JAMAICA JIMENEZ
Taguig City
Summary
Organized Patient Service Representative with 8 years of experience in healthcare. Adept at patient advocacy and education with commitment to efficiency. Skilled at coordinating busy offices and maintaining professionalism in stressful situations.
Overview
7
7
years of professional experience
Work History
PATIENT SERVICES REPRESENTATIVE II
CONIFER GLOBAL BUSINESS CENTER,INC
05.2022 - Current
- Collect and verify patient health benefits thru insurance carrier
- Coordinated referrals to specialists when necessary, ensuring seamless continuation of care for patients with complex needs.
- Provided exceptional customer service to patients, answering questions and addressing concerns.
- Verified insurance eligibility and coverage for patients.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Improved patient satisfaction by efficiently managing appointment scheduling and coordinating follow-up care.
- Enhanced communication between patients and healthcare providers, ensuring timely delivery of test results and medical advice.
- Assisted with billing inquiries and insurance verification, resulting in a smoother financial experience for patients.
- Facilitated patient education by providing clear explanations of treatment plans and addressing any concerns or questions.
- Maintained patient confidentiality by adhering to HIPAA regulations and diligently updating records as needed.
- Managed high call volume, prioritizing urgent issues and directing calls appropriately for optimal resolution.
- Contributed to team efforts in achieving quality assurance benchmarks related to patient services processes.
CUSTOMER CARE PROFESSIONAL
OPTUM GLOBAL SOLUTIONS
09.2020 - 04.2022
- Intervened with doctor's offices on behalf of the members to assist with appointment scheduling
- Surpassed performance metrics in key areas such as average handle time, quality assurance scores, and resolved cases per day.
- Logged call information and solutions provided into internal database.
- Enhanced customer satisfaction by addressing and resolving customer inquiries and complaints in a timely manner.
- Streamlined company processes for better efficiency, managing high call volume while maintaining exceptional service.
- Reduced customer churn rate with effective problem-solving skills and empathetic communication techniques.
- Achieved higher sales conversion rates by upselling products and services based on individual customer needs.
UMR INTAKE COORDINATOR
OPTUM GLOBAL SOLUTIONS
07.2016 - 08.2020
- Verified eligibility and compliance with authorization requirements for service providers.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Provided training to new staff members on the intricacies of various insurance plans and their specific prior authorization requirements.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Conducted regular audits to ensure compliance with regulatory standards and insurance company policies related to the approval process.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Supported team members by providing guidance on complex cases requiring detailed understanding of medical necessity criteria.
Education
Bachelor of Science - Information Technology
LEMERY COLLEGES
Lemery Batangas2016
Skills
- Excellent time management skills
- Strong interpersonal and communication skills
- Problem Solving
- Insurance Verification
- Organizational Skills
- Telephone Etiquette
- Active Listening
- Healthcare Knowledge
- Excellent Communication
- Properly organized and detail oriented
- Highly resourceful, objective and reliable
- Customer Service
Accomplishments
- CUSTOMER CARE PROFESSIONAL, OPTUM GLOBAL SOLUTIONS- RESPONDED AND PROVIDED QUALITY SERVICE TO MEMBERS AND PROVIDERS THROUGH
- REAL TIME RESOLUTIONS AND TIMELY FOLLOW-UP- INTERVENED WITH DOCTOR’S OFFICES ON BEHALF OF THE MEMBER TO ASSIST
- WITH APPOINTMENT SCHEDULING- RESPONDED TO MEMBER INQUIRIES AND ISSUES BY IDENTIFYING THE TOPIC AND TYPE
- OF ASSISTANCE THE MEMBER NEEDS
- JULY 2016 – AUGUST 2020
- UMR INTAKE COORDINATOR, OPTUM GLOBAL SOLUTIONS- RECEIVED INBOUND CALLS FROM HOSPITALS AND CLINICS ADDRESSING PRIOR AUTH
- CONCERNS BASED ON THE BENEFIT PLAN OF THE MEMBERS-PROCESSED PRIOR AUTHORIZATION REQUESTS FROM THE ONLINE PORTAL- ASSIGNED TO MANAGE HIGHLY COMPLICATED ACCOUNTS TO PROVIDE COMPREHENSIVE
- SERVICE TO THE MEMBERS AND CARE PROFESSIONALS-PROCESS RETRO PRIOR AUTHORIZATION REQUESTS FOR ACCOUNTS BASED ON THEIR BENEFIT
- PLAN
Timeline
PATIENT SERVICES REPRESENTATIVE II
CONIFER GLOBAL BUSINESS CENTER,INC
05.2022 - Current
CUSTOMER CARE PROFESSIONAL
OPTUM GLOBAL SOLUTIONS
09.2020 - 04.2022
UMR INTAKE COORDINATOR
OPTUM GLOBAL SOLUTIONS
07.2016 - 08.2020
Bachelor of Science - Information Technology
LEMERY COLLEGES
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