Eully Mae Castañeda

• Respond to client inquiries promptly and professionally via phone and email.
• Answer and direct incoming phone calls and manage correspondence efficiently.
• Schedule meetings, manage calendars, and coordinate appointments.
• Prepare billing statements and invoices, ensuring accuracy in calculations.
• Resolve numerical and financial discrepancies related to billing and payments.
• Maintain organized records of communications, transactions, and documents.

• Subject Matter Expert (SME): Serve as the “go-to” person within the department for technical questions and problem resolution within my area of expertise.
• Mentorship & Guidance: Support and mentor team members by sharing knowledge, providing training, and offering continuous guidance.
• Regulatory & Industry Updates: Stay current with healthcare policies, coding updates, and operational changes.
• Communication & Collaboration: Work closely with cross-functional teams to ensure seamless service delivery and high customer satisfaction.
• Policy Account Management: Handle and review member policy accounts, ensuring accurate coverage verification and benefit explanation.
• Claims Processing: Review, process, and adjudicate medical and pharmacy claims in compliance with company policies and guidelines.
• Pre-Authorization & Intake Forms: Process prior authorization requests and accurately provide medical codes including ICD and diagnosis (DX) codes.
• Issue Resolution: Identify and resolve complex issues related to projects and programs efficiently and professionally.
• Process Improvement: Provide recommendations to enhance procedures, improve workflow efficiency, and support agent performance.

• Inbound/Outbound Calls
  Reporting
  Coordinating with the Clients
• Conducted follow-ups to ensure customer satisfaction and retention.
• Provided product information and recommendations to customers.
• Inbound/Outbound CallsReportingCoordinating with the Clients