Experienced professional with a strong background in office and remote work. Excited to join a dynamic team and contribute my skills. Seeking a growth-oriented environment for professional development and advancement.
Hi, I’m
Valerie Romo
Ontario,USA
Summary
Overview
14
years of professional experience
1
Certification
Work History
Kaiser Permanente
Member Service Representative
01.2024 - Current
Job overview
- Addressed and resolved issues promptly with professionalism in a call center setting.
- Provide eligibility, coverage and benefit information. Copays, deductibles and out of pocket information.
- Trained in Medicare and Medicaid procedures. Utilized systems to verify Medicare eligibility and assigned providers.
- Facilitated provider access to member eligibility and benefit details. Coordinated with Claims to obtain status on claims, authorizations, referrals, and appeals.
- Resolved billing inquiries using ACI and MQV systems, addressing premium rates, tax credits, and account transactions.
- Processed payments, refunds, billing adjustments, and account transfers with accuracy and efficiency. Handled reinstatement and disenrollment requests while ensuring compliance with established procedures.
- Resolved member complaints by actively listening, empathizing, and finding suitable solutions.
- Filed grievances and complaints efficiently. Collaborated with various departments to address complex member issues and requests.
- Ensure confidentiality and accuracy of member records, updating demographic and profile information as needed.
- Document and respond to all incoming contacts, addressing complex calls effectively. Initiate communication with relevant Health Plans, medical groups, and facilities.
- Address member inquiries and offer information on doctors and facilities.
- Assist members with web and tech support, including KP.ORG promotion. Facilitate access to KP accounts, manage login credentials, and resolve password issues.
- Handled correspondence inquiries, literature requests, and connected calls to appropriate departments.
- Provided appointment information, ordered ID cards, and processed 1095 Tax forms. Delivered MRN information, cost estimates, and facilitated new member experiences.
- Participate in training programs to stay updated on product knowledge and industry regulations.
- Follow compliance and the Principles of Responsibility by maintaining privacy and confidentiality of information. Document conversations with members according to procedure. Follows established procedures to meet members needs. Effectively interact with diverse work units and relevant organizational departments.
Ashley Furniture HomeStore
Customer Service Representative
05.2019 - 08.2020
Job overview
- Provided exceptional customer service by promptly addressing inquiries, resolving issues, and ensuring customer satisfaction.
- Managed a high volume of incoming calls and emails, consistently meeting or exceeding performance metrics for response time and resolution.
- Assisted customers during Covid 19 pandemic, until furloughed.
- CRM and Salesforce system to check on orders, delivery information, product availability and other information as requested by the customer. Maintained detailed records of all customer interactions in CRM system for future reference and analysis.
- Developed strong problem-solving skills through analyzing complex situations quickly.
- Started compliance team with manager. Collaborated with cross-functional teams to escalate unresolved issues and ensure timely resolution for customers. Managed escalated customer issues with professionalism and empathy, ensuring swift resolution while maintaining a positive brand image.
- Resolved complex customer complaints by investigating the root cause of the issue and implementing appropriate solutions. Created logbook for open and closed claims. Created handbook that outlined the specific duties and expectations for my colleagues. Achieved 80% increase in customer satisfaction ratings through proactive problem-solving and personalized service delivery.
- Collaborated with cross-functional teams to escalate unresolved issues and ensure timely resolution for customers. Proactively followed up with customers after issue resolution to ensure their satisfaction was maintained.
- Built rapport with customers through active listening, empathy, and personalized interactions.
- Assisted customers in navigating company website, troubleshooting technical issues, and placing orders online.
- Handled billing inquiries including adjustments, and account updates accurately and efficiently.
- Assisted with order fulfillment processes such as tracking shipments or coordinating returns/exchanges when necessary.
- Contributed to team success by achieving individual targets while also supporting colleagues during peak periods.
- Recognized as a top performer within the department based on consistently high levels of customer satisfaction ratings. Increased efficiency by suggesting and implementing process improvements that reduced average handling time for customer inquiries.
- Cultivated positive relationships with key clients through regular communication channels such as phone calls or email correspondence.
- Assisted in training new hires by sharing best practices, providing guidance, and offering support during their onboarding process.
- Recognized as a subject matter expert within the department due to extensive knowledge of company products and policies.
- Cancel partial or complete orders as requested by customers or as needed due to discontinuation of items. Manage and maintain orders to ensure replacements, shortages, below minimums, discontinued items, must ship complete orders, crossed items/orders and others are all addressed and handled appropriately to ensure a clean order base.
- Select orders to organize full-truckload and partial deliveries. Schedule product pick-ups and deliveries to ensure a continuous flow of ordered and allocated product from our distribution center to the customers in the most timely and efficient manner.
- Contact customer to schedule deliveries and/or advise of product deliveries. Negotiate with customers, marketing specialists and/or other departments as needed to ensure all allocated product is delivered and/or picked up as scheduled.
- Ensure customer information such as contact information, address, phone number, delivery availability, etc. is accurate and current; update customers' delivery availability regularly to account for a holiday, seasonal and other changes.
