Rosa Reyes
Corona
Summary
Dynamic professional with extensive experience in member services at Bright Health/Molina, excelling in conflict resolution and customer satisfaction. Proven ability to leverage EMR systems and quality assurance skills to enhance patient care. Recognized for effectively guiding Medicare patients through health plan options, ensuring informed decisions and optimal service delivery.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Member Services
Bright Health/Molina
09.2023 - Current
- Handled customer complaints in an efficient and courteous manner.
- Managed customer conflicts and challenging situations by staying calm and accessing internal knowledgebases to develop strategic solutions.
- Leveraged software and systems to research and resolve member inquiries.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Participated in team meetings to discuss customer service strategies and goals.
- Engaged in conversation with customers to understand needs, resolve issues and answer product questions.
- Provided guidance to members on how best to use products or services offered by the organization.
- Answered incoming calls regarding membership benefits and services.
- Coordinated with internal teams to ensure timely and successful delivery of solutions according to client needs.
- Attended training sessions regularly to stay abreast of changes in company policies or procedures.
License Accident, Health and Life Agent
Self
Corona
03.2022 - Current
- License by the state of California for accident, health and life insurance, certified with health plans to assist medicare patients in choosing a part C health plan, explain health plans benefits and assist with the electronic application to assigned health plan
Quality Assurance Analyst
Parallon/HCA
07.2016 - 11.2021
- Company Overview: Remote
- Responsible for reviewing all eligibility approvals within a specific timeframe to ensure accuracy and appropriateness for admission, determined payment workflow, assigned authorizations as appropriate based on approval review, updated client's system with approval and communications approval outcomes to client contacts
- Assist with new hire training
- Conducted claims audits as assigned and other special projects
- Remote
Authorization Specialist
Parallon / HCA
05.2010 - 06.2016
- Responsible for coordinating daily operation and preparation of the authorization request
- Including but not limited to reviewing and preparation, obtaining medical records, submission of initial electronic treatment authorization and that may be necessary to maximize the number of billing days allowed by medi-cal
- Communicate TAR status to facilities as appropriate
- Special Projects assigned
- Assist with new hire training
Front Office Coordinator I and II
Talbert Medical Group
06.2007 - 10.2010
- Responsible for all aspects of Front Office duties and responsibilities, checking in patients, collection copayments, verifying insurance, answering a 6 line telephone
- Assist with new hire training
Education
Diploma -
Columbus High School
Downey, CAMedical Assistant Certificate -
Bryman College
Whittier, CASkills
- Quality assurance
- Medicare Advantage Plan Sales
- Patient Care
- Medical Records
- Experience Administering Injections
- Medical Office Experience
- Medical Scheduling
- EMR Systems
- Customer service
- Problem solving
- Conflict resolution
- Data entry
- Member services
Certification
License by Department of Insurance
Languages
Spanish, Fluent
Personal Information
Work Permit: Authorized to work in the US for any employer
Languages
Spanish
Professional
Timeline
Member Services
Bright Health/Molina
09.2023 - Current
License Accident, Health and Life Agent
Self
03.2022 - Current
Quality Assurance Analyst
Parallon/HCA
07.2016 - 11.2021
Authorization Specialist
Parallon / HCA
05.2010 - 06.2016
Front Office Coordinator I and II
Talbert Medical Group
06.2007 - 10.2010
Diploma -
Columbus High School
Medical Assistant Certificate -
Bryman College
Similar Profiles
Mayra GarciaMayra Garcia
Claims Auditor at Bright Healthcare Plan & Molina Healthcare PlanClaims Auditor at Bright Healthcare Plan & Molina Healthcare Plan
Jeffery RaysonJeffery Rayson
EDI Analyst\Systems Operator at Affinity Health Plan\Molina Health CareEDI Analyst\Systems Operator at Affinity Health Plan\Molina Health Care
Eva MahoneyEva Mahoney
TRIAGE NURSE CASE MANAGER at Senior Whole Health – Molina HealthcareTRIAGE NURSE CASE MANAGER at Senior Whole Health – Molina Healthcare
CHEYENNE LONGCHEYENNE LONG
Physical Therapist Assistant at Proresults Physical TherapyPhysical Therapist Assistant at Proresults Physical Therapy
Jacqueline OrtizJacqueline Ortiz
Team Lead Wellness Attendant at Float StateTeam Lead Wellness Attendant at Float State