Rita Leal

• Developed relationships with providers in order to coordinate care plans for patients who need additional support services.
• Assisting both new and existing providers in understanding program policies and assistance with claims filing.
• Ensured compliance with federal, state, and local laws regarding health care services.
• Performed data entry tasks accurately and efficiently to maintain up to date patient information.
• Worked collaboratively with physicians and other healthcare professionals on cases requiring multiple disciplines.
• Trained new employees on provider office processes and procedures.
• Utilized problem-solving skills to resolve patient/provider issues quickly and efficiently.
• Assisted in the development of new policies, procedures, and protocols related to health care services.
• Organized meetings between providers and patients to discuss treatment options.
• Provided guidance on billing/CPT codes when necessary for accurate reimbursement.
• Managed multiple projects simultaneously while meeting tight deadlines.
• Processed payments for services rendered.
• Processed claims electronically or manually as needed.

• Provided customer service to providers regarding insurance coverage and billing inquiries.
• Resolved customer complaints and escalated more complex issues to senior staff members.
• Processed claims and coordinated with providers, payers, and other third parties as necessary.
• Performed data entry tasks including entering patient information into electronic medical records systems.
• Answered incoming calls from clients and routed them to appropriate personnel for further assistance.
• Ensured all provider contracts were properly executed before initiating services or payment arrangements.
• Assisted customers in navigating the online portal for self-service requests.

• processes medical claims by verifying and updating information about submitted claims and reviewing the work processes required to determine reimbursement.

• Answer incoming calls from Providers that have inquiries about eligibility and benefits, claims or authorizations on members accounts.

• Answered customer inquiries and provided accurate information regarding products and services.
• Provided excellent customer service to resolve customer complaints in a timely manner.
• Gathered customer feedback through surveys and used the data to improve customer service.
• Assisted customers with product selection, ordering, billing, returns, exchanges and technical support.
• Maintained detailed records of customer interactions, transactions and comments for future reference.
• Performed administrative tasks such as filing paperwork, updating databases and generating reports.
• Demonstrated the use of advanced formulas and functions within Excel, such as VLOOKUP, SUMIFS, COUNTIFS.

• Recruited, interviewed and trained new key holders.
• Coordinated with other departments to ensure smooth operations.
• Maintained a safe and secure environment within the store.
• Tracked sales data to ensure accurate inventory levels.
• Monitored store performance and identified areas for improvement.
• Ensured compliance with all company policies and procedures.