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YYYYYY X. YYYYYY

0000 xxxxxx xxxx , xxxx , xxxxx 00000

xxx-xxx-xxxx abc@xyz.com

 

Summary of Qualifications

 

  Bilingual (English and Spanish) communicator with excellent listening and problem solving skills.

  Nearly four years of valuable, hands-on experience in the healthcare industry.

  Outstanding verbal communication and interpersonal skills to work with a variety of key stakeholders.

  Solid time management, attention to detail and organizational skills, including prioritizing tasks.

  Familiar with medical and insurance terminology and procedures, including CPT, HCPCS and ICD 9 codes.

  Proficient with Microsoft Office Suite.

Work Experience

 

Simply Health Care Plans                    May 2014-Present

Enrollment Coordinator, Enrollment Department

  Process applications for Medicare members seeking to enroll in an insurance plans.

  Assist personnel in other internal departments with questions or concerns regarding Medicaid and Medicare enrollment of members.

  Communicate effectively with colleagues to manage multiple discrepancy reports, ensuring member data is up-to-date and accurate with regards to eligibility and demographic information, among other facts.

 

Preferred Care Partners/United Health Care July 2012-Present

Patient Care Coordinator, Utilization Management (Jan. 2013-Present)

  Telephone physician offices or hospitals in a timely manner and speak with healthcare personnel to verify that referral requests received were accurate and sufficient for medical review.

  Ensure any decisions were made within the time limits required by Medicare.

  Process verified referral requests in an accurate, timely and efficient manner on behalf of patients.

  Use a computer software system to enter request information into the appropriate areas.

 

Customer Service Representative, Member Services (July 2012-Dec. 2012)

  Communicated effectively over the telephone with members as well as healthcare personnel at physician offices and hospitals on behalf of a health maintenance organization (HMO).

  Demonstrated knowledge of Medicare guidelines and policies to achieve performance objectives.

Education and Training

 

Computer Repair Technician Diploma, Florida Career College Hialeah, FL; earned 2009 (3.22 GPA)

  Identified and resolved problems with computers while learning about programs and social networks.

 

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