Abel Apodaca Email & Phone Number

Phoenix, Arizona, United States

Remote

Initiate and respond to telephone and written correspondence with members, providers and insurance carriers with established timeframes utilizing current reference materials Maintain performance and quality standard based on established metrics including turn-around timesResearch and identify any processing inaccuracies and route to the appropriate team for adjustmentIdentify any trends related to incoming or outgoing calls that provide policy or process improvement ma to support excellent customer service, quality improvement and call reduction Assist members with completing monthly premium payments via phone Verify members benefit based on plan selection Assist members with Prior authorization and referrals Verify provider is contracted in network with health plan

Phoenix, Arizona, United States

Investigate, evaluate, and settle insurance claimsDecides the appropriate amount the insurance company should payDetermine the reason why claim did not automatically process and verify if any error was submitted Contact claimants’ doctors or employers to get additional information on questionable claimsVerify that all ICD-9, CPT, modifiers and revenue codes are used correctly, prior to payment approval.

Phoenix, Arizona, United States

Through Spanish fluency, self-confidence, strong oral communication skills, and business acumen, supported customers and providers in all areas of data management and ensuring quality assurance on all information associatedManaged provider data to maintain and improve database information, communicating clearly to ensure accuracy of data and updates associatedReported and extracted data for various reports and analysesDeveloped and maintained standards for database integrity and quality assuranceCoordinated corrective activities to clean database and retain users through identification of errors and tangible solutionsAudited systems for data quality improvement initiatives

Phoenix, Arizona, United States

Communicated with external customers in both English and Spanish to understand, listen, and resolve issues related to all healthcare services and products associated with the businessMaintained strong knowledge of services offered to best identify needs of customersFacilitated team meetings to discuss scripting and program updates per supervisor, gaining strong understanding of supervisory tools – Empower, RTA, ECLAssisted consumers with FFM inquiries, as well as took part in diffusing difficult situations over the PhoneMaintained timely review of updated materials that cover new initiatives or changes to current processesEnsured quality and operational metrics were met or exceeded on a daily basis, following a daily schedule and maintaining weekly adherence at a 92% level or more