Rozio Delgado

FAQ About Rozio Delgado

• What is Rozio Delgado's address?

  Rozio Delgado is located at
  San Diego, San Diego, United States

• What is Rozio Delgado's job title?

  Rozio Delgado is a
  Responds to basic verbal and written inquiries from members, providers, brokers, and other callers regarding Health Plan coverage, policies and benefits. Documents all communications in IDX Customer Service Module. Utilizes Plan materials and other references to assist members and providers. Conducts new member orientations, follow-up on member health assessments, and other outbound calls as assigned to assist members in accessing health care and to ensure compliance with regulatory requirements. Accesses IDX to verify enrollment, eligibility, PCP selection, and claims status. Documents all calls in the IDX Customer Service Module immediately after each call or communication takes place. Provides support for the Grievance/Appeal unit, including but not limited to: Opens, sorts, dates, logs and distributes incoming appeals and grievance mail and faxes. Maintains confidentiality of material and information handled. Prepares and maintains case files, correspondence and database for appeals and grievances in accordance with company requirements.Verify that sufficient information is available for accurate verification and eligibility, direct contact with physician office/and or patient, determine if a secondary insurance should be added to the patient account ensuring the appropriate payer is selected for Primary insurance, utilize the centers selected vendor claims and eligibility and/or individual payer websites to obtain eligibility, benefits and/or pre-certs and authorization information. Enter patient information in the accounting system ensuring the selection is the appropriate payer and associated financial class, contacting patient's prior to the date of service to review coverage, Verify insurance/recipient eligibility, billing and follow-up on claims to Medicare, Medicaid and Private Insurer Payers, Review unpaid and/or denied claims, appeals and follow-up on accounts to zero status, Research and respond to Medicare, Medicaid and other Payer inquiries regarding billing issues and insurance updates.Performs or confirms quality assurance audits. Responsibilities include call/case/valuation monitoring, evaluation and calibration scoring/call coaching individual and group coaching, identifying trends. Assures compliance to in-house and/or external specifications for standards, methods, and procedures that result in the precision, accuracy, and reliability of audited work. Assists product support areas in gathering and analyzing data. The Program Specialist is responsible for supporting the operations of InTeleCenter™ programs including, but not limited to, reimbursement hotlines, patient assistance programs, foundations, safety surveillance programs and compliance programs, help patients or providers access the therapies they need, respond to requests from customers, who may include, but not limited to, physicians and their staff, hospital staff, pharmacists, patients, family members or friends of patients, distributors, and members of the clients’ sales forces also perform reimbursement support functions as project requirements. Respond to inbound calls from customers, identify how best to assist the caller, document calls in appropriate database, and handle/escalate calls per PSPs. Ensure that the appropriate reimbursement steps have been taken for the patient such as the insurance verification, prior authorization process, claim, PAP screening, SP Triage etc. Build relationships with patients, providers, or other key stakeholders to best meet their needs. Proactively keep them informed of progress, issues, and other important updates so they know the status. Recognize and identify trends within their region. Provide suggestions on how to address these issues to Supervisors and Client Management, educate and train team members on these issues as necessary. Assist with training new case agents by conducting training with program specific and shadow/reverse shadowing them and serving as a data check.. The Program Specialist is responsible for supporting the operations of InTeleCenter™ programs including, but not limited to, reimbursement hotlines, patient assistance programs, foundations, safety surveillance programs and compliance programs, help patients or providers access the therapies they need, respond to requests from customers, who may include, but not limited to, physicians and their staff, hospital staff, pharmacists, patients, family members or friends of patients, distributors, and members of the clients’ sales forces also perform reimbursement support functions as project requirements. Respond to inbound calls from customers, identify how best to assist the caller, document calls in appropriate database, and handle/escalate calls per PSPs. Ensure that the appropriate reimbursement steps have been taken for the patient such as the insurance verification, prior authorization process, claim, PAP screening, SP Triage etc. Build relationships with patients, providers, or other key stakeholders to best meet their needs. Proactively keep them informed of progress, issues, and other important updates so they know the status. Recognize and identify trends within their region. Provide suggestions on how to address these issues to Supervisors and Client Management, educate and train team members on these issues as necessary. Assist with training new case agents by conducting training with program specific and shadow/reverse shadowing them and serving as a data check.Received, reviewed, and entered data into computer system or tracking database according to established procedures. Ensured accuracy of all data recorded and performed database maintenance functions. Received, directed and relayed telephone messages and faxes messages. Answered all incoming calls and Redirected calls as appropriate and take adequate messages when required. Picked up and distributed incoming mail; opens, logs and routes office mail; stuffs, sorted and prepared outgoing mail; retrieved, delivered and sends faxes. Maintained general filing system and filed all correspondence. Assisted in planning and preparation of meetings, coordinated meeting arrangements. Maintained an adequate inventory of office supplies. Responded to public inquiries and provided word-processing and secretarial support. Coordinated the repair and maintenance of office equipment. Sharp Health Plan

• What industry does Rozio Delgado currently work in?

  Rozio Delgado currently works in the
  Sharp Health Plan

• What is Rozio Delgado's area of expertise?

