Alicia Denise Amaro
Philadelphia,PA
Summary
Case investigator and service coordinator dedicated to enhancing participant safety and ensuring compliance. Developed person-centered service plans that address diverse needs, improving healthcare access and outcomes. Collaborated with multidisciplinary teams to streamline processes and achieve optimal client results.
Overview
26
26
years of professional experience
Work History
Critical Incident Specialist (Temporary) (Remote)
SpectraForce Technologies
Philadelphia, USA
12.2025 - 03.2026
- Initiated critical incidents by confirming eligibility and validating events for reporting, ensuring accurate documentation.
- Close event cases when: participant health and safety are secured; steps taken to prevent recurrence—including referrals; and Person-Centered Service Plan is updated due to the incident.
- Collaborate and support Service Coordination with investigation process.
- Collaborated with Service Coordination to streamline investigation process and enhance communication.
- Closed event cases upon securing participant health and safety, implementing preventive measures, and updating Person-Centered Service Plan.
Investigator I (Hybrid)
Philadelphia Corporation for Aging (PCA)
Philadelphia, USA
01.2024 - 12.2025
- Successfully completed 5-day in-person state training provided by Pennsylvania Department of Aging.
- Investigated reports of abuse, neglect, exploitation, and abandonment of individuals aged 60 and above, ensuring adherence to Older Adults Protective Services law and regulations.
- Evaluated reports of abuse or neglect for substantiation within 20 days, facilitating referrals to appropriate agencies for necessary services.
- Evaluated cases for immediate intervention needs, ensuring appropriate legal protections were pursued for individuals at risk.
- Coordinated institutional investigations in collaboration with state licensing agencies and Ombudspersons, ensuring compliance and accountability.
- Successfully completed 5-day in-person state training provided by Pennsylvania Department of Aging.
- Reviewed police reports, medical records, and other documents for evidence.
Service Coordinator (Remote)
AmeriHealth Caritas
Philadelphia, USA
08.2022 - 12.2023
- Coordinated member services, facilitating timely access to critical healthcare resources.
- Provided support and resources to assist members with healthcare navigation.
- Developed individualized service plans addressing diverse physical, behavioral, and social needs.
- Conducted in-home and virtual needs assessments and annual care reevaluations.
- Informed participants of rights, supported grievance processes, and connected them to essential community resources.
- Ensured compliance with Pennsylvania Community Health Choices regulations through accurate documentation.
Community Health Navigator (Hybrid)
AmeriHealth Caritas
Philadelphia, USA
06.2016 - 11.2021
- Outreached to Keystone First members for face-to-face support, enhancing access to care.
- Connected members with essential resources, including local pharmacies and transportation services, ensuring continuity of care.
- Connected members to essential resources, including local pharmacies and transportation services.
- Educated members on care gaps and disease processes, improving health literacy and self-management.
- Accompanied members to primary care physician appointments and specialist visits.
- Completed required assessments for community care management, addressing social determinants of health.
- Facilitated completion of housing applications for MCHA, DCHA, and affordable housing programs.
- Assisted members in obtaining vital identification documents, including Social Security cards and birth certificates.
Claims Examiner
AmeriHealth Caritas
Philadelphia, USA
08.2015 - 06.2016
- Processed medical and hospital claims for state Medicaid.
- Processed Inpatient, Outpatient, Radiology, Home Health, Physical Therapy, DME, and other specialty claims.
- Achieved department expectations by maintaining high production and quality assurance.
- Reviewed and processed corrected claims.
- Monitored suspended claims daily to ensure timely resolution.
- Met all department expectations and requirements by performing with a high production and quality assurance.
- Tracked suspended claims each day.
- Reviewed audit results and corrected claims processing errors promptly to uphold quality standards and minimize delays.
Correspondence Representative
RTI
Conshohocken, USA
09.2014 - 08.2015
- Coordinated third-party billing for emergency room physicians across diverse clients and states to ensure timely and accurate payments.
- Keyed over 150 correspondences while maintaining quality assurance above 95%.
- Addressed inquiries from insurance representatives and patients regarding billing issues, providing clear and effective resolutions.
- Identified errors in claims submitted to coding providers, enrollment, and accounts receivable.
- Processed patient payments via phone using MyMedical Payments system, ensuring secure and efficient transactions.
Patient Service Specialist
NOVACARE (SELECT MEDICAL)
Philadelphia, USA
06.2010 - 07.2013
- Explained patient benefits and responsibilities to clarify information and improve patient satisfaction.
- Secured patient authorizations from insurance plans to ensure treatment continuity.
- Obtained patient referrals from Navinet and different insurance platforms to support care.
- Managed communications between patients and referring physicians to streamline care coordination.
- Coordinated training for newly hired patient service specialists, improving team competency and service delivery.
- Recorded patient data accurately during registration and updated relevant information.
- Analyzed key performance indicators (KPI) and physician referral reports to identify trends.
- Assisted physical therapist with existing patients to support treatment plans.
Administrative Assistant
ARBOR EARN (RESCARE)
Philadelphia, USA
08.2008 - 06.2010
- Handled high call volumes, ensuring customer satisfaction.
- Maintained accurate and proficient data entry.
- Tracked financial incentives effectively.
- Kept track of financial incentives diligently.
- Ordered office supplies to maintain inventory.
Teen Peer Educator
Philadelphia Department of Public Health
Philadelphia, USA
10.1999 - 08.2001
- Engaged youth as peer educator, delivering abstinence-focused sessions in schools and community centers to promote informed decision-making.
- Facilitated discussions with teens about STD, HIV screening, pregnancy, and self-esteem topics in various community settings.
- Presented educational content through interactive workshops with props and visuals to improve retention and understanding.
- Handed out condoms and informational pamphlets at local recreational centers to promote safe practices within the community.
- Connected patients with local health center resources for enhanced support.
- Reviewed and analyzed survey data on teen pregnancy, STD awareness, and self-esteem issues to pinpoint key trends for program development.
Education
Bachelor of Science - Health Administration
University of Phoenix
Philadelphia, PA01-2014
High School Diploma -
Strawberry Mansion High School
Philadelphia, PA01-2004
Skills
- Incident management systems
- Incident reporting tools
- Crisis management
- Case investigations
- Case management software
- Case load management
- Service coordination
- Data entry accuracy
- Microsoft Office proficiency
- Medical terminology expertise
- Remote support tools
- Customer satisfaction strategies
License
Valid PA driving license
Timeline
Critical Incident Specialist (Temporary) (Remote)
SpectraForce Technologies
12.2025 - 03.2026
Investigator I (Hybrid)
Philadelphia Corporation for Aging (PCA)
01.2024 - 12.2025
Service Coordinator (Remote)
AmeriHealth Caritas
08.2022 - 12.2023
Community Health Navigator (Hybrid)
AmeriHealth Caritas
06.2016 - 11.2021
Claims Examiner
AmeriHealth Caritas
08.2015 - 06.2016
Correspondence Representative
RTI
09.2014 - 08.2015
Patient Service Specialist
NOVACARE (SELECT MEDICAL)
06.2010 - 07.2013
Administrative Assistant
ARBOR EARN (RESCARE)
08.2008 - 06.2010
Teen Peer Educator
Philadelphia Department of Public Health
10.1999 - 08.2001
Bachelor of Science - Health Administration
University of Phoenix
High School Diploma -
Strawberry Mansion High School