Livecareer-Resume
Jessica
Claire
resumesample@example.com
(555) 432-1000,
, San Francisco, CA 94105
:
Summary
Versatile professional with over 10 years of experience providing service. An unwavering commitment to customers, with ability to build productive relationship, resolve complex issues and win customer loyalty. Team player who sees the whole picture while focusing on primary responsibilities. Bilingual in Spanish and English. Authorized to work in the US for any employer
Education
Wright College Chicago, IL Expected in December 2019 Associate : Nursing - GPA :
, Expected in 2015 MPH Worker Training Program : - GPA :
Kelvyn Park High School Chicago, IL Expected in December 2014 Certification in Motivational Interviewing Stanford : - GPA :
St Augustine College Chicago, IL Expected in 1997 GED : - GPA :
Certifications
CNA Patient Advocate July 2014 to Present
Highlights
  • Computer literate with the ability to learn customer service software applications. I am a professional
  • With verbal and written communication skills with the ability to type 45 wpm. Efficiency, exceptional
  • Telephone personality.
  • AS400
  • HIPPA Certification
  • Kronos
  • Lotus Notes
  • Microsoft Word, Excel, Access, PowerPoint, Outlook Express.
  • Microsoft Windows XP/Vista 32-64 bit.
  • Microsoft Office XP Professional
  • Sales Force
  • VPA (Virtual Physicians Assistant)
  • Vitech, ADS, RIMS, IMAX
  • Protouch
  • Allscripts
  • Accounting, Fax, Spanish
  • Administrative support, Faxing, Telephone
  • ADS, Insurance, Phone
  • Make appointments, Kronos, Answer phones
  • Scheduling appointments, Lotus Notes, Troubleshooting
  • AS400, Director, Type 45 wpm
  • Benefits, Access, Vista
  • Billing, Excel, Written communication skills
  • Cancer, Office
  • Case Management, Microsoft Office XP
  • CNA, Outlook Express
  • Clerical, PowerPoint
  • Computer literate, Microsoft Windows XP
  • Conferences, Microsoft Word
  • CSS, Monitors
  • Client, Organizing
  • Customer service, Patient Advocate
  • Customer support, Personnel
  • Client support, Primary Care
  • Databases, Processes
  • Database, Recording
  • E-Mail, Research
  • Email, RIMS
  • English, Sales
  • Faxes, Scheduling
Experience
Sutter Health - Case Management Assistant
San Mateo, CA, 04/2016 - Current
  • Provides assistance to the case management staff, including but not limited to, creating and faxing referral packets, organizing admission and discharge patient records, making phone calls, obtaining signatures, or any other assistance needed determined by the DCM Assists the case management team in scheduling family conferences.
  • Assists the case management team by making necessary arrangement for post-discharge follow up care.
  • Forwards the necessary patient clinical information for all admission, concurrent, and retrospective insurance reviews to payers for the completion of medical necessity reviews.
  • Monitors, documents, and tracks payer responses/requests of completed clinical reviews, including approvals, appeals, and denials, and communicates these to the appropriate personnel [hospital staff, physician, DCM, Claims Management, and Centralized Business Office (CBO).
  • Monitors and tracks the total hospital certified days of the patient for payers (commercial, managed care, and Medicaid) and communicates missing certifications to the DCM and CBO.
  • Initiates and completes insurance pre-certification for patients lacking certification, due to pre- admission issues, concurrent insurance changes, or outgoing hospital planned procedures.
  • Communicates pre-authorization outcomes to appropriate personnel (hospital and CBO).
  • Organizes and prepares the necessary clerical elements for the weekly Interdisciplinary Team Meeting to function timely and efficiently.
  • Performs general daily operational tasks/clerical support (i.e.
  • Phone calls, emails, faxes, copies, etc.) for the Case Management Department and as determined by the Director of Case Management (DCM).
  • Performs additional duties to assist the Case Management Department staff, support the revenue.
Air Methods - Patient Advocate
Waikoloa, HI, 05/2011 - 05/2016
  • I assist in care coordination and provide welfare information to eligible participants who are diagnose with cancer and others as needed, in order to ensure optimum outcomes.
  • I help identify, communicate with and follow up with these participants, helping to identify available medical provider resources and community resources as well as Fund services that will help meet participants' needs.
