1. RENEE L. HAYS
H ea lth c a r e P r o f ession al
602 W. Granada Court,Ontario,CA 91762
(909) 984-4857 – (909) 821-5639 – reneflorea@aol.com
C A R E E R O B J E C T I V E
Ambitious,personable,andhighlyorganized healthcare professional withexcellentcommunication
skillsseekinganopportunitytocontinuemy healthcare profession whereIcan maximize myresilient
workethic,Healthcare experience,andMemberService skills.
Q U A L I F I CA T IO NS
ProficientinMicrosoftWord/Works programs,Medicare Marx systems,Facets
Excellentcommunication/telephoneskills/people oriented
Work well underpressure/able tocompleteprojectsbyassigneddeadlines
Excellentknowledge of Medicare andMedi-Cal guidelinesandbenefits
HIPAA Certification
E X P E R I E N C E
S p e c t a t o r s S p o r t s
B a r
2 0 0 5 - 2 0 1 6
I n t e r V a l l e y
H e a l t h P l a n
1997 – 2012
O w n e r / M a n a ge r
All aspectsof operatingandrunningan S-Corpbusiness,includingpayroll,
accounts payable,accountsreceivable,scheduling,vendorrelationships, stocking,
ordering,maintenance andcustomerservice
M E D I C A R E R I S K M E M B E R S E R V I C E R E P R E S E N T A TI VE
Responsibilitiesincludeinformingmembersandeducatingthemontheir benefits
and healthcare options,processingandfollowinguponclaims, authorizations,
responsible forrecordingandenteringall member information,includingchange
inname,address,change inprimarycare physician,correctdate of birth,and lost
ID cards, makingsure that all memberconcerns,problems,andgrievances,are
understood andexpeditiouslyresolved,usingdirectcontactwiththe physician
offices,and medical groups,answeringtelephone linesinatimelyand
professionalmanner,informsmembersof,anddocumentsresearchoutcomes,
eitherby telephone orwrittendocumentation,responsibleformonthlyphysician
and medical groupterminations,contactingmembersandgoingover optionsto
insure changesare done withinHCFA guidelines,along withmembersatisfaction
ss
E N R O L L M E N T C O O R D I NA T OR
All enrollmentanddisenrollmentprocesses,includingprocessing andinputof
newapplications,andverifyingeligibility.
O U T B O U N D V E R F I CA T IO N R E P R E S E N T AT I VE
Responsible forconductingtelephoneinterviewswiththe beneficiariestoensure
marketingwasdone incompliance withMIPPA regulations,identifyingany
potential marketingallegations,confirmingintenttoenroll andassistingthe
beneficiarieswithanyfinal questionstheymayhave priortothe enrollment
E D U C A T I O N
U n i v e r si t y o f
P h o e n i x
2013 – 2016
B A C H E L O R O F S C I E N C E I N H E A L T H C A R E A D M I N I S T R AT I ON
The Bachelorof Science inHealthAdministration(BSHA) addressesthe basicbody
of knowledge,understanding,andskillsidentifiedasrelevanttoanever
