1. Eleanor Ochoa
Midvale, Utah84047
(915) 694-2366
eleanarchlt@aol.com
Career Summary
Highlyprofessional customerservice agent.Providingsuperiorresultstothe employer.
Education
GED
H & R BlockTax Course
HIAA StudyCourses
Fundamentalsof HealthA &B Supplemental Health,Fraud,ManagedCare part A,B & C
SaltLake CommunityCollege,SaltLake City,Utah
Studied:Communications,ComputerEssentials,BusinessManagement,CollegeEssentials,Algebra
CertifiedNurses’Assistant,completedandcertified
CPR & FirstAidLicense
PrerequisitestoNursing:Biology,Mathematicsforthe HealthSciences
Thayne marshInsurance School
Departmentof Insurance LicensedAccidentandHealthproducer
Special Skills
Chrome
WindowsOffice Suite
Scanner
PaperVison
Fax Machine
Internet
OutlookExpressEmail
Phoenix System
AmisysSystem
Tops System
Quattro Pro
Filing
CopyMachine
Production
Inventory
Statistics
MonitoringCalls
Training
Delivery
Stocking
Microfiche
FlipCharts
OverheadProjectors
Administrative andClerical
Procedures
Laptop
Detail Oriented
Team Player
Medical Terminology
DeanVaughnCertified
CPT
ICD-9
DRG
HCPCS
Medicare and Medicaid
EmploymentHistory
Bilingual CustomerService, General Dynamics,SaltLake City, Utah 02/2014-07/2014 (Seasonal)
 Utilize standardtechnologysuchastelephone,e-mail,andwebbrowsertoperformjobduties.
 Provide knowledgeable responsestotelephoneinquiriesinacourteousandprofessional
manner.Utilizedpre-scriptedresponsesverbatimtoprovide basicgeneral andclaimsspecific
informationinEnglishandSpanish.
 Followestablishedanddocumentedpoliciesandstandardoperationsproceduressuchasfilling
out timesheets,adheringtoprivacyrulesandrespondingtonumerousphone inquiries.

2.  Assistcallerwithfillingoutonline applicationsandsubmittingitelectronicallytoplanprovider
for processing.
 Complete basiccall logrelatedtothe phone inquiriessuchasclickingradiobuttonstoconfirms
whichscriptswere readthe CSR to the caller.
 Maintainup to date knowledgeof CMSregulationsandpoliciesastheyapply.
 Reportproblemsthatoccur viaonline systemssotheycanbe addressby the appropriate
parties.Respondtotelephone inquirieswithinthe setupdepartmental staffingandtime
parameters.
 May be requiredtoworkGDIT scheduledholidays,overtime maybe required.Performother
relateddutiesasassigned.
CertifiedNurses’Assistant,3-DMedical Staffing,SaltLake City,Utah 11/2008-11/2013
 Provide nursingassistanceoncall tothe Universityof Utahand JohnHuntsmanCancer andSalt
Lake Regional Patients.
 Care provideddependeduponpatient’splantchart,all of care needsprovidedtreatments.
 Workedon multipleareaof the facilitysuchas:Orthopedic,Cancer,BurnUnit,ICU, NCC and
Medsurg.
Bilingual CustomerService,RemedyStaffing,SaltLake City,Utah03/2010-08/2010
 Take in and outboundcallsfor the US CensusProject.Capture dataandcorrect data,
demographicsforUS Households.
 Keptinformationconfidential.
 AssistwithSpanishandEnglishcustomers.
 Provide excellentcustomerservice andmeetandexceedstrictadherencetoqualityand
attendance standards.
BenefitsAdvisor,ExtendHealth,SaltLake City,Utah 08/2009-01/2010
 Assisteligibleretirees/enrolleeslosinggroupcoverage toenroll inMedicare,Medicaps,
Medicare Advantage andPart D Drug Plan.
 ClientsincludeGM,Avon,Volkswagon,FordCaraustar,ReynoldsandReynoldsandCooper
RubberTire.
 ObtainAHIPlicensure andcarriercertificationforall plansoffered.
