Demitria A. Rios
Tucson
Summary
Committed to continuous professional development.
Experienced with managing complex authorization processes, ensuring compliance and efficiency. Utilizes strong problem-solving abilities to streamline workflows and enhance patient and provider satisfaction. Knowledge of industry standards including guidelines.
Results driven associate with a proven track record of exceeding performances targets through efficient work habits. Dependable skilled team player.
Overview
14
14
years of professional experience
Work History
Authorization Specialist 2
Centene Corp.
10.2020 - Current
- Processing incoming referral requests via web and by faxes for medical services, and submitting them to the appropriate clinical reviewer.
- Processed and reviewed authorization requests to ensure compliance with policy guidelines.
- Supporting utilization management team in documenting authorization requests in a timely manner, Including maintaining up to date guidelines.
- Providing related medical services for members' healthcare needs.
- Assisted in training new team members on company policies and procedures for handling authorization requests.
- Staying up to date with the company's mandatory transcript learnings.
- Provides team support and guidance in the team chat, including one on one support.
- Processing provider and facility authorization requests efficiently to ensure timely healthcare access.
- Medical data entry
CSR2
Centene Corp.
03.2017 - 10.2020
- Daily tasks, answering incoming calls for medical services. Including claim inquiries, provider and facility credentials, reviewing prior authorizations. Benefits and eligibility inquires with providers and members.
- Caller center and working from home setting
- Answering 20/25 or more inbound calls. For members services, as well as provider/facility services.
- Assisting with special projects as needed.
- Assisting with one on one training with new hires.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
Sales Advocate
Speedy Cash
02.2016 - 09.2016
- Processed in person vehicle loans, Money handling including in person cash transaction, money grams, also personal and employment check cashing
- Answered incoming calls, assisting customers with over-the-phone payments
- Developed strong customer relationships through effective communication and support.
- Assisted customers in understanding loan products, enhancing service satisfaction levels.
- Assisted with creating cash drawers as well as deposit counts
- Managed client accounts diligently, monitoring purchase history and identifying opportunities for cross-selling or upselling.
Sales associate
Ross, dress for Less
11.2011 - 03.2016
- Customer service including; Front-end supervisor
- Performed cash, card, and check transactions to complete customer purchases.
- Assisted customers with product selection, enhancing overall shopping experience.
- Resolved customer inquiries and complaints promptly, fostering positive relationships and repeat business.
- Reducing items to clearance as needed.
- Rotated stock and restocked shelves to maintain product availability and store appearance.
- Stand in loss prevention associate/sales floor security.
- Resolved customer complaints with patience and understanding, restoring customer confidence.
- Provided training to new staff on sales techniques and store procedures, ensuring consistent customer service experience.
- Volunteered for extra shifts during holidays and other busy periods to alleviate staffing shortages.
Education
High School Diploma -
Tucson High Magnet School
Tucson, AzSkills
- Customer service
- Money handling
- Retail sales/Management skills
- Prior authorization specialist
- Data entry
- Effective communication skills
- Trainer
- Medical terminology expertise
- Data entry proficiency
- HIPAA compliance
- Insurance verification
Timeline
Authorization Specialist 2
Centene Corp.
10.2020 - Current
CSR2
Centene Corp.
03.2017 - 10.2020
Sales Advocate
Speedy Cash
02.2016 - 09.2016
Sales associate
Ross, dress for Less
11.2011 - 03.2016
High School Diploma -
Tucson High Magnet School
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