ZAYNA R. GOENAGA
Orlando,FL
Summary
Goal oriented customer service representative with 3+ years of experience in the healthcare environment, seeking an opportunity with a company where I can apply my strong organizational skills, and commitment to delivering efficient, compassionate service.
Overview
8
8
years of professional experience
Work History
Customer Care Representative II
Elevance Health
04.2022 - 11.2024
- Excel in a fast-paced environment, handling inbound calls for members and providers, providing support, and resolving inquiries
- Handle confidential information, PHI, and documents with discretion and maintain their proper organization
- Addressed customer complaints and mitigated dissatisfaction by employing timely and on-point solutions.
- Logged call information and solutions provided into internal database.
- Inbound representative for provider services, updating providers on claim status information.
- Submitting appeals on behalf of the member or provider and entering all provided information into the system.
- Communicates with utilization management in regards to all authorizations.
- Works with the pharmacy department in regards to medications that require authorizations and providing explanations and or updates to members needs.
- Assist with setting up transportation for members through third party transportation service.
Provider Enrollment Specialist
Advent Health Corporate
01.2018 - 02.2022
- Coordinates day-today administration of Adventist Health System's provider enrollment program, ensuring all existing and new physicians and other health care providers are enrolled and in compliance with all affiliation and participation requirements.
- Monitors and coordinates the application and approval process for all new AHS physicians and credentialed health care professionals, ensuring all provider files are current and noted in detail in the system of record.
- Monitors data collection, reviewing and evaluating quality of all provider information received through the application process.
- Acquires additional information as necessary and verifies documentation in accordance with established policies and procedures.
Crew Member
McDonald's
01.2017 - 01.2018
- Developed a foundation in customer service through customer interaction, recommending products, and processing transactions, setting the stage for a successful start to a customer service-focused role
- Maintained high productivity and efficiency, skills that are valuable in achieving and exceeding quarterly metrics
Education
High School Diploma -
Metropolitan Soundview High School
05-2016
Skills
- Microsoft Office (Word,Excel, Powerpoint)
- Typing 50 WPM
- Knowledge of medical terminology and HIPAA regulations
- Multitasking with great attention to detail
- Customer service orientation
- Time management
Timeline
Customer Care Representative II
Elevance Health
04.2022 - 11.2024
Provider Enrollment Specialist
Advent Health Corporate
01.2018 - 02.2022
Crew Member
McDonald's
01.2017 - 01.2018
High School Diploma -
Metropolitan Soundview High School
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