Amber Gilbert

-Responsible for increasing retention of Medicaid/CHIP through direct member telephonic and face to face outreach and by helping members to help complete the Medicaid and CHIP applications and renewals.

-Serve as a lead within the team, monitoring the progress and flow of applications and team activities.

-Recently executing the start of pilot programming to outbound call campaign with Jefferson Health Plans ACA (Pennie) members to ensure completion of annual wellness visits, allowing bridge of closing gaps to be addressed.

• Executing this campaign individually has allowed for a gross improvement predicted to bring in over $500,000

Knowledge, Skills and Abilities:

· Friendly and compassionate disposition

- Responsbile for increasing retention of Medicaid/CHIP through direct member telephonic and face to face outreach and by helping members to help complete the Medicaid and CHIP applications and renewals.

-Assist consumers with submitting eligibility applications and help members walk through document collection for application

-Conduct member assistance and outreach and education activities to members

-Serve as a lead within the team, monitoring the progress and flow of applications and team activities.

· Excellent communication and problem-solving skills

· Organized and ability to triage tasks with superior time management skills.

o History of working with health insurance programs in areas such as assisting people with the application, facilitating enrollment, and explaining Medicaid/CHIP and other state services (SNAP/LIHEAP) eligibility criteria.

o Performing community outreach to community resources preferably about health or social services programs.

· Working knowledge of the Pennsylvania Medical Assistance Program, CHIP, and the public assistance benefit application

· Extensive Engagement with community members, including events, training, classes, small group interactions. public speaking, training, and/or individual and small group engagement.

· Able to work effectively and professionally in a fast-paced environment.

· Knowledge of and ability to work and engage with the uninsured, under-served and underrepresented populations.

Primary Responsibilities:

· Monitors and regularly communicates status of applications to ensure progress toward completion and within agreed-upon timelines.

-Overseeing vendor relationships for retention program monitoring.

-Confidence with executing community event planning overseeing relationships with community partners, vendors, and community individuals.

· Educate the broader community about the Health Insurance Marketplace, Medicaid, CHIP, and other health insurance programs.

· Leads, plans and participate in community-wide events to educate on health benefit programs available.

· Partners with community-based organizations, businesses, and partners to reach out to potential enrollees.

· Continued updates on all policies and procedures that have to do with the implementation of the Health Insurance Marketplaces.

· Keep meticulous records including consent forms and applications. Responsible for department reporting to internal and external stakeholders.

· Utilize the 2-1-1 Information & Referral line as a means of screening potential consumers in need of education on health insurance programs or assistance with enrollment.

· Provide training to 2-1-1 Information & Referral Specialists as needed on best practices for screening and assessing to retain referrals for potential consumers in need of assistance or education on Health Insurance Marketplaces.

• Serves as the point person/technical resource for issues regarding all lines of business.
• Anticipate and identify causes of interruption in unit functions and takes appropriate action to meet performance expectations.
• Develop, among staff, a consciousness for the need for teamwork to attain departmental objectives. As well as direct staff in a constructive and positive manner to foster positive employee relationships.
• Recommend candidates for hire to the Manager based on subjective and objective findings identified by using a standardized interviewing tool.
• Ensures that reports are completed, accurate, and timely to meet regulatory and company regulations.
• Attend and assume a leadership role in Team meetings, staff meetings, and all external cross-functional meetings.
• Attends external meetings as representative of Health Partners Plans and represent department at meetings which have an impact on Call Center operations and reports on the same.
• Assist Member Relations Representative with accurate benefit information for callers.
• Assist in the coordination of special assignments including reports and departmental projects.
• Provide phone coverage on high-called volume days to provide telephone support as required and handle calls which escalate beyond the Member Relations Representatives abilities.
• Act as a liaison to member’s who request one-on-one assistance.
• Provide Floor Support.
• Responsible for handling Supervisor call backs, agent mailing requests, Team Lead queue for answering agent calls/supporting team with benefit questions.
• Collaborate with leadership and support team to set up touch point meetings with an agenda. Provide recommendations and feedback based off team performance.
• Tracking/Trending of call volumes and escalated matters, reporting on trends and issues that impact the Member Relations Department.
• Coordinate cross-functional and interdepartmental initiatives.
• Schedule and assist with the facilitation of team meetings, and huddles.
• Adhere to the following turn-around times for issue resolutions via e-mail, Macess, in-person, etc.
• Follow Department guidelines on response time and resolution (acknowledgement) for standard inquiries and, expedited issues.
• Evaluate staff quality performance utilizing coaching tools as a resource for improvement.
• Mentoring staff using intense one on one coaching sessions as a means of performance enhancement.
• Facilitate initial group and individual training sessions to support staff with knowledge gaps to perform across functional discipline.
• Review staff’s monthly audits appeals for accuracy and appropriateness of submission.
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• Outreach & Care Coordination: Conduct targeted outbound calls to members to promote retention efforts of member loss,
• Benefit Education: Answer inquiries regarding eligibility, coverage, and locating in-network doctors.
• Assist members with scheduling appointments, arranging transportation, and resolving grievances.
• Collaboration: Partner with internal departments (Care Management, Member Relations) to address social determinants of health and refer members to dedicated Care Coordinators
• Outbound campaign documentation clearly and keeping track of KPI reporting for team members daily\
• Creation of SOPs for team training, sharing of information and training of any materials.