  • I also help patients make appointments, accompany them during their clinical visits.
Purple (Communications) - CAER Representative
Washington, DC, -
  • Contribution Accounting Enrollment Representative is a new roll that the fund created as of June 01, 2013.
  • The position is a combination of both contribution and enrollment representative.
  • I am responsible for collecting contributions from employers, processing participant and dependent enrollment and eligibility.
  • New employer/employee orientation.
  • This also COBRA, STD/ADD, LIFE and FMLA processing and applying cash by participants through Self-Pay.
Bioplus Specialty Pharmacy - Contribution Accounting Representative
OH, State, -
  • Responsible for collecting contributions from employers based on their Collective Bargaining Agreements with the various Local Unions.
  • Based on the Collective Bargaining Agreements, enrollments and elections are essential to the process of inputting work history for each of our participants which provides eligibility for health care coverage.
  • This also includes processing applications for COBRA and processing and applying cash by participants through Self-Pay and/or COBRA.
Pgim Global Short Duration High Yield Fund, Inc. - Customer Service Representative/Care Coordinator
Mount Pleasant, SC, 09/2011 - 10/2011
  • Customer service representative is responsible for inbound/outbound calls providing benefits as well as the terms of eligibility for members and providers.
  • When significant changes in insurance coverage like increased co-payments or new limitations on treatment or prescription drug coverage occur, we are bound to promptly inform workers of the new restrictions.
  • Assisting participant on how to elect a (PCP) Primary Care Physician, Biometrics.
  • Assisting potential patients on scheduling appointments.
  • Recording potential patients information on VPA (Virtual Physicians Assistant).
  • Verifying insurance information with potential patients HMO/PPO.
  • Assisting with building new online applications.
Temp Agentrics - Customer Support Specialist
City, STATE, 11/2010 - 09/2011
  • CSS Daily tasks in customer support include troubleshooting customer inquiries, recording issues in an Incident tracking database, providing status updates on known issues, and continually building Online applications.
  • Troubleshooting customer inquiries.
  • Recording issues in an incident tracking database.
  • Providing status updates on known issues.
  • Continually building proficiency in our online applications.
Tripp Lite - International Sales Coordinator, Representative
City, STATE, 11/2007 - 01/2010
  • Providing sales and administrative support involving efficient handling of top and confidential agreements.
  • Supporting the company's product by troubleshooting or answering and questions or concerns regarding the company's products.
  • Process inquiries by phone, fax, email in relation to company business.
  • Resolve and average of 200 inquiries in any given week and consistently met performance benchmarks in all areas (speed, accuracy, volume).
  • Work with new customers and update them on order status and inquiry.
  • Conveyed in a reassuring manner step by step instructions to resolve application issues.
  • Put customer at ease by acknowledging their need for explanation and information.
  • Provide client support and technical issue resolution via E-Mail, phone and other electronic medium.
  • Identify and correct or advise, on operational issues in client computer systems.
Unite Here Health - Enrollment Representative
City, STATE, -
  • Responsible for processing and maintaining all aspects of participant and dependent enrollment and eligibility, for assigned plan units between the Regional Offices, Contribution Accounting and, as needed, other internal teams and departments.
Metro One Telecommunication - Customer Service Representative
City, STATE, 01/1999 - 01/2007
  • Answered inbound calls in support of customer needs.
  • Conveyed in a reassuring manner step by step instructions to resolve application issues.
  • Reviewed and issued audits on account information and processes.
  • Performed queries in multiple databases.
  • Answer phones and respond to customer requests.
  • Transfer customer calls to appropriate staff.
  • Identify, research, and resolve customer issues using the computer system.
