Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Christina Garza

San Antonio,TX

Summary

Well versed in running through the daily work processes in high-stress environments. Expert in resource management and key decision-making. Articulate, motivational and analytical in approaching problems impacting the members.

17+ years of experience working with the Medicaid program primarily with the StarPlus Product. 2 years of experience working as a Team Lead. Excellent understanding of business operations with extensive experience in member education, developing and overseeing projects. Knowledgeable of HIPPA, Compliance, DFPS and HHSC contract regulations. Excellent knowledge of Excel, Trucare, Amysis, TMHP, MESAVE, and Enrollment Manual Database.

Overview

18
18
years of professional experience

Work History

Program Coordinator II

Superior Health Plan
2017.01 - Current
  • Review ISP expiring report from HHSC approximately 90 days prior to end of ISPs
  • Track Individual Service Plan reassessment for assigned Texas Regions through completion to ensure that are being submitted to HHSC timely.
  • Lead scan calls with HHSC Program Support Unit monthly to discuss progress and critical cases. Took call notes, did roll call, sent meeting notes and totals to leadership after scan call.
  • Lead scan calls with Superior Health Plans internal departments to discuss progress and critical cases. Took call notes, did roll call, sent meeting notes and totals to leadership after scan call.
  • Gather information daily from several large-scale spreadsheets and do V look up to update Master Log with current data.
  • Keep open communication with various internal departments via email and Teams.
  • Communicate all past due cases and case issues with each assigned department daily.
  • Complete compliance report weekly and report totals to leadership.
  • Complete pivots daily to report totals to management.
  • Utilize Outlook to create new meetings, reminders, and to help time manage my workday.
  • Compose and retrieve emails in Outlook accordingly.
  • Utilize Zoom to create and attend meetings.
  • Research and resolve cases with complex issues to its entirety.
  • Train and Mentor new employees.
  • Developed and maintained relationships with HHSC Program Support Unit Leadership.
  • Collaborated with other program coordinators to achieve consistency in our work process.
  • Kept ISP Master Tracking Log and personal tracking logs accurate, up-to-date and easily accessible for accessibility.
  • Analyzed ISP Master Log by tracking and reporting issues to identify areas of improvement.
  • Do v lookups to update Program Support Units expiring reports with current data to provide them with most current information on member's cases.
  • Ensure that reports to HHSC are sent secured and timely.
  • Cross train existing employees
  • Utilize power point to create and complete refresher trainings.
  • Maintain positive relationships with my team.
  • Utilize TMHP portal to pull report and to view current member status.

SERVICE COORDINATOR

Superior Health Plan
2016.01 - 2017.01
  • Identify special needs members through completion of health screens and other resources
  • Work with community outreach/member advocates to coordinate member care.
  • Work with Adult Day Care Center advocates to coordinate member care
  • Create authorizations for Adult Day Care
  • Task all member inquires and requests to assigned case worker.
  • Inbound and Outbound call handling on Queue.
  • Managed over 15 calls per day.
  • Maintained Call Times.
  • Communicated with member and agencies to ensure provider services were in place for member.
  • Resolved customer complaints and issues to best of my abilities.
  • Assessed member needs and developed solutions to meet needs.
  • Developed and maintained database of service providers and vendors for easy and quick access to list of qualified agencies.
  • Optimized members call in experience by delivering superior services and effectively troubleshooting issues.
  • Gathered, organized and input information into Trucare.

Intake Team Lead

Superior Health Plan
2013.01 - 2016.01
  • Review ISP expiring report from HHSC approximately 90 days prior to end of ISPs.
  • Coached team members in techniques necessary to complete job tasks.
  • Track Individual Service Plan reassessment for all of our Texas Regions through completion to ensure that they are being submitted to HHSC timely.
  • Lead scan calls with HHSC Program Support Unit monthly to discuss progress and critical cases. Took call notes, did roll call, sent meeting notes and totals to leadership after scan call.
  • Lead scan calls with Superior Health Plans internal departments to discuss progress and critical cases. Took call notes, did roll call, sent meeting notes and totals to leadership after scan call.
  • Keep open communication with various internal departments via email and Teams.
  • Communicate all past due cases and case issues with each assigned department daily.
  • Utilize Outlook to create new meetings, reminders, and to help time manage my workday.
  • Compose and retrieve emails in Outlook accordingly.
  • Utilize Zoom to create and attend meetings.
  • Conducted regular reviews of operations and identified areas for improvement.
  • Research and resolve cases with complex issues to its entirety.
  • Train and Mentor new employees.
  • Developed and maintained relationships with HHSC Program Support Unit Leadership.
  • Collaborated with other program coordinators to achieve consistency in our work process.
  • Kept ISP Master Tracking Log and personal tracking logs accurate, up-to-date and easily accessible for accessibility.
  • Analyzed ISP Master Log by tracking and reporting issues to identify areas of improvement.
  • Worked with team to identify areas of improvement and devised solutions based on findings.
  • Ensure that reports to HHSC are sent secured and timely.
  • Cross train existing employees
  • Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
  • Maintain positive relationships with my team.
  • Utilize TMHP portal to pull report and to view current member status.
  • Ensure documentation is up to date in all systems.
  • Monitor Postings email box daily
  • Cross check ISP expiring spreadsheet with list from HHSC.
  • Minimized resource and time losses by addressing employee or production issue directly and implementing timely solutions.

Intake Specialist

Superior Health Plan
2009.01 - 2013.01
  • Initiate scheduling for Individual Service Plan for member.
  • Called members to verify their demographics demographics.
  • Maintain integrity of PHI
  • Maintain working relationships with other departments
  • Attend ongoing training and in-services as directed
  • Perform tasks necessary to promote member compliance such as verifying appointments.
  • Screen for eligibility.
  • Identify members without PCP and refer to Member Services
  • Answers phone queues.
  • Documented all calls into our core system.
  • Maintained accurate, up-to-date client records for reliable reference and communications.
  • Managed 25 calls per day.

Texas HealthSteps Coordinator

Superior Health Plan Inc
2006.01 - 2009.01
  • Educate members on Texas Health Steps Program through telephonic outreach.
  • Assisted members with appointments and rides to doctors' office for Well Checks.
  • Documented information in applicable systems
  • Coordinated and implemented community events, including Start Smart Baby showers, healthy lifestyle events and various community initiatives.
  • Assist in finding and connecting members to community social services and agencies.
  • Communicated with Providers to ensure members were up to date with their immunizations and WellChecks
  • Managed over 50 calls per day.

Education

No Degree - Business Management

Del Mar College
Corpus Christi, TX

High School Diploma -

Alice High School
Alice, TX
05.1994

Skills

  • Proven patience and self-discipline
  • Conflict resolution
  • Relationship and team building
  • Sound decision making
  • Staff training and development
  • Deadline – driven
  • Managed care contract knowledge
  • Research and data analysis
  • Team Oversight
  • Office Administration
  • Report Preparation

Languages

Spanish
Professional Working

Timeline

Program Coordinator II

Superior Health Plan
2017.01 - Current

SERVICE COORDINATOR

Superior Health Plan
2016.01 - 2017.01

Intake Team Lead

Superior Health Plan
2013.01 - 2016.01

Intake Specialist

Superior Health Plan
2009.01 - 2013.01

Texas HealthSteps Coordinator

Superior Health Plan Inc
2006.01 - 2009.01

No Degree - Business Management

Del Mar College

High School Diploma -

Alice High School
Christina Garza