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Click here or scroll down to respond to this candidateCandidate's Name
.PROFESSIONAL SUMMARYHardworking, highly motivated professional eager to lend combined knowledge and skills to enhance business performance. Operates well in both individual and team capacities, leveraging seasoned work ethic to quickly adapt to different processes and drive company objectives. Resourceful and results-driven with a passion for growth and efficiency to meet company needs and increase service value.EXPERIENCEEnrollment Configuration AnalystJuly 2020 - January 2024 Clever Care Health Plan, Arcadia, CACreated detailed layout documents to create a CMS workflow process for the Enrollment Team.Provided technical guidance for the implementation of complex projects involving multiple systems.Worked closely with vendor during product testing phases in order to resolve any compatibility issues.Reviewed and modified CMS exhibits so that they met compliance and departmental guidelines.Customer Service Solutions SupervisorOctober 2019 - June 2020 La Care Health Plan, Los Angeles, CAPerformed regular audits of employee performance against established standards for quality assurance purposes.Organized effective team meetings to discuss issues and solutions.Developed new hires by coaching and evaluating employee performance.Reviewed policies and procedures to improve the efficiency of department processes.Supervised direct reports and enforced adherence to established procedures and deadlines.Interviewed potential candidates and provided thorough reviews to HR to aid in hiring decisions.Eligibility DirectorApril 2018 - June 2020 Network Medical Management, Alhambra, CADirected all aspects of project management including planning, budgeting, staffing, scheduling, monitoring, and reporting.Managed multiple projects simultaneously while staying within deadlines.Mentored and coached staff members, enabling them to reach their highest potential.Reconcile monthly health plan eligibility data using Eligibility Manager software.Provided support for internal and external clients.Eligibility ManagerSeptember 2013 - March 2018 SynerMed, Monterey Park, CAPrepared reports summarizing findings from eligibility reviews and investigations.Coordinated with other departments within the organization to ensure effective communication about changes in policies or procedures.Collaborated with management team members on special projects related to process improvement initiatives.Maintained accurate records of all eligibility determinations and related activities.Created and implemented training materials for staff on new procedures or processes related to eligibility determination.Established and maintained multiple electronic files to conduct regular reviews and updates.Trained employees in job-specific tasks and evaluated continuing education needs to improve team performance.Interviewed potential candidates and provided thorough reviews to HR to aid in hiring decisions.Eligibility SupervisorMarch 2006 - August 2013 SynerMed, Monterey Park, CACollaborated with management team members on special projects related to process improvement initiatives.Maintained accurate records of all eligibility determinations and related activities.Created and implemented training materials for staff on new procedures or processes related to eligibility determination.Interviewed potential candidates and provided thorough reviews to HR to aid in hiring decisions.Processed and reconciled health plan electronic eligibility files using DataWing software.Served as a liaison between contracted health plans, doctor's offices and internal customers.EDUCATIONHigh School DiplomaJuly 1992Whittier High School, WhittierREFERENCESReferences available upon requestCONTACTPHONE NUMBER AVAILABLEEMAIL AVAILABLEGlendale, CA 91206SKILLSProject ManagementResource AllocationData EntryStaff SupervisionInsurance VerificationMS OfficeCustomer ServiceAttention to detail.Data retrieval systemsWork Planning and PrioritizationWriting RequirementsProcess ImprovementStaff ManagementTraining and DevelopmentTime ManagementConflict ResolutionProblem SolvingData Analysis. |
