Lydia X Chavez
Claims Representative at MOLINA HEALTHCARE INC- Claim this Profile
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Spanish Native or bilingual proficiency
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English Native or bilingual proficiency
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Spanish as secondary Native or bilingual proficiency
Topline Score
Bio
Credentials
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Interpersonal Communication
LinkedInDec, 2021- Nov, 2024 -
Improve Cognitive Flexibility at Work
LinkedInOct, 2021- Nov, 2024 -
Critical Thinking
LinkedInOct, 2020- Nov, 2024 -
Customer Service: Working in a Customer Contact Center
LinkedInOct, 2020- Nov, 2024 -
De-Escalating Intense Situations
LinkedInOct, 2020- Nov, 2024 -
Effective Listening
LinkedInOct, 2020- Nov, 2024 -
Note-Taking for Business Professionals
LinkedInOct, 2020- Nov, 2024 -
The Six Morning Habits of High Performers
LinkedInOct, 2020- Nov, 2024 -
Medicare Member Materials 101
Molina HealthcareAug, 2015- Nov, 2024 -
MLTSS State of Mind
Molina HealthcareJun, 2015- Nov, 2024 -
HIPAA Security 102 Payer Version
Molina HealthcareFeb, 2015- Nov, 2024 -
ICD 10 Awareness Training 2015
Molina HealthcareFeb, 2015- Nov, 2024 -
Marketplace EE Awareness Training
Molina HealthcareFeb, 2015- Nov, 2024 -
NICE Performance Manager Staff
Molina HealthcareFeb, 2015- Nov, 2024 -
Secure Mail
Molina HealthcareFeb, 2015- Nov, 2024 -
iLearn - HIPPA Privacy 201 Member Services
Molina HealthcareFeb, 2015- Nov, 2024 -
iLearn - HIPPA in the HiTechEra
Molina HealthcareFeb, 2015- Nov, 2024 -
iLearn Training
Molina HealthcareFeb, 2015- Nov, 2024 -
2014 General Annual Fraud, Waste& Abuse Training
Molina Healthcare -
2015 Compliance Plan Training
Molina Healthcare -
Health Insurance Marketplace--HIM
Molina Healthcare -
Impact of ICD-10 Overview- Revenue Cycle
Molina Healthcare -
Injury & Illness Prevention Program
Molina Healthcare -
Medicare Compliance
Molina Healthcare -
Medicare Disenrollment 101
Molina Healthcare -
Medicare Eligibility & Enrollment 101
Molina Healthcare -
Medicare Part C Organizations Determinations & Appeals Annual Compliance
Molina Healthcare
Experience
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MOLINA HEALTHCARE INC
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United States
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Hospitals and Health Care
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100 - 200 Employee
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Claims Representative
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Feb 2017 - Present
Responsibilities: Answers incoming calls from providers and billing agencies and provide basic claims status information. Duties include• Acting as initial point of contact for incoming Claims Provider Service calls• Responding to provider and billing agency telephone inquiries regarding the status of claims;• Providing basic information, such as code verification, date of claim payment, and durable medical equipment eligibility; and• Perform extensive phone work in a professional manner with permission to put caller on hold;• Ability to listen effectively and ask appropriate questions in order to determine the needs of the caller;• Appropriately route calls and apply good judgment in identifying calls that should be forwarded to others for resolution;• Pay attention to detail and provide accurate information; and• Maintain resilience in a fast-paced work environment and when dealing with difficult callers.• Ability to establish and maintain effective and cooperative working relationships with co-workers and others contacted in the course of the work;• Assume responsibility and exercise good judgment in making decisions within the scope of authority of the position;• Ability to think and work effectively under pressure and accurately complete tasks within established times;• Prioritize tasks and meet deadlines and maintain confidentiality; and• Some knowledge of medical terminology and related procedure and diagnostic coding (CPT/ICD, HCPCS), as well as knowledge of how to access available resource tools.• Ability to sit in front of and operate a video display terminal and perform 10-key by touch for extended periods of time; and• Comply with all safety requirements; and adhere to all company policies and procedures.
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Molina Healthcare
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United States
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Hospitals and Health Care
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700 & Above Employee
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Membership Representative
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Sep 2015 - Present
I have been employed as a permanent employee in a busy call center (The Premium Payment Center/Member Services/Escalations Depts.) assisting members throughout the United States with premium payments, enrollment issues, and other healthcare concerns.Worked in conjunction with the Enrollment & Billing Team, Pharmacy Department, the Federally Facilitated Marketplace, Covered California and the Washington Exchange to better assist Molina Healthcare members enrolled with Marketplace as well as Medicaid covered members for their healthcare needs. Responsibilities included PCP changes, sending out member ID cards, PHI forms and other member materials. With access to systems such as Provider One & CVS Caremark, I had the ability to assist member needs with RX & enrollment issues.Submitted escalation issues, grievances and appeals for reinstatements, denied Claims and Prior Authorizations to corresponding departments and providing other personal information regarding membership coverage serving several states across the nation. Adaptable to change and used different PC OS systems within the Molina network. Assigned to follow up and complete independent projects during down time with the ability to meet time budget goal as requested by Leads & Supervisors.Excellence attendance, punctual, demonstrate professionalism and trustworthy. Ability to work independently, I am resourceful, organized and maintain a clean workstation. Worked in a restricted, PCI Compliance area and able to meet KPI goals -- Adherence averaging at 94.64%, QA scores of 100% for the past few months, and HEDIS alerts. Over 60 iLearn Certificates of Completion from Molina HealthCare.
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Customer Service
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Nov 2003 - Jul 2011
CALL BOARD COORDINATORProvided telephone and face-to-face customer service/support within high-volume call centers Handling an average of 300 calls daily, busy customer service desk. Responsibilities were to greet and place customers on waiting list for various poker games and assist in seating them working in conjunction with Floor Men. Performed co-workers job duties when they were away from their desks without interfering with my own job duties.CHIP SERVICE PERSONAs a Chip Service Person responsibilities included attending casino patrons by performing cash transactions exchanging cash to chips or color change for gaming purposes. Responsible with up to $10,000 in company funds and assisted poker dealers by providing set-ups by request (Fresh Deck of Cards); Greeted customers in a professional and courteous manner, ability to stand and walk for 90% of the shift, regularly lift up to 11 lbs. in chip racks; used/wore apron to keep track of transactions.SECURITY DISPATCHERTrained by former LAPD detective with LAPD Dispatcher’s manual, daily activities included to type and keep record of all incidents taken throughout the shift, perform inventory, and assist casino staff by providing equipment such as radios, flashlights, and employee uniforms. Knowledge of basic security codes. Duties also included maintaining key control, monitor radio traffic, and receiving incoming and outgoing phone calls included those of medical emergency (911 calls working in conjunction with law enforcement). Assisted supervisor and manager with written reports attached with evidence working in conjunction with Surveillance department. Distributed payroll checks to all casino employees, log in loss prevention, and dispense of medical aid equipment. Worked irregular shifts (day, swing, graveyard), weekends, holidays and overtime.
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Education
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2011 - 2011
ABC ADULT SCHOOL
Certificate of Completion, Accounting Technology/Technician and Bookkeeping, Business Start Up -
2003 - 2004
Concorde Career College-Garden Grove
Certificate of Completion, Dental Assisting graduate with Honors -
1998 - 1999
Long Beach City College
GED, Office Assistant Certificate of Completion, General Education, Office & Technology -
1990 - 1992
Millikan High School
General Education
Community
