Alexandria Federico
Tucson,AZ
Summary
Adaptable Eligibility Specialist with a proven ability to excel in dynamic environments. Demonstrates exceptional skills in policy interpretation, needs assessment, and case management software. Known for enhancing client satisfaction through effective communication and problem-solving strategies while maintaining high confidentiality standards. Achievements include streamlining application processes to optimize efficiency and improve outcomes for government program applicants.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Eligibility Specialist
Aetna, a CVS Health
Tucson, AZ
08.2024 - Current
- Reviewed applications to verify client information and resolve discrepancies.
- Managed intake of new claims and performed routine follow-ups.
- Assessed potential fraud cases by conducting investigations into suspicious activities.
- Analyzed financial information provided by applicants to verify income levels.
- Attended regular training sessions to stay up-to-date on new rules and regulations.
- Granted, modified, denied, or terminated assistance based on key information and eligibility determination.
- Explained reasons behind application denials and recommended further action.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Collaborated with other departments within the organization to ensure accurate processing of applications.
- Coordinated with other departments to promote prompt processing of client applications.
- Monitored client accounts for any changes that could impact eligibility requirements.
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
- Processed client applications in accordance with established guidelines.
- Developed strategies to improve efficiency in the processing of applications and customer service delivery.
- Entered client information and files into databases for further review and tracking.
- Provided guidance on how to apply for benefits and answered questions related to the process.
- Verified applicant's identity and other relevant documents such as birth certificates or Social Security cards.
- Performed careful reviews of applicant data to ascertain compliance with eligibility criteria for economic assistance.
- Reviewed applications for eligibility and determined whether applicants met the criteria to receive benefits.
- Conducted system analysis and testing to identify and resolve technical issues or inefficiencies.
Medicare Specialist
Connie Health Inc.
Tucson, USA
06.2023 - Current
- Advocate for Medicare recipients
- Review plan benefits
- Verify eligibility for Medicare and Medicaid
- Assisted in the development of training materials for new Medicare Specialists, fostering a knowledgeable team environment
- Provided timely responses to inquiries from patients, healthcare providers, and colleagues regarding Medicare policies and procedures
- Developed strong working relationships with insurance carriers, facilitating prompt resolution of disputed claims
Healthcare Scheduler
Banner Health
Tucson, USA
08.2022 - 06.2023
- Schedule medical appointments
- Send prior authorization request
- Submit referral request
- Triage patients depending on symptoms
- Manage insurance profiles
- Billing and coding
- Optimized scheduling processes by implementing efficient software tools and organizational systems
- Developed customized reports to provide insight into key performance metrics related to scheduling effectiveness, timeliness, and resource utilization
- Proactively addressed potential risks within the schedule by conducting thorough analyses and implementing preventive measures where necessary
Medicare Specialist
GoHealth
Tucson, USA
12.2020 - 07.2022
- Assist in people in finding health coverage to fit their medical needs
- Maintaining HIPPA laws in a medical setting
- Working in the healthcare setting verifying insurance
- Maintained up-to-date knowledge of Medicare regulations, contributing to compliant department operations
- Streamlined the Medicare enrollment process by effectively managing and organizing application documentation
Program Service Evaluator
State of Arizona
, USA
09.2019 - 12.2020
- Work with the community to ensure benefits for those in need
- Determine eligibility for nutrition, medical and cash benefits by interviewing clients
- Verify employment, rent, utilities, living situations of clients
- Enhanced family support by identifying and addressing individual needs through comprehensive assessments
- Collaborated with multidisciplinary teams to develop and implement tailored case plans for families in need
- Maintained accurate documentation of case activities, contributing to efficient program operations and compliance with regulations
Collector
Citibank
, USA
09.2016 - 09.2019
- Job Coach/trainer
- Improved customer satisfaction by effectively resolving delinquent accounts through negotiation and payment plans
- Streamlined debt collection processes for increased efficiency in the workplace
- Reduced outstanding debts by implementing strategic collections tactics and maintaining open lines of communication with customers
- Enhanced client relationships by consistently maintaining clear communication and promptly addressing concerns
- Achieved successful debt collection results by utilizing negotiation skills and developing customized payment plans
Education
General Educational Development - Medical Billing & Coding
University of Phoenix
10.2022
High School Diploma -
Pueblo Magnet High School
05.2007
Skills
- General Ledger Accounting
- Financial Analysis
- Warehouse Distribution Experience
- Microsoft Office
- Contracts
- Live chat
- Supervising experience
- Windows
- Account Reconciliation
- Accounts Payable
- Conflict management
- Salesforce
- SAP
- NetSuite
- Typing
- HCPCS
- Medical receptionist
- HIPAA
- Medical records
- EHR systems
- Recordkeeping and data input
- Documentation and paperwork
- Applicant support and service
- Resource information
- Benefits administration
- Government relations
- Policy interpretation
- Eligibility procedures
- Medicaid
- Application review
- Confidentiality
- Microsoft office
Certification
Life and Health Insurance, 08/01/21, 08/01/25
Timeline
Eligibility Specialist
Aetna, a CVS Health
08.2024 - Current
Medicare Specialist
Connie Health Inc.
06.2023 - Current
Healthcare Scheduler
Banner Health
08.2022 - 06.2023
Medicare Specialist
GoHealth
12.2020 - 07.2022
Program Service Evaluator
State of Arizona
09.2019 - 12.2020
Collector
Citibank
09.2016 - 09.2019
Life and Health Insurance, 08/01/21, 08/01/25
General Educational Development - Medical Billing & Coding
University of Phoenix
High School Diploma -
Pueblo Magnet High School
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