Jeannette S. Fonseca Rodríguez is seeking a position where she can apply her experience in customer service, human resources, and healthcare. She has over 4 years of experience working in appeals and grievance departments, quality control, and as a case coordinator. Her skills include excellent communication, knowledge of computer programs like Microsoft Office, and being bilingual in Spanish. She is currently working towards an Associate's Degree in Pharmacy Technician from National University College.

1. Jeannette S. Fonseca Rodríguez
5053 Saddle Drive Lafayette IN 47905
Phone: 787-530-7669 – 305-803-0508
Email: sibelizfonseca@gmail.com
OBJECTIVE: Position where I can apply my central processing unit experience, proven communication and
interpersonal skills to improve operations and surpass the quality standards set by the institution.
SKILLS SUMMARY
Advanced interpersonal and excellent communication skills. Knowledge in computer programs such as Microsoft
Office suites. E-Z Cap, ADP, Peachtree, Inmediata, Cpr+, Abarca, OnBase, MedHok, QNXT and Rx30. Experience
and ability to apply technical concepts and financial analysis to clinical evaluation. More than 4 years’ experience in
human resources and customer service.
Knowledge of the Medicare processes and regulatory requirements. Able to work at a high pace, different types of
cases maintaining a high quality. Interpret and apply Pharmacy utilization and trend data, effective presenter and
problem solver. Bilingual Spanish.
PROFESSIONAL EXPERIENCE
MMM Holdings, LLC March 2013 - Present
Appeals & Grievance Department – Analyst
 Works Inquiries, Complaints and Appeals (Standard and Expedites). Analyzes, investigates and documents the
evidence according to the denial code and processes the case according to established policy.
 Define problems, collect data, establish facts, bring valid conclusions and implement appropriate solutions.
 Sends appropriate notices to members and providers within established time frames according to member or
provider request.
 Interacts with Sales/Marketing, Human Resources, Compliance, Medical and Legal departments.
 Create presentations and/or manuals of the new applications systems to train the A&G staff and HR.
 Perform Authorizations for medical procedures, equipment or medications that comply with Medicare Guidelines.
 Interview applicants to determine if person is a match for job opening in Appeals & Grievance Department .
 Produced audit reports weekly, monthly, quarterly and annual.
Special Care Pharmacy and Compounding Services November 2011 – March 2013
Quality Control Department –Rx Reconciliation Auditor
 Internal audit
 Lead initiatives to communicate changes and modify processes and documentation as needed.
 Interacts with Sales/Marketing, Compliance, Medical and Legal departments.
 Produced audit reports weekly, monthly and quarterly.
 Assistant to Quality Director with hiring processes and corrective action for Quality Department employees.
 Created and validated statistical process and quality audits.
 External audit – Health Insurance and Joint Commission.

2. Special Care Pharmacy Respiratory Therapy Services May 2010 – November 2011
Case Coordinator
 Implement effective and appropriate program communications plans. Monitor all regulatory data collection,
reports, file submissions, CMS guidance.
 Educate patients on health matters specific to their case.
 Assistant to Quality Director; present monthly reports and track progress.
 Inventory control, medical equipment dispatch.
 Develop case files for health insurance companies on patients required medication.
PROFESSIONAL TRAINING
Crucial Conversations (2007), Emergency Management (2007), Self-Control And Stress Management (2009),
Emotional Intelligence (2010), Prevention Of Sexual Harassment (2010), Customer Service Sensitivity (2010-
2012), Corrective & Disciplinary Actions For CMS Violations (2010-2011), Policy Conflict (2011),
Monitoring Policy (20011), Information Security (2011), Sales (2011), HEDIS Applications Course (2011),
Appeals And Grievances Training Course (2010-2011), On base Software Seminars (2011), Lost Control (2013),
Human Resource Training (July 2013) Advanced Data Management in Excel 2003 (2014) Health Insurance
Portability and Accountability Act (HIPPA) (2014) Occupational Safety and Health Administration (OSHA)
(2014) Control Flu (2014)
EDUCATION
National University College August 2011 – Present
Associate’s Degree in Pharmacy Technician
Bayamon Community Collage 2008 - 2009
Assistance Administrative - Technic Certification