Experience

Health Services For Children With Special Needs

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Customer Service Associate

  • Aug 2004 - Present

  Answer inbound and make outbound calls in a high volume call center. Collect vital member information to input into computer during call.● Resolve an average of 550 member inquiries and requests weekly, and consistently meet performance benchmarks in all areas (speed, accuracy, volume).● Schedule provider appointments including transportation service to and from provider offices.● Handle upset member calls with sensitivity while maintaining a professional attitude. Make appropriate position-level decisions and take action to ensure successful handling of member requests. ● Assist members with appropriate language translation/interpretation services.● Update member information regularly to ensure integrity of database and reporting.● Partner with Director of Customer Care to identify challenges and opportunities that lead to improved processes and operations within the department.● Conduct status checks on claims.● Schedule EPSDT physical appointments and confirm the status of the appointments

• Medicaid Enrollment Analyst

  • Jan 2018 - Aug 2019

  ● Coordinate enrollment and disenrollment and track eligibility of enrollees.● Facilitate information exchange between HSCSN, Department of Health Care Finance (DHCF), and other government agencies regarding enrollment and disenrollment issues.● Reviews and tracks eligibility of prospective enrollees and maintains the enrollment database on a daily basis.● Responsible for maintaining the integrity of member enrollment, eligibility, and demographics in HSCSN’s enrollment database.● Prepare, process, and maintain new enrollments and other changes to member enrollment on a daily basis.● Process monthly audits between HSCSN enrollment database and DHCF’s enrollment rolls.● Collaborate in system development.● Work closely with numerous departments in the recertification process of existing members.● Manage accurate and timely updating of computer systems with members demographic information, Primary Car Provider, and Primary Insurance.● Reconcile all eligibility discrepancies, researching disenrollment request, internal and external reporting.● Research, collect, and submit documentation to maintain eligibility in all systems.

• Customer Service Representative

  • Aug 2004 - Dec 2017

  ● Answer inbound and make outbound calls in a high volume call center. Collect vital member information to input into computer during call.● Resolve an average of 550 member inquiries and requests weekly, and consistently meet performance benchmarks in all areas (speed, accuracy, volume).● Schedule provider appointments including transportation service to and from provider offices.● Handle upset member calls with sensitivity while maintaining a professional attitude. Make appropriate position-level decisions and take action to ensure successful handling of member requests. ● Assist members with appropriate language translation/interpretation services.● Update member information regularly to ensure integrity of database and reporting.● Partner with Director of Customer Care to identify challenges and opportunities that lead to improved processes and operations within the department.● Conduct status checks on claims.● Schedule EPSDT physical appointments and confirm the status of the appointments