  Rozio Delgado specializes in
  Responds to basic verbal and written inquiries from members, providers, brokers, and other callers regarding Health Plan coverage, policies and benefits. Documents all communications in IDX Customer Service Module. Utilizes Plan materials and other references to assist members and providers. Conducts new member orientations, follow-up on member health assessments, and other outbound calls as assigned to assist members in accessing health care and to ensure compliance with regulatory requirements. Accesses IDX to verify enrollment, eligibility, PCP selection, and claims status. Documents all calls in the IDX Customer Service Module immediately after each call or communication takes place. Provides support for the Grievance/Appeal unit, including but not limited to: Opens, sorts, dates, logs and distributes incoming appeals and grievance mail and faxes. Maintains confidentiality of material and information handled. Prepares and maintains case files, correspondence and database for appeals and grievances in accordance with company requirements.Verify that sufficient information is available for accurate verification and eligibility, direct contact with physician office/and or patient, determine if a secondary insurance should be added to the patient account ensuring the appropriate payer is selected for Primary insurance, utilize the centers selected vendor claims and eligibility and/or individual payer websites to obtain eligibility, benefits and/or pre-certs and authorization information. Enter patient information in the accounting system ensuring the selection is the appropriate payer and associated financial class, contacting patient's prior to the date of service to review coverage, Verify insurance/recipient eligibility, billing and follow-up on claims to Medicare, Medicaid and Private Insurer Payers, Review unpaid and/or denied claims, appeals and follow-up on accounts to zero status, Research and respond to Medicare, Medicaid and other Payer inquiries regarding billing issues and insurance updates.Performs or confirms quality assurance audits. Responsibilities include call/case/valuation monitoring, evaluation and calibration scoring/call coaching individual and group coaching, identifying trends. Assures compliance to in-house and/or external specifications for standards, methods, and procedures that result in the precision, accuracy, and reliability of audited work. Assists product support areas in gathering and analyzing data. The Program Specialist is responsible for supporting the operations of InTeleCenter™ programs including, but not limited to, reimbursement hotlines, patient assistance programs, foundations, safety surveillance programs and compliance programs, help patients or providers access the therapies they need, respond to requests from customers, who may include, but not limited to, physicians and their staff, hospital staff, pharmacists, patients, family members or friends of patients, distributors, and members of the clients’ sales forces also perform reimbursement support functions as project requirements. Respond to inbound calls from customers, identify how best to assist the caller, document calls in appropriate database, and handle/escalate calls per PSPs. Ensure that the appropriate reimbursement steps have been taken for the patient such as the insurance verification, prior authorization process, claim, PAP screening, SP Triage etc. Build relationships with patients, providers, or other key stakeholders to best meet their needs. Proactively keep them informed of progress, issues, and other important updates so they know the status. Recognize and identify trends within their region. Provide suggestions on how to address these issues to Supervisors and Client Management, educate and train team members on these issues as necessary. Assist with training new case agents by conducting training with program specific and shadow/reverse shadowing them and serving as a data check.. The Program Specialist is responsible for supporting the operations of InTeleCenter™ programs including, but not limited to, reimbursement hotlines, patient assistance programs, foundations, safety surveillance programs and compliance programs, help patients or providers access the therapies they need, respond to requests from customers, who may include, but not limited to, physicians and their staff, hospital staff, pharmacists, patients, family members or friends of patients, distributors, and members of the clients’ sales forces also perform reimbursement support functions as project requirements. Respond to inbound calls from customers, identify how best to assist the caller, document calls in appropriate database, and handle/escalate calls per PSPs. Ensure that the appropriate reimbursement steps have been taken for the patient such as the insurance verification, prior authorization process, claim, PAP screening, SP Triage etc. Build relationships with patients, providers, or other key stakeholders to best meet their needs. Proactively keep them informed of progress, issues, and other important updates so they know the status. Recognize and identify trends within their region. Provide suggestions on how to address these issues to Supervisors and Client Management, educate and train team members on these issues as necessary. Assist with training new case agents by conducting training with program specific and shadow/reverse shadowing them and serving as a data check.Received, reviewed, and entered data into computer system or tracking database according to established procedures. Ensured accuracy of all data recorded and performed database maintenance functions. Received, directed and relayed telephone messages and faxes messages. Answered all incoming calls and Redirected calls as appropriate and take adequate messages when required. Picked up and distributed incoming mail; opens, logs and routes office mail; stuffs, sorted and prepared outgoing mail; retrieved, delivered and sends faxes. Maintained general filing system and filed all correspondence. Assisted in planning and preparation of meetings, coordinated meeting arrangements. Maintained an adequate inventory of office supplies. Responded to public inquiries and provided word-processing and secretarial support. Coordinated the repair and maintenance of office equipment.

• Which languages does Rozio Delgado speak? 

  Rozio Delgado speaks the following languages:
  No languages available.

• Which industries has Rozio Delgado previously worked in?   

  Rozio Delgado has prior experience in the following industries:
  Sharp Health Plan , Allied Health Group , Covance , Sedona Staffing , Express Employment Professionals

• What is Rozio Delgado’s work experience?  

  Rozio Delgado has the following professional experience:
  Sharp Health Plan , Allied Health Group , Covance , Sedona Staffing , Express Employment Professionals .

• How can I find Rozio Delgado on LinkedIn?  

  You can view Rozio Delgado’s
  LinkedIn profile at LinkedIn URL.

• What are Rozio Delgado’s work email addresses?  

  Rozio Delgado’s work email addresses are
  [email protected] .

• What company does Rozio Delgado work for?  

  Rozio Delgado works at
  Sharp Health Plan