Ma. Jessica Martinez

Senior Assistant Clinical Coordinator, Senior Customer Service Representative, Training Coach, Team Lead, and Virtual Healthcare Receptionist with more than 8 years of BPO experience.

Worked with Amazon as a Kindle Specialist, with a UK telco as tech support, billing/eligibility specialist, and fault manager, and with UnitedHealth Group/Optum (Obama care, Employer and Individual Member Services, Provider Services Prior Auth ) for 6 yrs handling member services' billing, eligibility, benefits, prior auth, claims, and appeals, as well as, provider services' prior auth and predetermination requirements.

✅ Fluent in English oral and written

✅ Expert on communications inbound and outbound via phone, chat, and email

✅ Used to handling patients, medical providers, and other health insurance companies

✅ HIPAA compliant

✅ Assists on appointment setting

✅ Explanation of benefit plans and eligibility

✅ Checking medical claims

✅ Prior Authorization for benefit coverage and Predetermination for medical necessity requirement check

✅ Assists on appeals and peer to peers process

✅ Prepare performance reports

✅ Managed a team max of 20 people

✅ Audited calls for training and quality

✅ Supported training classes

✅ Outbound marketing calls

✅ Social Media monitoring

✅ Data Entry

✅ Credentialing

✅ Comfortable working independently on projects, be a team player, and can work unmonitored

✅ Highly trainable and a fast learner

✅ PRIMARY SYSTEM: Ryzen 5 8GB ram

✅ SECONDARY SYSTEM: Intel Core i3 12GB ram

✅ LAN connection of 25 Mbps