Experience

CLINICAL MEDICAL SERVICES INC

• United States
• Medical Device
• 1 - 100 Employee

• Supervisor, Referral, and Second Level Review Services

  • Dec 2019 - Present

  - Supervise the performance and management of the day-to-day activities of the referral coordinator’s staff. - Plan and develop objectives for the work team under supervision to maximize the productivity of human talent. - Coordinate and supervise the second-level coordinator's staff's tasks analyzing medical orders, clinical documents, benefit certifications, pre-authorization management, and service quotations for various medical insurances, such as Advantage, Medicaid, and commercial. - Coach and train the department's employees about the different contracts the company has with medical insurers; local clinical criteria guidelines (LCD) for durable medical equipment (DME) coverage; types of durable medical equipment (DME), benefits coverage, Fee Schedule, and HCPC codes; patient financial obligations, among others. - Oversee compliance with industry standards, corporate policies, and federal and state laws to maintain high standards of customer service. - Contribute to identifying growth opportunities and propose solutions to improve customer service. - Resolve employee inquiries to clarify processes and ensure the quality of service provided. - Handle escalated calls of complex patient/caregiver and provider situations for various medical insurances. - Evaluate the performance and discipline the supervised work team in case of non-compliance with corporate policies. - Submit reports and briefings as requested by customer service management and senior management. - Validate the payroll of the supervised work team and evaluate the hours to be paid and not to be paid (ADP system). - Participate in the process of interviews and selection of employees for the department. Show less

• Call Center Customer Service Representative

  • Apr 2018 - Dec 2019

  Handle a high volume of calls from patients, caregivers, and medical providers using the CISCO system. Document the procedures and update the clinical and demographic information of the patients during the call. Process daily orders for services of durable medical equipment (DME) for adult and pediatric patients. Guide patients, caregivers, and medical providers on the services available with the company.



Colombian Army

• Bogotá, Capital District, Colombia

• Legal Advisor Officer

  • Dec 1998 - Dec 2012

  - Provide legal advice to the commanders of military units for tactical, administrative, and disciplinary decision-making. - Conduct criminal, disciplinary, and administrative investigations, and project decisions in such matters. - Submit proposals considering the legal implications, factual variables, and courses of action, for the development and implementation of new and better administrative processes. - Train the military and civilian employees of the military unit in legal and administrative matters. - Serve as a liaison between the Unit Command and the civil and judicial authorities of the region. - Replace leaders of other areas and dependencies at the order of the Higher Command. - Supervise the performance and management of the day-to-day activities of the office’s administrative assistant staff. Show less



Gobernación de Santander

• Government Administration
• 100 - 200 Employee

• Legal Advisor

  • Oct 1996 - Nov 1998

  - Conduct disciplinary investigations of high-level employees of the territorial administration. - Provide legal advice to the Governor in administrative, disciplinary, and public policy decisions. - Draft and review contracts and administrative orders for the signature of the Governor. - Supervise the performance and management of the day-to-day activities of the office’s administrative assistant staff. - Evaluate the performance of the supervised work team. - Conduct disciplinary investigations of high-level employees of the territorial administration. - Provide legal advice to the Governor in administrative, disciplinary, and public policy decisions. - Draft and review contracts and administrative orders for the signature of the Governor. - Supervise the performance and management of the day-to-day activities of the office’s administrative assistant staff. - Evaluate the performance of the supervised work team.