Sylvia Ortega
Harlingen
Summary
Detail-oriented Provider Services Representative with a strong background in claims processing and document verification. Proven expertise in managing provider networks and enhancing relationships within the healthcare industry. Skilled in analytical problem-solving and clear communication, contributing to streamlined processes and improved patient satisfaction.
Overview
5
5
years of professional experience
Work History
Provider Services Representative
Aetna, a CVS Health
09.2021 - Current
- Facilitated resolution of provider disputes using effective problem-solving techniques.
- Coordinated with internal departments to resolve issues and ensure timely solutions.
- Analyzed feedback from providers to identify areas for service improvement.
- Guided new providers in using systems, processes, and policies to foster strong relationships.
- Verified accuracy of submitted documentation prior to processing claims or services rendered.
- Developed strong customer relationships to encourage repeat business.
- Gathered customer feedback through surveys and used the data to improve customer service.
- Provided exceptional customer service to ensure customer satisfaction.
- Increased customer satisfaction ratings by effectively answering questions, suggesting effective solutions, and resolving issues quickly.
Education
High School Diploma -
Madison High School
Houston, TX05-2005
Skills
- Provider dispute resolution
- Claims processing
- Insurance verification
- Document verification
- Customer relationship management
- Customer service
- Customer satisfaction surveys
- Relationship building
- HIPAA compliance
- Service improvement analysis
- Information gathering
- Data entry proficiency
- Problem resolution
- Work prioritization
- Remote office availability
- Office equipment proficiency
- Spanish fluency
- Adaptability and flexibility
- Reliability
- Professional phone voice
- Goal-oriented mindset
Timeline
Provider Services Representative
Aetna, a CVS Health
09.2021 - Current
High School Diploma -
Madison High School