eligibility rep / healthcare / customer service

Daunisha Carvajales3324 western aveSacramento, Ca 95838 916-617-8584/916-472-1454Dnjswrld@Gmail.Com
OBJECTIVE:To obtain a position that  challenges me to maximize my full potential and will utilize my skills in the medical field while allowing  me to grow professionally.
Grant union high school Dates: 9/1997-6/2001Sacramento,CaHigh School Diploma
Qualities:IDXEpicWordexcelOutlookMicrosoft accessType approx 45-50wpm+10KeyExcellent customer servicecapable of working in a team environment or as an individualdetailed orientedproduction goal drivenable to utilize strong analytical skills to accurately update, maintain, and retrieve eligibility information. Can work independently with minimal direction motivated to find answers by being resourceful with the tools and resources provided.Capable of managing multi-lined phonespositive attitudestays focusable to handle fast paced work/deadlinesknowledge of medical insurance, calls to health plans. Liaison rollcharting and supervising work flow.Knowledge of per-member per-month (pmpm) capitation methodology of paymentKnowledge of Health Maintenance Organization (HMO) and Independent Physician Association (IPA) insuranceExcellent written and verbal skills
Sutter Physician ServicesDates:09/2007-06/2013Sacramento , CA
Eligibility Rep 1,2,Liaison – 
Rep 1- I received incoming calls/written request from members, care centers and our customer service department requesting to update members physicians,plan codes, copays and demographic info. I was responsible for updating that info in the IDX/EPIC System
Rep 2- I received similar info directly from the healthplans including membership count, adds,terminations and updates. According to the health plan these electronic files were received on a daily,weekly, or monthly basis.
Liaison- position which consisted of the same duties as rep 1 and 2 and included audits, monitoring work flow (assigning other reps within department) And making sure work was being completed on pace or by deadlines. Reported directly to dept lead/supervisors on any discrepecies we may have had within dept or close communication with other dept supervisors as needed. I scheduled/held/ran weekly meetings or meetings as needed with reps to review personal/department performance,work flow and deadlines.
Fair Oaks EstatesDate:  06/2005-09/2008Sacramento,Ca 
MED AIDE- Pulled and passed medicationsOutgoing/incoming calls with physician offices/ families/Pharmacy'sChartingadmitted residents to care facilityHandle emergencies
Trendwest ResortsDates: 08/2004-05/2005Sacramento, Ca 
Receptionist/Phone rep- 

ReferencesReferences are available upon request

  • ID#: 89769
  • Location: Sacramento, CA , 95838

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