Reliable and detail-oriented professional with 25+ years clinical and administrative experience. Backed by a solid work history and recognized as dedicated and loyal with a desire for continuous learning. Team approach to providing collaborative business and healthcare services. Uncompromising integrity, work ethic and professionalism. Bilingual - Fluent in Spanish.
Overview
26
26
years of professional experience
Work History
Call Center Supervisor
Bio-Genetics Laboratory
St. Petersburg, FL
01.2021 - Current
Oversee a staff of 45 to 50 employees.
Planned and led team meetings to review business results and communicate new and ongoing priorities.
Monitored daily operations, including call volume, average speed of answer, service levels, customer satisfaction scores, and other key metrics.
Developed training materials for new hires on how to handle different types of calls effectively.
Facilitated individual coaching sessions with CSRs to realign productivity goals.
Delivered constructive call process feedback.
Resolved escalated customer complaints in an efficient manner while maintaining positive relationships with clients.
Reviewed employee performance and provided ongoing feedback and coaching to drive performance improvement.
Trained and supervised new employees to promote overall team productivity and consistent service.
Coverage Consultant (Private Contractor)
Bayfront Hospital Baby Place
St. Petersburg, FL
01.2020 - 01.2021
Screened uninsured patients for Medicaid benefits.
Applied online for Medicaid applications for qualifying patients.
Upload the required documents into the patient's folders.
Processed birth certificate letters of newborns and updated the birth name into the FLMMIS website.
Generated PIN activations for newborns on the FLMMIS website.
Completed Medicaid applications via My Access.
Processed Emergency Medical Assistance for undocumented patients
Created new patient accounts and transferred information to the external hospital system.
Updated approved Medicaid information to internal and external hospital systems.
Patient Advocate
CareValent
St. Petersburg, FL
01.2018 - 01.2020
Facilitated communication between providers, patients, and family members.
Updated members on health plan coverage and the status of accepting providers.
Submitted weekly reports to leadership on accepting providers.
Reached out to potential providers regarding members' health plan reimbursement rates.
Complied with all established company policies and procedures while upholding the security and confidentiality of documents and data.
Submitted the contract agreement to providers and facilities regarding health plan reimbursement rates.
Worked with patients to appeal insurance decisions and coordinated with providers to resolve problems.
Healthcare Scheduler Specialist
Metro Health and Wellness
St. Petersburg, FL
01.2017 - 01.2018
Manage the daily operation of behavioral health and medical scheduling for healthcare providers.
Function as the first point of contact with clients and patients.
Responsible for scheduling BH counseling and medical appointments for established and new patients.
Process in office referrals for HRT services on gender identifying clients and patients
Conduct intake information on walk-in clients requesting behavioral health services.
Set up appointments, organize paperwork, and distribute information via mail, email, or telephone.
Offer support to the department through coordination, monitoring, tracking, and reporting information.
Assistant to the department lead as backup and liaison with assigned duties, services, and projects.
Care Coordinator
Cordant Health Solutions
Tampa, FL
01.2015 - 01.2016
Coordinated toxicology screenings for Workers' Compensation patients at the request of adjusters and case managers.
Provided screening kits to physicians offices and labs for the collection of specimens.
Provided toxicology reports to contracted carriers and physicians offices upon request.
Collected any changes or updates, and documented all incoming and outgoing calls into the database.
Communicated test results to authorized carriers via email and/or via telephone.
Conducted follow-up calls to the physicians office for the status of specimen collections.
Responsible for coordinating the collection to be performed at the patient's next office visit with the treating physician.
Met and exceeded the amount of collected specimens required by management monthly.
Credentialing Specialist/Delegation
WellCare
Tampa, FL
01.2005 - 01.2010
Conducted reviews of providers' credentialing, including new applications, re-credentialing, and ongoing maintenance of provider credentialing.
Cross-checked the vendor credentialing database with the WellCare database.