  • Follow-up on customer inquiries not immediately resolve.
  • Complete call logs and reports.
  • Research billing issues, misapplied payment.
Work History
Kindred Hospital Chicago Central - Assistant
Chicago, IL 05/2016 - Current
  • Provides assistance to the case management staff, including but not limited to, creating and faxing referral packets, organizing admission and discharge patient records, making phone calls, obtaining signatures, or any other assistance needed determined by the DCM Assists the case management team in scheduling family conferences.
  • Assists the case management team by making necessary arrangement for post-discharge follow up care.
  • Forwards the necessary patient clinical information for all admission, concurrent, and retrospective insurance reviews to payers for the completion of medical necessity reviews.
  • Monitors, documents, and tracks payer responses/requests of completed clinical reviews, including approvals, appeals, and denials, and communicates these to the appropriate personnel [hospital staff, physician, DCM, Claims Management, and Centralized Business Office (CBO).
  • Monitors and tracks the total hospital certified days of the patient for payers (commercial, managed care, and Medicaid) and communicates missing certifications to the DCM and CBO.
  • Initiates and completes insurance pre-certification for patients lacking certification, due to pre- admission issues, concurrent insurance changes, or outgoing hospital planned procedures.
  • Communicates pre-authorization outcomes to appropriate personnel (hospital and CBO).
  • Organizes and prepares the necessary clerical elements for the weekly Interdisciplinary Team Meeting to function timely and efficiently.
  • Performs general daily operational tasks/clerical support (i.e.
  • Phone calls, emails, faxes, copies, etc.) for the Case Management Department and as determined by the Director of Case Management (DCM).
  • Performs additional duties to assist the Case Management Department staff, support the revenue.
Unite Here Health - Patient Advocate
Chicago, IL 05/2011 - 05/2016
  • I assist in care coordination and provide welfare information to eligible participants who are diagnose with cancer and others as needed, in order to ensure optimum outcomes.
  • I help identify, communicate with and follow up with these participants, helping to identify available medical provider resources and community resources as well as Fund services that will help meet participants' needs.
  • I also help patients make appointments, accompany them during their clinical visits.
- CAER Representative
, -
  • Contribution Accounting Enrollment Representative is a new roll that the fund created as of June 01, 2013.
  • The position is a combination of both contribution and enrollment representative.
  • I am responsible for collecting contributions from employers, processing participant and dependent enrollment and eligibility.
  • New employer/employee orientation.
  • This also COBRA, STD/ADD, LIFE and FMLA processing and applying cash by participants through Self-Pay.
- Contribution Accounting Representative
, -
  • Responsible for collecting contributions from employers based on their Collective Bargaining Agreements with the various Local Unions.
  • Based on the Collective Bargaining Agreements, enrollments and elections are essential to the process of inputting work history for each of our participants which provides eligibility for health care coverage.
  • This also includes processing applications for COBRA and processing and applying cash by participants through Self-Pay and/or COBRA.
- Enrollment Representative
, -
  • Responsible for processing and maintaining all aspects of participant and dependent enrollment and eligibility, for assigned plan units between the Regional Offices, Contribution Accounting and, as needed, other internal teams and departments.
Vein Clinics of America - Customer Service Representative/Care Coordinator
Downers Grove, IL 09/2011 - 10/2011
  • Customer service representative is responsible for inbound/outbound calls providing benefits as well as the terms of eligibility for members and providers.
  • When significant changes in insurance coverage like increased co-payments or new limitations on treatment or prescription drug coverage occur, we are bound to promptly inform workers of the new restrictions.
  • Assisting participant on how to elect a (PCP) Primary Care Physician, Biometrics.
