ROSALIND ALVARADO
Sanford,FL
Summary
Oriented professional with strong Customer Service background and Medical Management skills, possessing expert knowledge in the area of Healthcare. Desires to gain a position with a notable, thriving company. Authorized to work in the US for any employer.
Overview
21
21
years of professional experience
Work History
Customer Experience Rep
Value Based Health Partners
Nashville, TN
09.2021 - 02.2022
- Responded to incoming calls utilizing listening and communication skills to identify member's problems, needs and opportunities.
- Effective liaison between members, providers and internal departments.
- Delivered exceptional customer service to every member by leveraging extensive knowledge of benefits.
- Cross-trained and provided back up for customer service managers
- Quickly and accurately answered member questions, suggested effective solutions and resolved issues to increase member satisfaction.
- Worked closely with other team players to solve member issues.
Health Navigator
Consumer Medical
Norwell, MA
01.2021 - 10.2021
- Supported clients with positive advocacy and assistance to meet their routine needs and address critical issues
- Assisted team members and managers with tasks to maintain productivity and meet project milestones
- Maintained good working relationship with co-workers and management
- Communicated effectively, with people from varied backgrounds with diverse needs
Member Services Team Lead
Jacobson Group
Chicago, Illinois
10.2019 - 12.2020
- Assisted members by coordinating responses involving multiple departments and personnel
- Engaged with customers to understand and resolve issues and answer product questions
- Referred unresolved customer grievances to designated departments for further investigation
- Responded to concerns or complaints of members by taking prompt action, investigating and resolving wide range of issues.
Medicare retention supervisor
MetroPlus Health
New York, NY
01.2020 - 01.2020
- Temp to perm position assignment ended due to COVID.
- Implemented employee incentive programs to promote positive work culture and increase retention.
- Documented performance review schedule and monitored management for timely completion.
- Adhered to appropriate legal scripting when required.
Medical Management Specialist
Affinity Health Plan
Bronx, NY
10.2018 - 06.2019
- Educated and assisted providers, hospitals, and facilities with: authorization process, clinical submissions, updates, approvals
- Assisted with appeals status and setting up "Peer to Peer"
- Performed both Medicare Advocate and Medical Management responsibilities
- Acknowledged member issues and resolved their problems quickly and efficiently
- Effectively communicated with other employees, other departments and upper management to ensure provider assistance and complete care of members
- Assist with CPT and HCPCS
- Assisted members with PCA assessment appointments, Home care and CDPAP agencies..
Medicare Customer Service Supervisor
Affinity Health Plan
Bronx, NY
04.2011 - 06.2019
- Was trained and educated to be an effective leader
- Established and implemented departmental goals
- Managed teams performance through, feedback, documentation and coaching
- Assisted With Claims Inquiry, Balance Billing
- Supervisor escalated calls
- Handled month adherence and KPI Reports
- Monthly Team Meetings
- Educated and assisted our member's inquires in regards to: Medicare insurance benefits
- Medicare Savings Programs (MSP) Medicaid
- Assisted with other daily needs such as Rapid Resolutions, Grievances, Complaints, eligibility, balance billing, provider appointments and transportation
- Performed outreach calls to existing and new members to discover their needs and explain how certain programs could be useful to them
- Responsible for assisting and monitoring Medicaid eligibility.
Customer Service Specialist
Affinity Health Plan
Bronx, NY
06.2006 - 04.2011
- Responsible for assisting the CSD with the handling of escalated issues as needed, supervisor calls, and monthly projects
- Assist CSD with the handling assigned projects in addition and not limited to
- Abandoned Call Backs
- Project, PCP Error Project, Customer Satisfaction Survey Project
- Conduct via phone call and or mail members with minimal use of the plan to ensure satisfaction
- Served as a liaison among departments and outside vendors as needed
- Trained, developed and motivated Customer Service staff to achieve successful performance as detailed in the Customer Service Performance Plan, to exceed call center productivity and quality goals while adhering internal and external policies, procedures, rules and guidelines.
Customer Service Representative
Affinity Health Plan
Bronx, NY
10.2001 - 06.2006
- Handled incoming calls from members and providers concerning Medicaid, Child Health Plus, Family Health Plus
- Assist providers and members with the process of registering on the web portal
- Provided orientations to new and exiting members with Medicaid and other LOB, assist
- Provided primary customer support to internal and external customers.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Quickly and accurately answered customer questions, suggested effective solutions and resolved issues to increase customer satisfaction.
Education
Associate of Business Administration - Healthcare Management
Monroe College
The Bronx, NYAssociates in Business Administration - Business Administration And Management
Baruch College of The City University of New York
New York, NY06.1986
Word Processing Certificate - Word Processing
American Business Institute
Bronx ,NY05.1983
High School Diploma -
Norman Thomas High School
New York, NY06.1982
Skills
- CGA (10 years), CGA certification
- Microsoft Office, Microsoft excel
- Epace, Trucare, Facets, (10 years)
- Experienced Team Leader
- Issue resolution
- Outstanding people skills
- Excellent communication
- Patient and Empathetic
- Great team player
- Fluent in English and Spanish
- Knowledgeable in HIPPA abilities regulations and CMS
- HIPPA (10 years), HIPPA compliance certification
- Domestic violence certification
- CMS certification
Timeline
Customer Experience Rep
Value Based Health Partners
09.2021 - 02.2022
Health Navigator
Consumer Medical
01.2021 - 10.2021
Medicare retention supervisor
MetroPlus Health
01.2020 - 01.2020
Member Services Team Lead
Jacobson Group
10.2019 - 12.2020
Medical Management Specialist
Affinity Health Plan
10.2018 - 06.2019
Medicare Customer Service Supervisor
Affinity Health Plan
04.2011 - 06.2019
Customer Service Specialist
Affinity Health Plan
06.2006 - 04.2011
Customer Service Representative
Affinity Health Plan
10.2001 - 06.2006
Associate of Business Administration - Healthcare Management
Monroe College
Associates in Business Administration - Business Administration And Management
Baruch College of The City University of New York
Word Processing Certificate - Word Processing
American Business Institute
High School Diploma -
Norman Thomas High School
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