Produced reports, maintained provider changes, and reviewed and filed reports.
Conducted pre-delegation and annual audits in accordance with the agreement and regulatory requirements.
Prepared audit reports to ensure provider satisfaction.
Offering support for the department through coordination, monitoring, tracking, and reporting information.
Provided quality checks for accuracy, and looked for ways to enhance processes and effectiveness.
Managed Care/Customer Service
Florida Orthopeadic Institute
Tampa, FL
01.2001 - 01.2005
Managed the daily operations of the front desk in a busy practice, with an average of 52 appointments each week.
Contacted the State Board licensing offices to verify board certifications for physicians.
Ensured proper processing and collection of fees and charges.
Set up appointments, organized paperwork, and distributed information via mail, telephone, and email.
Handle patients' check-in and check-out, and relay patients' Workers' Compensation status.
Responsible for organizing, updating charts, and verifying insurance.
Remained compliant with all healthcare facilities, HMOs, and insurance requirements.
Functioned as the first point of contact with insurance companies and clients.
Customer Service
Health Plan Services
Tampa, FL
01.1999 - 01.2001
Education
Basic X-Ray Technician - Medical Office Procedures
Ultimate Medical Academy
Tampa, FL
01.2011
Skills
Sensitivity and confidentiality
Problem solving
Written communication
Verbal communication
Interpersonal communication
Organization
Prioritization
Multi-tasking
Attention to detail
Independence
Minimal direction
Computer knowledge
Microsoft Word
Microsoft Excel
Microsoft PowerPoint
Microsoft Outlook
Data entry
Typing speed
Managed care
Credentialing
Customer service
Workers compensation
Basic X-Ray technician
Medical office procedures
Electronic medical management
Radiation safety
Positioning and procedures
Equipment operation
Maintenance
Patient care management
Call monitoring
Coaching and mentoring
Training delivery
Staff motivation
Medical terminology
Anatomy and physiology
HIPAA compliance
Front office
Back office
Scheduling
Training management
Coremedicalproficiencies
Managed Care
Credentialing
Customer Service
Workers Compensation
Basic X-Ray Technician
Medical Office Procedures
Medical Assistant
CPR/BLS
HIV/AIDS
First Aid
Electronic Medical Management (EHR/EMR)
Radiation Safety and Protection
Positioning and Procedures
Equipment Operation and Maintenance
Patient Care Management
Clinical Lab Procedures
Vital Signs
Medical Terminology
Anatomy and Physiology
HIPAA Compliance
Specimen Collection and Handling
Urinalysis
Clinical Techniques
Minor Surgical Prep
Wound Care
Front/Back Office
Scheduling
Keyapplicableskills
Operates with a high degree of sensitivity and confidentiality.
Self-starter with strong problem-solving skills, able to assess situations and identify solutions.
Good written, verbal and interpersonal communication skills.
Well-organized, able to prioritize and multi-task with a keen eye for detail.
Works independently with minimal direction and supervision.
Computer knowledgeable in Microsoft Word, Excel, PowerPoint, and Outlook.
Accurate data entry skills with typing speed of 50-60 wpm.
Languages
Spanish
Professional
Timeline
Call Center Supervisor
Bio-Genetics Laboratory
01.2021 - Current
Coverage Consultant (Private Contractor)
Bayfront Hospital Baby Place
01.2020 - 01.2021
Patient Advocate
CareValent
01.2018 - 01.2020
Healthcare Scheduler Specialist
Metro Health and Wellness
01.2017 - 01.2018
Care Coordinator
Cordant Health Solutions
01.2015 - 01.2016
Credentialing Specialist/Delegation
WellCare
01.2005 - 01.2010
Managed Care/Customer Service
Florida Orthopeadic Institute
01.2001 - 01.2005
Customer Service
Health Plan Services
01.1999 - 01.2001
Basic X-Ray Technician - Medical Office Procedures
Ultimate Medical Academy
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