Paola Rodriguez Email & Phone Number

West Covina, California, United States

My role as Outpatient Coordinator is to promptly, efficiently and accurately execute all aspects of the referral process. A coordinator's responsibility is to promote the quality and cost effectiveness of medical care through strict adherence to UM (utilization management) policy and procedure. A coordinator must anticipate customer needs by actively pursuing to understand the wants and needs of the customer, and listening for cues to identify what level of intervention they need in a case management setting. This position works closely and in tandem with assigned UM nurses and their member pool which will exceed 150 members per case manager.A coordinator must understand and execute the principles of UM to facilitate the right care at the right time in the right setting; communicate effectively and interact with the provider group and health plans daily or as indicated by UM and referral authorization issues or other member concerns, such as barriers to care and benefit inquiries.This role is largely responsible with providing care coordination to members in the scope of but not limited to: referral requests, appointment scheduling, transportation, arranging home visits or telephone appointments with nurse case managers, and assistance in navigating the healthcare system. Member engagement is of the utmost importance and is at the center of all duties.

Brea, California, United States

As a Client Services Coordinator, I am responsible for processing medical treatment requests in accordance with departmental policies, regulatory requirements, and client contractual agreements in a utilization management setting. Along with providing exceptional customer service, I am accountable for meeting performance metrics to ensure service level agreements are met. This role routinely contacts physician’s offices, health insurance plans, or patients to complete medical treatment requests for cancer patients all over the United States.

Orange County, California, United States

The Customer Service Representative is the first point of contact for Cal Optima members and providers. I assisted members and providers by navigating member benefits, issues with access to care, and provided education to better coordinate services. Other duties included: resolving inquiries related to member eligibility and enrollment and providing references and education to members eligible for programs in their service area. As part of the intake process, duties included identifying calls to initiate billing inquiries, grievance cases, and pharmacy related prior authorization cases, as well as assistance with scheduling interpreter services and coordination of care where necessary. Calls are routed through customer service to reach several departments internal to Cal Optima that range between their Member Liaison Program, Whole Child Model representatives, One Care Connect and PACE lines of business; behavioral Health, Grievances & Resolutions department, and Utilization Management for appropriate handling.

Foothill Ranch, California, United States

High volume, inbound call center, working primarily with product warranty. Created customer profiles using Salesforce and initiated the warranty process for product replacement. Updated customers about their order status and educated both returning and new customers of their warranty policy, honoring that warranty once all details and prerequisites were met over the phone. Clients included warehouse manufacturers, third party contractors, and retailers/wholesalers both carrying and working with our products. All communication with consumers would be established as a "one-call-resolution", but calls were often made outbound to notify customers of changes to their orders, promptly. This included large amounts of independent work, but the goal was to always strive together as a team. Empathy and a positive attitude were highlighted in our daily exchanges with all clients.

High School Diploma

Certificate Of Completion, Medical Billing / Electronic Medical Records (Emr)

Certificate Of Completion, Administrative Medical Assisting