Adrian Pino Email & Phone Number

Florida, United States

Miami, Florida, United States

• Operational Alignment: Developed and enforced practices and procedures to ensure alignment with the organization's mission, vision, and values, fostering consistency and focus across teams.• Leadership and Task Prioritization: Led daily task prioritization, ensuring clear expectations and results among team members, promoting productivity and adherence to standards.• Process Improvement and Compliance: Managed deviations from established practices, driving continuous… Show more • Operational Alignment: Developed and enforced practices and procedures to ensure alignment with the organization's mission, vision, and values, fostering consistency and focus across teams.• Leadership and Task Prioritization: Led daily task prioritization, ensuring clear expectations and results among team members, promoting productivity and adherence to standards.• Process Improvement and Compliance: Managed deviations from established practices, driving continuous improvement and ensuring compliance with organizational guidelines.• Data-Driven Decision-Making: Leveraged analytical skills to perform complex duties, coordinate processes, and support strategic decision-making.• Call Center Leadership: Managed inbound inquiries for the senior pod, resolving complex issues and ensuring accurate, timely solutions.• International Training and Collaboration: Conducted overseas training sessions, gathering real-time data to address performance issues, align business practices, and support leadership in resolving call center challenges.• Subject Matter Expertise: Acted as the SME for both senior leadership and provider contact centers, resolving escalations, supporting agents, and addressing complex issues.• Operational Analysis: Researched and analyzed issues and operational policies to identify root causes and implement effective solutions.• Team Support and Training: Assisted supervisors with daily management, identifying training needs, and mentoring less experienced advocates to enhance team performance.• Continuous Improvement: Led efforts to identify and resolve operational problems, coordinating with internal and external teams to implement improvements. Show less

Miami, Florida, United States

• Quality Assurance Auditing: Identified and addressed quality issues in inbound/outbound calls and written inquiries by monitoring performance, analyzing data, and conducting thorough audits.• Process Evaluation and Improvement: Conducted detailed research and analysis to identify root causes of defects and trends, providing actionable insights to improve quality and efficiency.• Reporting and Recommendations: Developed and presented reports on audit findings, including… Show more • Quality Assurance Auditing: Identified and addressed quality issues in inbound/outbound calls and written inquiries by monitoring performance, analyzing data, and conducting thorough audits.• Process Evaluation and Improvement: Conducted detailed research and analysis to identify root causes of defects and trends, providing actionable insights to improve quality and efficiency.• Reporting and Recommendations: Developed and presented reports on audit findings, including recommendations for improvements, and training opportunities, ensuring management had clear visibility into quality issues.• Compliance and Fraud Investigation: Ensured compliance by reviewing guidelines, investigating potential non-compliance or fraudulent claims, and forwarding findings for further action.• Performance Documentation: Monitored and evaluated call quality, documenting issues and performance metrics for management review and continuous improvement. Show less

Miami, Florida, United States

• Customer Support and Education: Consulted with customer service to address complex insurance claims and policy questions, resolved issues, and ensured clear understanding of products and services.• Policy Interpretation: Performed in-depth research to respond to inquiries, interpreting policy provisions to provide effective solutions.• Claims Adjudication: Reviewed and adjudicated high-risk claims, ensuring accurate processing according to contract benefits and organizational… Show more • Customer Support and Education: Consulted with customer service to address complex insurance claims and policy questions, resolved issues, and ensured clear understanding of products and services.• Policy Interpretation: Performed in-depth research to respond to inquiries, interpreting policy provisions to provide effective solutions.• Claims Adjudication: Reviewed and adjudicated high-risk claims, ensuring accurate processing according to contract benefits and organizational guidelines.• Claims Processing: held claims, processed adjustments by collaborating with ambulance services, inpatient facilities, and other stakeholders.• Research and Development: Conducted detailed research to develop claims, including contacting providers or members for additional information.• System Installation and Troubleshooting: Installed and managed computerized systems for tracking, information gathering, and troubleshooting, enhancing operational efficiency.• Process Improvement: Adapted routine procedures as needed to address unique cases, ensuring flexibility and responsiveness in handling claims and inquiries. Show less

