Diane Rodriguez

Work History

Work History
Nov 2011 - Present

Member Service Representative

1199 National Benefit Fund

•Advise and educate 1199 National Benefit Fund members and retirees on their hospital, medical, dental, vision, prescription benefits and pre-certification requirements•Aide members with their worker’s compensation, disability and family medical leave act benefits•Advise members' on status of claims and submit analysis for adjustments•Advise members on appeal and balance billing procedures•Assist participants with locating participating network physicians•Aide members' with enrollment requirements under 1199 NBF and Fidelis•Advise members on employer contribution contracts which determines their level of benefits•Advise Retiree members on their Medicare part B reimbursement procedures•Request a release of medical/prescription cards, explanation of benefits and letters of creditable coverage as requested by member•Maintain the strictest adherence to compliance and HIPAA regulations

Mar 2010 - Jul 2010

Web Master (Internship)

Michael Mazzeo Gallery

•Updated and maintained website using Adobe Dreamweaver, Flash, Photoshop, CSS and HTML

•Developed and designed new web interfaces, layouts and site graphics

•Created and designed test website for demonstration purposes

•Created Icons using Photoshop

•Converted DVD files to flv files

•Served as liaison between clients and the gallery

Apr 2006 - Nov 2006

Member Service Representative

Building Service 32BJ Health Fund

•Advised and educated 32BJ Health Fund members on their hospital, medical, dental, vision, prescription benefits and pre-certification requirements•Advised members on deductible, coinsurance and co-payments•Advised members on their pension, 401K and profit sharing benefits•Advised members on claim status and made adjustments on claims when necessary•Assisted participants with locating participating network physicians

•Advised members on employer contribution contracts which determines their level of benefits•Issued medical/prescription cards, explanation of benefits and letters of creditable coverage as requested by member•Updated members’ demographics•Maintained the strictest adherence to compliance and HIPAA regulations

May 2004 - Apr 2006

Provider Service Representative

Empire Blue Cross Blue Sheild

•Managed 60 - 80 calls daily from nationwide providers at Empire Blue Cross Blue Shield call center•Advised hospital administrators/providers on patient’s hospital, medical, dental, vision, prescription benefits and pre-certification requirements•Advised providers on patient’s lifetime maximum, deductible, coinsurance and co-payments•Advised providers on claim status and submitted analysis for adjustments•Verified member eligibility status•Faxed hospital negative status recovery documentation to provider•Worked closely with manager on monthly claim reports•Issued explanation of benefits to provider as requested•Captured medical records/claims correspondence into system•Maintained the strictest adherence to compliance and HIPAA regulations

Oct 2003 - Apr 2004

Administrative Assistant

SmartMail Services, Inc.

•Coordinated with various staff for operational support activities of the unit; served as a liaison between departments and operating units in the resolution of day-to-day administrative and operational problems•Scheduled and coordinated meetings, interviews, appointments, events and other similar activities for managers, which also included travel and lodging arrangements•Managed a 20 line telephone system, assisted visitors and resolved a range of administrative problems and inquiries•Assisted in payroll when necessary•Assisted the Information Technology department set up switches, install programs and new hard drives on the main server•Worked closely with the Human Resources department, Accounts Payable department, East Coast Vice President, and General Manager

Dec 1998 - Jul 2003

Senior Enrollment Representative

HealthFirst, Inc.

•Data-Entry of Child Health Plus, 1199, Healthy New York, Commercial, Fidelis, Medicare, and Medicaid applications into the MHS, Continuum and On Contact•Worked on monthly rosters•Verified and kept log of numbers for Medicaid applications received daily•Audited Medicaid applications previously entered into MHS to assure accurate demographic information•Worked closely with the Marketing department as well as the Appeals and Grievances department.•Emeved Medicaid applications•Filed applications for the end of the month process•Completed referral requests from Member Services, Finance, Claims and 1199 National Benefit Fund•Worked closely with Managers and Supervisors to complete assigned tasks

Education

Education
Aug 2010 - Present

Bachelor in Technology

New York City College of Technology

Skills

Skills

Programming Language

ActionScript 3.0 HTML XML CSS   (Currently learning Ajax, JavaScript and PHP)  

Microsoft Office

Excel Word Outlook PowerPoint Works Schedule Publisher Access

Operating Systems

Windows 7 Windows Vista Windows XP MAC

Adobe CS3, CS4 and CS5

Dreamweaver Flash Illustrator InDesign Photoshop

Additional computer skills

Typing 60 wpm, WordPerfect 6.1, ViTech, Medical Manager, Document Tracking System (DOTS), Continuum, CS90, On Contact (ELK), Remote Assistance, Power MHS 5.7.1, Syntonics, Qnxt 3.4, Medco, IRIS, iObserver, PageMaker (Desktop Publishing), Lotus cc: Mail, Foxprod, Electronic Medicaid Eligibility Verification System, Pitney Bowes metering Machines.

CustomSmall

Portfolio:  www.diane-rodriguez.net