  • Assisting potential patients on scheduling appointments.
  • Recording potential patients information on VPA (Virtual Physicians Assistant).
  • Verifying insurance information with potential patients HMO/PPO.
  • Assisting with building new online applications.
Temp Agentrics - Customer Support Specialist
Chicago, IL 11/2010 - 09/2011
  • CSS Daily tasks in customer support include troubleshooting customer inquiries, recording issues in an Incident tracking database, providing status updates on known issues, and continually building Online applications.
  • Troubleshooting customer inquiries.
  • Recording issues in an incident tracking database.
  • Providing status updates on known issues.
  • Continually building proficiency in our online applications.
Tripp Lite - International Sales Coordinator, Representative
Chicago, IL 11/2007 - 01/2010
  • Providing sales and administrative support involving efficient handling of top and confidential agreements.
  • Supporting the company's product by troubleshooting or answering and questions or concerns regarding the company's products.
  • Process inquiries by phone, fax, email in relation to company business.
  • Resolve and average of 200 inquiries in any given week and consistently met performance benchmarks in all areas (speed, accuracy, volume).
  • Work with new customers and update them on order status and inquiry.
  • Conveyed in a reassuring manner step by step instructions to resolve application issues.
  • Put customer at ease by acknowledging their need for explanation and information.
  • Provide client support and technical issue resolution via E-Mail, phone and other electronic medium.
  • Identify and correct or advise, on operational issues in client computer systems.
Metro One Telecommunication - Customer Service Representative
Mount Prospect, IL 01/1999 - 01/2007
  • Answered inbound calls in support of customer needs.
  • Conveyed in a reassuring manner step by step instructions to resolve application issues.
  • Reviewed and issued audits on account information and processes.
  • Performed queries in multiple databases.
  • Answer phones and respond to customer requests.
  • Transfer customer calls to appropriate staff.
  • Identify, research, and resolve customer issues using the computer system.
  • Follow-up on customer inquiries not immediately resolve.
  • Complete call logs and reports.
  • Research billing issues, misapplied payment.
Languages
Bilingual in Spanish and English.
Skills
  • Computer literate with the ability to learn customer service software applications. I am a professional
  • With verbal and written communication skills with the ability to type 45 wpm. Efficiency, exceptional
  • Telephone personality. AS400
  • HHIPPA Certification
  • KKronos
  • LLotus Notes
  • MMicrosoft Word, Excel, Access, PowerPoint, Outlook Express.
  • MMicrosoft Windows XP/Vista 32-64 bit.
  • MMicrosoft Office XP Professional
  • SSales Force
  • VVPA (Virtual Physicians Assistant)
  • VVitech, ADS, RIMS, IMAX
  • PProtouch
  • AAllscripts,
  • Accounting, administrative support, ADS, make appointments, scheduling appointments, AS400, benefits, billing, cancer, Case Management, CNA, clerical, Computer literate, conferences, CSS, client, Customer service, customer support, client support, databases, database, E-Mail, email, English, faxes, fax, faxing, insurance, Kronos, Lotus Notes, Director, Access, Excel, Office, Microsoft Office XP, Outlook Express, PowerPoint, Microsoft Windows XP, Microsoft Word, Monitors, organizing, Patient Advocate, personnel, Primary Care, processes, Recording, Research, RIMS, Sales, scheduling, Spanish, telephone, phone, Answer phones, Troubleshooting, type 45 wpm, Vista, written communication skills
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    Resume Overview

    School Attended

    • Wright College
    • Kelvyn Park High School
    • St Augustine College

    Job Titles Held:

    • Assistant
    • Patient Advocate
    • CAER Representative
    • Contribution Accounting Representative
    • Enrollment Representative
    • Customer Service Representative/Care Coordinator
    • Customer Support Specialist
    • International Sales Coordinator, Representative
    • Customer Service Representative

    Degrees

    • Associate
    • MPH Worker Training Program
    • Certification in Motivational Interviewing Stanford
    • GED

    By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

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