Veronica Brito Delgado
Glendale,AZ
Summary
My objective is to work at the capacity of a Quality Assurance Analyst II ensuring the products, services, and processes meet quality standards and customer expectations.
Overview
13
13
years of professional experience
Work History
Claims Liaison I
Centene Corporation
Tempe, AZ
05.2017 - Current
- Adhered to quality expectations and metrics.
- Answers incoming provider calls regarding claim status for AHCCCS (AZ Complete) claims using Omni
- Ability to identify root cause issues, provide education/ resolution to provider's inquiries in a timely and accurate manner
- Reviews provider's claim requests for appropriate information and correct reimbursement
- Accurately routes claims requiring adjustments for correction or sends claim to correct department to update member's insurance information
- Efficiently use different systems as resources such as CenPass, TruCare Cloud, FileNet, CareConnect, Central Point and follow the state workflow
- All of this to accurately adjudicate claims on Amisys in accordance with health plan guidelines, company standards, and company procedures
- Deliver management with feedback regarding identified issues
Technical Support Representative/Medicare CSR
General Dynamics Information Technology/ Vangent Inc.
Phoenix, AZ
03.2012 - 05.2017
- Over 12 years of experience working with quality metrics
- Read and/or respond with scripted responses to questions dealing with general healthcare information and/or basic to moderate technical support to customers.
- Provide knowledgeable responses to inquiries (phone, web chat, email, TTY) in a courteous and professional manner
- Help with technical support questions and troubleshooting the MyMedicare.gov website.
- Handle Part A level 1/Part B level 1 claim inquiries
- Look up procedure codes and its coverage
- Review paid, rejected, and denied claims
- Look up the reason for denial and assist them on how to submit an appeal
- Make simple terminations for employer's insurance
- Answer premium billing, and payment questions
- Maintain up-to-date knowledge of regulations, processing procedures, and policies
- Assist with delivery of internal employee training for new and temporary employees as requested
- Manage a high volume of incoming calls from Medicare Beneficiaries and non-beneficiaries and provided timely and accurate information by using Scripts and the NGD Program
- Operated different tools on the website in order to assist caller's needs
- Helped with comparing Medicare drug plans, Medicare advantage Plans, and Medigap policies
- I would also help research for providers and suppliers
- Maintain appropriate documentation of all policies
Education
High School Diploma - General Studies
Washington High School
05.2006
Skills
- Problem-solving
- Leadership
- Time management
- Interpersonal communication
- Organization
- Teamwork
- Critical thinking
- Oral and written communication
- Bi-lingual (English/ Spanish)
Timeline
Claims Liaison I
Centene Corporation
05.2017 - Current
Technical Support Representative/Medicare CSR
General Dynamics Information Technology/ Vangent Inc.
03.2012 - 05.2017
High School Diploma - General Studies
Washington High School
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