LOVELIE R. ZUÑIGA

• With 1year+ of experience in Worker’s Compensation Department, I specialized in interacting with healthcare professionals.
• Ability to get the status of the bill and follow up, along with posting payments, ability to proofread all the medical records with CMS-1500/IHCFA
• Analyzing all the denials C8.1 and C8.4 to dispute and submit the necessary documents, Reconsideration or Appeals.
• Composes and edits documents and attaches legal documents such as authorization for surgeries/nonsurgical and injection processes. Notice of the Decisions from the board and other invoices are needed.
• Monitored emails, organized inbox, and prioritized messages for supervisor.
• Managed electronic and paper filing systems by updating paperwork, maintaining documents, and accurately recording information.
• Streamlined administrative processes for increased productivity through effective email management and calendar coordination.
• Maintained strict confidentiality of sensitive information, ensuring trust and reliability in client relationships.

Tools

• Carisk (ihcfa)
• Imagine
• MS Teams
• Medics (ADS)
• Adobe acrobat (PDF)
• Excel File
• Medics Cloud Portal (EHR)
• 3cx Communications System
• Outlook
• WCB portal
• Insurance portal
• EClinicalWorks Portal (EHR)
• SharePoint

• With 4years as a Medical Assistant / Senior Associate in Operations
• Providing accurate information
• Scheduling appointments
• Collecting relevant details from healthcare providers
• Crafting and issuing authorizations based on medical necessity.
• Encoding CPT code and W9 NPI Registry of the providers

Tools

• Radconsult
• EMR (Electronics Medical Records)
• Interaction Desktop I3
• NPI Registry
• Outlook
• Excel
• Skype
• Humana portal

• Back Office (Non-Clinical and Inbound)
• Handling newly hired as a training support.
• CSR Clinical Fax, OCR,WFS and CSR Clinical Inbound.
• Exhibited strong work ethic by consistently arriving on time, completing tasks diligently.
• Adhered to company policies, procedures, and safety guidelines during daily work activities.
• Assisted in development of new training module, resulting in more comprehensive onboarding experience for new apprentices.
• Learned wide range of simple and complex techniques from on-the-job training.
• Received constructive feedback from mentors, leading to improved performance and increased knowledge.
• Completed assigned tasks efficiently and accurately, contributing to overall project success.

• With three years of expertise in Customer Service and Technical Support
• Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
• Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
• Excel independently, prioritizing exceptional service and efficient issue resolution.
• Proficient in troubleshooting phone software OS/IOS and intricate internet connection problems
• Specializing in guiding users through seamless account activations.
• A meticulous approach ensures thorough information gathering, coupled with a deep understanding of insurance terms and conditions. In scenarios requiring device replacement or refunds
• Navigate complexities with clarity, consistently delivering positive and satisfying resolutions.
• Developed strong product knowledge to provide informed recommendations based on individual customer needs.

Tools

• Avaya
• Google sheet
• Excel
• Simulator software for troubleshooting
• Imei software IPhone/Android.

• As a Telequalifier, my role involved working with provided data where all clients had previously expressed interest in investing. I conducted calls to gather necessary information, ensuring a smooth process. I specifically asked clients for their most convenient callback times, coordinating with our brokers to initiate contact at the scheduled times specified by the clients.
• This approach aimed to enhance customer engagement and satisfaction in the investment process.
• Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
• Educated customers about billing, payment processing and support policies and procedures.

Tools

• Avaya
• Excel