 Use internetandmedicare.govwebsiteandlookupprescriptionstoverifycoverage andexplain
patientresponsibilityanddonuthole,compare healthplans,verifyprovidernetworkstatus.
 ExplainHRA reimbursementandsetup.
 FollowHIPPA andSalesMarketingRules.
 Use internetandWindowsVistaPrograms.
SeniorCustomer Service Rep.,UHG/EwingAssociates/Ingeneix,SaltLake City,Utah9/2008-3/2009
 AssistmemberswithfillingoutMedicaidapplications.
 Make outboundcallstomembersof Evercare and AARPSecure Horizonstodetermineif they
prequalifyforMedicaidinthe respectivestates.
 Knowledgeof MedicaidGuidelinesandapplicationprocessinthe followingstates:MI,MA,IL,
IN,CA,CO, WA,FL, GA, TX, UT, OH, AZ, NCand VA.
 Mail outand followupwithmemberstodetermine if applicationwasreceivedandmailedto
the state.
 UsedCicso System/AvayaIPAgent.

3.  Contact State Medicaid departmentstodetermine if applicationwere approvedordenied.
 Assistedwithtranslationof Spanishmembers’callsandtranslationof applications.
ProviderService Representative,MolinaHealthCare of Utah, SaltLake City,Utah 12/2005-09/2007
 AuditproviderofficestoverifytheymeetNCQA standards.
 Travel 50% of the time to visit700 providers’officesinNorthernUtah.
 Educate and orientproviderofficeswithrespecttocontractsand plans.
 Assistinpreparationanddeliveryof healthfairstopromote Molinaproductsandchanges.
 Assistproviderofficeswithclaims,paymentissues,memberissues,answeremails,update excel
worksheets,trackanddocumentproviderissuesandassistinproviderlist.
 MeetwithState of Utah benefiteligibilityworkerstodiscussnetworkissuesandattendstate
meetings.
 Assistincredentialingandconfigurationof providerspricingschedulesandmaintainedof
database of credentialingprocedures.
CertifiedNurses’Assistant,Love Healthcare,SaltLake City,Utah03/2002-06/2007
 On call to provide certifiednursingassistance tohospitalsinSaltLake Valley.
 Abilitytoadaptto differentjobneedsbasedonthe type of facilityandneedsof patients.
 Workedwith all typesof patientsandagesencompassingall aspectsof care.
CertifiedNurses’Assistant,Beehive Homes,Saltlake City,Utah12/2004-08/2005
 Assistelderlypatientsinimprovingqualityof life andencouragingmoral.
 Assistpatientswithactivitiesof dailylivingwhichinclude:dressing,toileting,cleaningrooms,
personal hygiene,bathing,assistswith meals,feeding,walkingandachievinggoalsof personal
care plans.
 Passmedicationstopatients.
 TakingVital Signs.
 Chartingand recordingall activitiesonthe shift.
 Constantcontact withAdministratorandFamilyof concerns.
 Supervise otheremployees andtrainnew hires.
Personal Plans/ClientService,NorthwesternMutual Financial,SaltLake City,Utah03/2003-12/2004
 Educatingclientsandinternal agentsinEnglishandSpanish,withregardstothe sellingof
variouscarriers’ products.
 Takingapplications,reviewingforcompleteness,signingandsendingapplicationstorespective
carrier.Workingwithunderwritingatthe variouscarrierswithregardsto additional information
needed,clarification,obtainingmedical records,andthencontactingclientof approval,decline
or rate up,use of medical terminology.
 Liaisonbetweenclient,internal agentsandcareersthroughoutthe underwritingprocess
contactedby phone andemail.
 Renewals,proposals,quotesandhandlingof all changesof eligibility andplansandagentletter
of recordchanges.
 Handlingall enrollments,terminationchanges,claims,appeals,benefits,billingandpremium
issuesforsmall groupclientsandpersonal plans,andshortterm plans.
 Heldtrainingandpreparedall materials fornew andexistingagentswithregardstosellingthe
underwritingof plans.