Summary
Overview
Work history
Education
Skills
Languages
Timeline
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Antonio Rodriguez

Antonio Rodriguez

Letterkenny,Donegal

Summary

A dedicated and knowledgeable professional with a can-do attitude. Responsible, self-motivated, organized & keen to learn and develop new skills. Proficient knowledge of the American health care system such as Medicare & Medicaid including policies and regulations. Experience in providing guidance and support to individuals and organizations seeking to understand and utilize healthcare insurance effectively.

Skilled in conducting thorough assessments of insurance plans & advocating for client needs. Goal driven, great problem solver & logical thinker. As a bilingual in the languages of Spanish and English, I have excellent verbal & written communication skills which can be a useful and fundamental skills to any work environment. One of my greatest strengths is my ability to excel both independently and collaboratively with a team, given that l have an excellent understanding of the importance of teamwork to produce productive & efficient results.

Overview

9
9
years of professional experience

Work history

Senior Appeals Representative

Optum
Letterkenny, Republic of Ireland
04.2022 - Current
  • Conduct reviews of Medicare Part C claims.
  • Conduct an independent decision based on research of the initial claim processing activity, documented procedures & policies, and information supplied with the appeal request by either members or providers.
  • Initiating a response to the inquirer and appropriate parties to the appeal in the form of an adjustment to payment, refund request for over payment or written correspondence when upholding the processing of the service.
  • Working within multiple computer applications to complete the process of the appeals.
  • Displaying effective telephone and written communication skills while responding timely to Medicare inquiries that constitute an appeal or reopening of an initial claim determination.
  • Providing extra support to the team regarding case questions as well as training new hires in the department.
  • Providing Spanish translation assistance of letters, phone calls & emails to other coordinators in the event of the appeal being in Spanish.
  • Led training sessions on Direct Member Reimbursement scenarios, onboarding new hires and advancing staff expertise within the department.
  • Supporting OJT role & completing daily teams reports, assigning work direction & addressing case questions from team members.

Chef de partie

Stateside American Restaurant
Letterkenny, Republic of Ireland
08.2017 - 04.2022
  • Responsible for the efficient running and supervision of the kitchen in the absent of the head chef.
  • Worked part of a team of highly motivated Cooks. Revising and assist in creating a new monthly menu.
  • Supervised in the preparation of food under the supervision of the Head Chef.
  • Created dishes for customers with special dietary or cultural needs.
  • Decisions on the quantities portion sizes of the food to be prepared and served.
  • Responsible for the quality control of stock and prepared foods, Comply with all health and safety regulations, manage food orders directly from the suppliers.

TEFL-ENGLISH TEACHER

Idiomas Ruge
Caracas, Venezuela
05.2015 - 06.2017
  • Teaching and educating students according to individuals academic needs, abilities and potential.
  • Provide exercises in terms of writing and grammar.
  • Monitor, train, instruct and guide students.
  • Develop a student-centered classroom, encouraging critical thinking and making time for group discussions.
  • Planning and preparing activities that engage students in language and literacy.
  • Used effective teaching and class management techniques to deliver instructions to a class of 15+ students.
  • Play a key role in supporting the delivery of effective learning experiences.
  • Responsible for the welfare of the students.

Education

Luisa Teresa De Monte Mayor Los Guayos
Co. Carabobo, Venezuela

Central University of Venezuela

Errigal College
Letterkenny, Co.Donegal

Errigal college
Letterkenny, Co. Donegal

Swilly Group

MOS Excel Associated

ETB

Skills

  • Advanced Knowledge of Office Software
  • Power BI Proficiency
  • Basic SQL Knowledge
  • Data Visualization
  • Basic AI Python Knowledge
  • Data entry
  • Presentation Skills
  • Data base administration
  • Medical Terminology
  • Compliance Ethic
  • Analytical and critical thinker
  • Ability to Analyze reports
  • Flexible and adaptable
  • Decision Making
  • Great organizational Skills

Languages

English
Fluent
Spanish
Native
Portuguese
Intermediate

Timeline

Senior Appeals Representative

Optum
04.2022 - Current

Chef de partie

Stateside American Restaurant
08.2017 - 04.2022

TEFL-ENGLISH TEACHER

Idiomas Ruge
05.2015 - 06.2017

Luisa Teresa De Monte Mayor Los Guayos

Central University of Venezuela

Errigal College

Errigal college

Swilly Group

MOS Excel Associated

ETB
Antonio Rodriguez