Sonia Villicana
Salt Lake City
Summary
Dynamic Recovery Specialist with a proven track record at Select Health, excelling in customer service and conflict resolution. Adept at processing medical claims and authorizations, leveraging strong analytical skills to enhance operational efficiency. Bilingual communicator, fostering collaboration across departments to meet diverse client needs and improve service delivery.
Overview
13
13
years of professional experience
Work History
Recovery Specialist /Prior Authorization Specialist
Select Health
Murry
02.2024 - 03.2025
- Received and translated various customer and business documentation
- Answered customers' questions in both English and Spanish based on individual caller requirements
- Collaborated with team members in different departments to meet needs of Spanish-speaking customers
- Employed excellent multitasking, research, and time management abilities to effectively handle high volume of calls
- Placed outbound calls to follow up with Spanish-speaking customers and resolve issues
- Reviewed members and providers claims and documentation to assess validity of claims and determine eligibility for different solutions
- Accepted transfer calls to offer interpretation services for non-English-speaking customers
- Processing and authorizing the payment of medical claims, negotiating bills on an as-needed basis, and monitoring medical bills to make sure there are no errors in billing or items which aren't covered by insurance
- Identified areas where improvements can be made within the department by analyzing trends in denials and approvals.
- Reviewed claims submitted without valid pre-authorization codes and took corrective action when necessary.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Developed relationships with external vendors providing pre-authorization services.
- Conducted quality assurance audits of prior authorization processes according to established standards.
- Advised provider offices on proper coding practices that are necessary for successful claim submission.
- Researched clinical criteria and determined eligibility for requested services based on plan provisions.
- Facilitated communication between providers, payers and health plans regarding prior authorization processes.
- Maintained accurate records of all authorization activities in the database system.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Assisted with developing policies and procedures related to prior authorizations.
Bilingual Customer Service
Apria Health Care
Salt Lake City
02.2020 - 12.2022
- Received and translated various customer and business documentation
- Answered customers' questions in both English and Spanish based on individual caller requirements
- Collaborated with team members in different departments to meet needs of Spanish-speaking customers
- Employed excellent multitasking, research, and time management abilities to effectively handle high volume of calls
- Placed outbound calls to follow up with Spanish-speaking customers and resolve issues
- Reviewed customers' claims and documentation to assess validity of claims and determine eligibility for different solutions
- Accepted transfer calls to offer interpretation services for non-English-speaking customers
- Investigated durable medical equipment concerns, communicating between departments such as sales and production to understand issues
- Helped resolve product returns, responded to shipping inquiries and answered order status questions
- Processed orders and coordinated delivery schedules to meet customer needs
- Determined charges for services requested, collected deposits or payments, and arranged for billing
- Updated accounts with customers' current personal and purchasing information
- Engaged with customers to understand and resolve issues and answer product questions
- Kept records of customer interactions and transactions, recording details of inquiries, complaints, comments, and actions taken
Customer Service Representative
Home Depot Call Center
Ogden
04.2017 - 06.2017
- Managed inbound and outbound calls to respond to inquiries and resolve concerns
- Provided solutions, recommendations, and replacements, using an empathetic approach and demeanor
- Recommended products and services to members and educated customers about relevant offerings
- Implemented best practices in fostering exceptional customer care support and satisfying customers
- Researched assistance requested and offered accurate information
Customer Service Specialist
Ogden Clinic
Ogden
04.2015 - 05.2017
- Answered incoming telephone calls and provided information regarding store hours, location, and policies
- Prepared order sheets and sent out invoices and statements for payments due
- Answered calls or emails from customers and assisted with special requests or resolving complaints
- Followed established protocols for escalating customer complaints to management
- Running operation of the office as well as money transactions while assisting agents with various tasks
Customer Service Specialist
Black Turtle
Layton
06.2014 - 12.2014
- Provided solutions, recommendations, and replacements, using an empathetic approach and demeanor
- Managed inbound and outbound calls to respond to inquiries and resolve concerns
- Recommended products and services to members and educated customers about relevant offerings
- Cross-sold financial services aggressively to customers and followed up with existing account holders to offer new products
- Implemented best practices in fostering exceptional customer care support and satisfying customers
- Provided expert service by communicating information to customers and following up on promises
- Researched assistance requested and offered accurate information to resolve issues and respond to inquiries
Customer Service Specialist
Farmers Insurance
Harrisville
06.2012 - 03.2014
- Managed inbound and outbound calls to respond to inquiries and resolve concerns
- Recommended products and services to members and educated customers about relevant offerings
- Provided solutions, recommendations, and replacements, using an empathetic approach and demeanor
- Documented detailed notes in CRM system to track customer interactions
- Informed customers and professionals on eligibility, benefits, claims payment, and authorizations
Clerk Cashier
Megaplex Theater
Ogden
10.2011 - 06.2013
- Duties included - serving a large and diverse amount of clients on a daily basis, filling orders, cashiering and handling any general customer service issues
Education
High School Diploma -
George Washington High School
Ogden, UT08-2012
Skills
- Project management
- Appointment scheduling
- Resource allocation
- Financial analysis
- Data entry
- Database management
- Customer service
- Conflict resolution
- Effective communication
- Time management
- Task prioritization
- CRM software
- Strong work ethic
- Meeting scheduling
- Teamwork and collaboration
Education
other
Timeline
Recovery Specialist /Prior Authorization Specialist
Select Health
02.2024 - 03.2025
Bilingual Customer Service
Apria Health Care
02.2020 - 12.2022
Customer Service Representative
Home Depot Call Center
04.2017 - 06.2017
Customer Service Specialist
Ogden Clinic
04.2015 - 05.2017
Customer Service Specialist
Black Turtle
06.2014 - 12.2014
Customer Service Specialist
Farmers Insurance
06.2012 - 03.2014
Clerk Cashier
Megaplex Theater
10.2011 - 06.2013
High School Diploma -
George Washington High School
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