- Develop and maintain a good understanding of product knowledge to ensure the product is ordered correctly to complete sets as the customer requires.
US Legal Support
Customer Service Assistant/ Litigation
05.2018 - 01.2019
Job overview
- Assist CSR with client communications/correspondence as needed to retrieve records for litigations.
- Assisted attorneys in all phases of litigation (i.e. fees, film breakdowns, authorizations, no records, Subpoenas etc.).
- Managed document production and organization for large-scale cases, ensuring accuracy and compliance with court rules.
- Reviewed and analyzed documents for relevance, privilege, and confidentiality in accordance with discovery protocols.
- Handle incoming invoices/correspondence. Handle field/agent calls/emails. Research bad location contact information; unable to locate locations.
- Drafted correspondence to clients regarding case updates or requests for additional information.
- Managed multiple deadlines simultaneously while maintaining attention to detail and accuracy.
- Maintained confidentiality of sensitive client information throughout all stages of litigation.
- Follow-up on all CSR emails and request daily.
- Custodian Invoices: Research that invoice is within fee limits for requested records/legals. Pay invoices via check or credit card. Enter any credit card payments in MR. Confirm if check status cleared / provide check copies on payment issues.
- Schedule pick-ups and notaries. Research and assist with amends.
- Call on and send cancellation letter.
- Send non-compliant/responsive and status letters to custodians.
- Communicate with clients to answer questions and solve any concerns regarding orders; to obtain additional information, authorizations forms, amending request approvals and further processing instructions.
Parkview Hospital
Medical Records Clerk / Archivist
07.2011 - 03.2013
Job overview
- Prepare new charts and have them handy for use as new patients get admitted.
- Make copies of various forms when required.
- Mail or fax out requests for records when presented with a properly completed medical release.
- Pull charts as needed for special audits, peer review, refill requests, Dr signatures.
- Organized and filed patient information, ensuring confidentiality and compliance with HIPAA regulations.
- Scan paper documents in new system to become electronic forms.
- Make copies of records in response to in-coming medical releases.
- Order forms and other necessary supplies when needed.
- Maintained accurate and up-to-date medical records for patients.
- Reviewed medical charts for completeness, accuracy, and proper documentation.
- Assisted healthcare providers in locating specific patient information as requested.
- Performed data entry tasks to update patient demographics, insurance details, and medical history.
- Maintained a well-organized filing system for easy retrieval of physical documents when needed.
- Managed the scanning and indexing of paper documents into the electronic health record system.
- Ensured all scanned documents were legible, properly labeled, and stored securely in the EHR system.
- Audited existing files to identify incomplete or outdated information requiring updates.
Education
AUMT InstituteOntario, CA
NHA Certified Phlebotomy Technician from Phlebotomy
03.2019
University Overview
John W NorthRiverside, CA
High School Diploma from Education
01.2007
University Overview
Skills
- Salesforce
- Availity
- Aci
- Mqv
- Genesys
- Adobe Acrobat
- Customer Service
- Communication skills
- Call center
- Medical records
- Phlebotomist
- Computer skills
- Data entry
- Microsoft Office
- Microsoft Word
- Microsoft Excel
- Microsoft Teams
- Office experience
- Bilingual
- Organizational skills
- CRM software
- Video Conferencing
Certification
- CDL class A
- NHA Certified Phlebotomy Technician, 03/01/19
Languages
Spanish
Professional Working
Timeline
Member Service Representative
Kaiser Permanente
01.2024 - Current
Customer Service Representative
Ashley Furniture HomeStore
05.2019 - 08.2020
Customer Service Assistant/ Litigation
US Legal Support
05.2018 - 01.2019
Medical Records Clerk / Archivist
Parkview Hospital
07.2011 - 03.2013
AUMT Institute
NHA Certified Phlebotomy Technician from Phlebotomy
John W North
High School Diploma from Education
Similar Profiles
Marie A. StevensonMarie A. Stevenson
Patient at Patient FinancialAdvisor, Kaiser Permanente Eligibility and FinancialServices, FinancialAdvisor, Kaiser PermanentePatient at Patient FinancialAdvisor, Kaiser Permanente Eligibility and FinancialServices, FinancialAdvisor, Kaiser Permanente
Edith NagunaEdith Naguna
Special Needs Program Care Mgt RN Consultant at Kaiser Permanente - Southern California Permanente Medical GroupSpecial Needs Program Care Mgt RN Consultant at Kaiser Permanente - Southern California Permanente Medical Group
MICHAEL NAVAMICHAEL NAVA
Area Director at Kaiser Permanente – The Permanente Medical GroupArea Director at Kaiser Permanente – The Permanente Medical Group
Diana IovescuDiana Iovescu
Program Manager III- Centers for Reproductive Health/IVF at Kaiser Permanente- The Permanente Medical GroupProgram Manager III- Centers for Reproductive Health/IVF at Kaiser Permanente- The Permanente Medical Group
Mary GutierrezMary Gutierrez
Caregiver at IHSS Adult Services ProgramCaregiver at IHSS Adult Services Program