• Utilized Salesforce software to track customer interactions and streamline communication processes.
• Supported outreach initiatives to educate clients on available health plan options and benefits, as welcome call campaign for new member outreach
• Collaborated with team members to ensure compliance with regulatory guidelines and policies.
• Medicare business (enrollment, appeals and grievances, Complaint Tracking Module, claims, billing, marketing, etc.).
• Educate callers about Jefferson Health plan with the intent of retaining members and addressing gaps in care and supporting care coordination through appointment scheduling, transportation assistance, and referrals to care coordinators as necessary.
• Answer eligibility, benefits and provider inquiries, assuring that members receive service, use the plan correctly and gain a high level of satisfaction with the plan.
• Collaborate with internal departments to facilitate resolutions to member’s issues and concerns.
• Respond to member and member-related calls in a courteous, professional & efficient manner providing timely follow-up to requests for information and service.
• Report on trends and issues which impact the membership.
• Conduct targeted telephonic outreach to members using a prepared script depending on Manager’s direction.
• Enroll members in the Care Coordination Program as indicated by criteria.
• Open or build new cases in the care management system and route to the appropriate staff following the direction of the Team Leader or Manager.
• Research members’ demographics and build cases in healthcare management system by: Calling hospitals, PCP offices, and/or home care agencies to locate a member’s most recent phone number.
• Schedule and coordinate transportation needs.
• Identify and assist with care gaps.
• Document all care coordination activities in a member’s case, per appropriate CCMS screens.
• Utilize the language line as indicated by the needs of the member.
• Refer members to the appropriate Nurse Advice lines and appropriate programs.
• Maintain accurate data entry into designated software systems.
• Promote excellent communication between Quality Management (QM), Utilization Management (UM), Care Coordination, Healthcare Economics and Special Needs Unit (SNU).
• Maintain call records, logs and other documentation in accordance with departmental requirements.
• Operate all applications and telephone systems effectively and efficiently, following established protocols for security, transfer and information exchange.
• Participate in appropriate staff meetings and training sessions, reporting on trends and issues which impact members and Health Partners as a whole.
• Attend monthly meetings as scheduled.
• Perform other clerical and support tasks as assigned.

• In charge of handling Medicare Annual Wellness Visit checks with patients, verifying questions with patient and addressing information for billing purposes.
• In charge of handling front desk registration for patients as scheduled appointments, calls, messages, and walks in throughout office hours
• In charge of handling insurance documents and forms to submit for yearly submissions.
• Applied knowledge and medical background to identify within patient chart diagnosis' and testing also done yearly to communicate with insurance companies.

• Team player with exceptional customer service skills.
• Heavy patient and physician interaction.
• Duties include but are not limited to: collect patient information and process registration; verify insurances; order studies; answer telephones; scan relevant documents into patient record; provide issue resolution to patients, visitors, physicians and other departments; collect co-pays for services rendered; in certain areas of the department schedule patients for appointments/procedures and obtain insurance authorizations.
• Work areas include: Out-patient Registration, Admissions, Pre-Admission Testing, Pain Management, Same Day Registration, Ambulatory Surgery Center Registration, off-site Lab Draw Stations, and ER Registration (to provide back-up as needed).

• This position is responsible for scheduling and coordinating appointments and ancillary services with clients, providers, physicians and examiners. In addition, the ability to communicate clearly and confidently with physicians, their staff, attorneys and claims adjusters is critical to the success of this role.
• Schedules and confirms appointment dates and times with physicians' offices.
• Communicates with adjusters and customers regarding physician CV’s, appointment scheduling, changes, no shows/cancellations, and receipt of medical records including
• Coordinates with the client to obtain required medical records prior to examination.
• Gather and create timely chart preparation by ensuring all records required are included, creates a cover letter detailing specific client questions, issues, and service requests.
• Prepares and sends exam notification letters daily.
• Responsible to submit invoicing and/or issue to accounting and IME/Peer reporting for charges incurred. Coordinates ancillary services such as transportation and translation, when needed.
• Answer incoming calls and emails handle inquiries appropriately in a prompt, friendly and professional manner. Process and maintain spreadsheets for provider payments utilizing CorVel internal programs.
• Organizes and maintains document storage and record keeping in reporting system. Follows strict state guidelines regarding forms and timelines.
• Perform other duties as assigned by Unit Manager

• Scheduled evaluations and procedures for patients.
• Liaised effectively with patients, doctors and staff members, assessing medical charts and promoting high level of communication and interaction.
• Applied HIPAA privacy and security regulations while handling patient information.
• Verified demographics and insurance information to register patients in computer system.
• Organized and maintained records by updating and obtaining both personal and financial information from patients.
• Obtained necessary signatures for privacy laws and consent for treatment. Communicated financial obligations to patients and collected fees at time of service. Called insurance companies and verified patient coverage.
• Managed patient admissions and hospital discharges to various settings, including home care, rehabilitation or self-care.
• Maintained knowledge of community services and resources and referred patients to appropriate organizations. Helped patients obtain health care services by setting up referrals.

• Create a team environment which fosters inclusivity and positive connections.
• Responsible for directing and leading the team to achieve store objectives which include sales and profit goals, recruiting, performance management, training, and development.
• Ensure that your store achieves company objectives and KPI goals
• Lead an operationally sound business by balancing company policies, procedures, shrink/loss prevention, payroll, reporting, and scheduling
• Processed daily paperwork, balanced register drawers, produced staffing schedules and prepared deposits.
• Recruit, develop and train top talent who are sales, customer, and fashion-focused
• Set the example for The Torrid Connection and ensure the team is providing a shopping experience that will encourage positive customer connections and loyalty
• Implement merchandise strategies while also providing a clean, consistent, and inviting store environment that inspires customers to shop
• Maintain an effective and open line of communication with District Manager and HQ partners