Doral, Florida, United States

• Call Management: Promptly answered incoming calls, screened inquiries, and relayed messages efficiently, ensuring seamless communication.• Patient & Referral Relations: Warmly greeted patients, referral sources, and healthcare professionals, creating a welcoming environment and fostering positive relationships with business partners like insurance adjusters, nurse case managers, and doctor’s offices.• Patient Intake & Authorization: Managed patient intake processes by verifying… Show more • Call Management: Promptly answered incoming calls, screened inquiries, and relayed messages efficiently, ensuring seamless communication.• Patient & Referral Relations: Warmly greeted patients, referral sources, and healthcare professionals, creating a welcoming environment and fostering positive relationships with business partners like insurance adjusters, nurse case managers, and doctor’s offices.• Patient Intake & Authorization: Managed patient intake processes by verifying benefits, co-payments, visit limitations, and authorizations to ensure seamless patient experiences.• Scheduling & Record Management: Efficiently scheduled patient appointments according to clinic policies and maintained accurate patient records in compliance with organizational guidelines.• Insurance & Payment Processing: Completed insurance verifications, collected co-payments and deductibles, and ensured proper billing practices.• Documentation & Reporting: Documented therapy notes for physicians and maintained timely communication with relevant parties.• Office Management: Maintained stock of clinical and business forms, ensured the cleanliness and functionality of office space, and managed inventory of therapy equipment and supplies.• Support to Clinical Staff: Assisted with patient care and monitoring when needed, contributing to overall clinical efficiency.• Compliance & Confidentiality: Ensured adherence to clinic policies, managed patient confidentiality, and participated in quality and safety improvement activities.• Miscellaneous Support: Provided additional support to the Clinic Manager as needed, helping with a variety of tasks to enhance clinic operations. Show less

Miami, Florida

Miami, Florida

Customer Issue Resolution: Addressed customer inquiries, complaints, and billing issues with the utmost courtesy and professionalism, ensuring one-call resolution and providing alternative solutions to retain customer business.Account Activation & Billing: Handled business transactions related to new customer account activations, processed billing inquiries, and made financial adjustments to protect and collect revenues.Customer Communication: Used web-based tools to communicate… Show more Customer Issue Resolution: Addressed customer inquiries, complaints, and billing issues with the utmost courtesy and professionalism, ensuring one-call resolution and providing alternative solutions to retain customer business.Account Activation & Billing: Handled business transactions related to new customer account activations, processed billing inquiries, and made financial adjustments to protect and collect revenues.Customer Communication: Used web-based tools to communicate effectively with customers, demonstrating strong typing and grammar skills to provide clear and accurate information.Sales & Quota Achievement: Successfully met or exceeded sales quotas by offering value-added solutions that enhanced customer satisfaction and loyalty.Workforce Management: Assisted management with workforce scheduling, tracking vacation schedules, and ensuring compliance with company guidelines.Employee Training & Development: Trained new employees, helping them develop the skills and knowledge needed for success in their roles.Technical Support: Acted as a technical solutions expert, troubleshooting product and service issues and ensuring high levels of customer satisfaction.Recognition & Achievements:Achieved Top Customer Service Specialist within the department during Q1 2015.Ranked #1 Customer Service Specialist nationwide in February 2015.Goal-Oriented Performance: Consistently met department goals, including achieving targets for Net Revenue Score (NRS), First Call Resolution (FCR), and Willingness to Recommend (WTR).Call Efficiency: Ensured optimal handling of billing and sales calls, maximizing both call efficiency and customer experience. Show less

Miami, Florida

Bachelor Of Arts - Ba, Health/Health Care Administration/Management, 3.85 Gpa

Associate Of Arts (A.A.), Business, Management, Marketing, And Related Support Services