMHAs
- Educate members about covered services including Consumer Directed Services, LTSS, and Value-Added Services as appropriate, and non-covered services such as how to access affordable integrated housing
- Educate members with special needs to foster compliance with program and positively impact outcomes
- Participate in initial and ongoing training as required
- Perform outreach to members as needed
- Assist with training new hire classes
- Trained new hire classes by shadowing through zoom meeting.
Medicare Support Team
Centene Corporation Medicare Support Team
04.2018 - 09.2019
- Currently part of the Medicare
- Along with daily duties of a CSR II agent, assisting agents via Skype Chat- Work Processes, navigating our systems, Documentation, claims issues, Rewards issues, assist with any questions or issues which the agent is unable to handle
- Complete reports/ special projects assigned by leadership: Aging Report, submitting ticket requests, A&G outbound call initiative, Assisting Supervisor's, Leads, and Member Advocates as needed
- Trouble shooting system issues: Managing down scripting, Member and provider callbacks, Inbound/Outbound calls, Escalated calls, Kudos calls, Jump in to take inbound call to assist when there is a high call volume, Disenrollment Survey calls, Medicare Voicemail Box (return calls) Process Material Requests: Compile spreadsheets for submission to CCS productions for material request unable to process in OMNI, Request expedited materials through submitting Ember tickets, Request EOB's through Emdeon system and mail out to member's Process Manual Material Requests including the following PHI/AOR forms, OTC Brochures, Disenrollment forms, Claim Reimbursement forms, EOB's accessed through Emdeon
Aetna Medicare Representative
CVS Caremark
08.2016 - 10.2017
- Referenced materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits, and authorization status matters
- Helped members and/or providers regarding website registration and navigation
- Educate members and/or providers on health plan initiatives Provide first call resolution working with appropriate internal/external resources and ensure closure of all inquiries
- Processed customer correspondence and provided the appropriate level of follow-up in a timely manner
- Researched and identified processing inaccuracies in claim payments and routed to the appropriate team for claim adjustment
- Categorized trends related to member and/or provider inquiries that may lead to policy or process improvements that support excellent customer service and impact quality and performance standards
- Work with other departments on cross functional tasks and projects as needed
- Provided excellent customer service to internal partners
- Approved and denied medications for doctor's offices
- Work prior authorizations for doctors, Nurses, Medical Assistants
- Handle correspondence from emails and faxes
- Provide doctors' offices with any current questions they have with member's medications
- Use AS400 to run Test claims on all calls.
Education
Bachelor of Arts - Psychology
The University of Arizona Global Campus
Arizona City, AZ08.2024
Pharmacy Technician - Pharmacy Technician
Southern Careers Institute Pharmacy
San Antonio, TX04.2014
High School Diploma -
Warren High School
San Antonio, TX06.2013
Skills
- 8 years Customer Service
- 8 years Call center (inbound and outbound)
- 8 years Office Clerk/Data Entry
- 4 Years of Work from Home
- Basic Computing - Average typing speed 45 WPM
- Intermediate Software skills- Microsoft Suites, World Wide Web, and social media
- Teamwork/Communication – Proficient working as team member of team or individually Strong multi-task, written and verbal communication skills
- 8 years in Medical Background- Knowledge in Medical Terminology, Records, Pharmacy, Authorizations, Insurance, Claims, Medical office background
- Good Telephone Etiquette
- Analytical Thinking
Timeline
Remote Customer Service Representative
Helpmates Staffing
10.2023 - Current
Precertification Specialist
The START center for Cancer Care
04.2023 - 08.2023
Admissions Coordinator
Innova Recovery Center
01.2023 - 03.2023
Service Coordinator
Superior HealthPlan
09.2019 - 12.2022
Medicare Support Team
Centene Corporation Medicare Support Team
04.2018 - 09.2019
Aetna Medicare Representative
CVS Caremark
08.2016 - 10.2017
Bachelor of Arts - Psychology
The University of Arizona Global Campus
Pharmacy Technician - Pharmacy Technician
Southern Careers Institute Pharmacy
High School Diploma -
Warren High School
Similar Profiles
Tana SadighiTana Sadighi
File Clerk – Contract Role at Helpmates StaffingFile Clerk – Contract Role at Helpmates Staffing
Julio ContrerasJulio Contreras
Aircraft Assembler at Helpmates StaffingAircraft Assembler at Helpmates Staffing
John D MoralesJohn D Morales
File Clerk at Helpmates StaffingFile Clerk at Helpmates Staffing
Dana VanlandinghamDana Vanlandingham
Registered Nurse at Skilled Nursing Facilities (ShiftKey)Registered Nurse at Skilled Nursing Facilities (ShiftKey)
Gregorio Valenzuela-MendezGregorio Valenzuela-Mendez
Delivery Driver at Groomers SeafoodDelivery Driver at Groomers Seafood