CHRISTINA MORALES
Winter Haven
Summary
To secure a challenging position with an organization that can benefit from my experience, skills, motivation, and solid work ethic. Knowledge, expertise and leadership skills are just some of the attributes that I can offer. I am also an accomplished team leader.
Overview
28
28
years of professional experience
1
1
Certification
Work History
Executive Account Relations Representative
Independent Living Solutions – Florida Community Care
Tampa, FL
04.2022 - Current
- Manage relationships and performance of assigned in-network provider groups. Monitor provider compliance with Medicaid laws and contractual requirements. Assist in contracting tasks for goods and services acquisition from responsible sources at reasonable prices. Provide orientation for new providers across all service lines. Collaborate with care coordinators to address authorization issues, member placement, and eligibility concerns.
- Manage Medicare sales representatives and conduct presentations to provider staff to facilitate beneficiary enrollment. Support the establishment and maintenance of Medicare accounts across West and Central Florida to enhance membership and service offerings. Assist in contract administration tasks, including modifications and execution of agreements. Evaluate providers to identify selections that maximize benefits for the health plan.
- Assist internal support teams in resolving provider contractual inquiries related to fee-for-service agreements. Organize and facilitated group meetings with clear objectives and expected outcomes for both internal and external stakeholders. Source services through various channels, including advertising and negotiation techniques. Recommend providers for contracting based on analyzed data and information. Manage multiple projects effectively while adhering to deadlines. Conduct negotiations on pricing and technical requirements, preparing all necessary documentation for contract execution.
Ancillary Provider Field Services Representative
WellCare/Centene – Sunshine Health
Jacksonville, FL
09.2018 - 04.2022
- Work closely with all Home Health, DME, Hospice, Dialysis and Skilled Nursing Facilities throughout North Florida to ensure a successful relationship with the health plan. Provide new provider orientation for all applicable product lines. Conduct site visits to service providers to provide education on policies and initiatives, resolve issues, educate staff/providers on policies and collect credentialing information.
- Provide continual training to assigned providers on wellcare.com portal and other resources to assist with claims, authorizations, member benefits, etc. Perform special projects as assigned. Provide oversight of delegated functions, as applicable. Conduct Provider Trainings for the Long-Term Care Plan which is a new LOB to WellCare/Staywell Florida market. Tasked to work on crucial SNF membership project. Provide insight on claim issues. Follow up with Providers accordingly. Provided expertise in LTC and CMS plans. Work closely with Utilization Management and Care Coordinators to get any Authorization issues addressed accordingly.
- Plans, prepares and executes effective group meetings/discussion with proper objectives and expected outcomes with internal and external customers. Participating in educational or outreach activities associated with health care programs. Maintains provider data integrity including monitoring provider credentialing, location additions, demographic updates, and terminations. Provided continual training to assigned providers on clearinghouses and other resources to assist with claims, authorizations, member benefits, etc. Coordinate with the State, other key stakeholders, and CMS staff to identify and address evolving program issues or to provide guidance on programmatic matters. Reviewed policy documents in relation to Medicare, Medicaid, or other health insurance programs. Assisted in the coordination of educational or outreach activities associated with health care programs.
Professional Experience Network Management Representative
Alignment HealthCare
New York
01.2018 - 08.2018
- Conducted new provider orientation and trained providers on the Provider Manual updates and State Policy updates. Served as contact for provider inquiries, tracked inquiries and response times. Assisted in efforts to enhance ease of use of physician portal and future service enhancements. Managed IPA’s as well as smaller medical groups within Duval and Clay County. Created and sent weekly Pending Post Discharge Medication Reconciliation reports to ensure and improve STAR rating. Delivered Care Gap reports, worked on HEDIS/RAF and delivered monthly CAP reports. Worked with Provider’s and relevant staff on frequent “flyers” to the ER and overall utilization.
- Liaison between UM Department and Provider regarding problem authorizations and ensure resolution. Contacted non-contracted Providers/Facilities when necessary to discuss/negotiate Single Case. Serviced Agreements and created LOA’s. Created Provider Events to refresh ICD-10 coding (CE credits offered). Collaborated with Sales/Marketing and conducted provider visits in hopes of creating compliant events that will yield growth. Assisted/Identified Vendors Claims issues and ensured resolution. Responsible for reporting/requesting all Notice of Change and ensured changes are uploaded in the Provider Portal in a timely manner.
Senior Provider Relations/Business Development NY MLTC
WellCare Health Plan of NY
New York
02.2010 - 11.2017
- Serviced and fostered partnerships between providers and vendors. Interim Manager for MLTC Outreach Team. Meet potential vendors to analyze profitability of possible contract. Assisted in initiating contracting process. Trained and lead Jr. Account Managers. Audited Vendors (Audit Day Care, Medical Model, License Home Care Agencies).
- Liaison between IHCSA and our Intake Team (i.e. ensure proper follow up to ensure enrollment). Troubleshooted any vendor or provider issues. Provided internal consultation to progress existing contracts. Created and presented educational and/or detailed sales presentations at community events and professional conferences.
Senior Marketing/Community Outreach Specialist
WellCare Health Plan of NY
New York
02.2010 - 11.2017
- Used previous experience to solidify relationships with hospitals, providers and various city agencies. Spearheaded the opening of new marketing sites. Built good relationships with various CBO’s, Providers and Internal and External. My goal was to always exceed productivity goals set forth and meet all quality requirements. Maintained a professional working relationship with Provider Relations to ensure company goals were met. Conducted team trainings and MLTC Workshops for Medicare and Medicaid staff. Facilitated Trainings for new hires and observed/evaluated progress once starting field duties.
- Worked closely with Providers to educate them on MLTC benefits in regard to patients while generating leads. Performed site audits to prospective LHCA’s and Adult Social Day Care Centers. Conceptualized and executed marketing events. Liaison between vendors and our intake department. Promoted to this position as part of the LTC Launch as a pilot program.
Medicare Benefit Consultant
WellCare Health Plan of NY
New York
11.2005 - 02.2010
- Participated in various Marketing events (RV, CBO and Provider events). Enrolled Medicare Beneficiaries to the plan that matched their needs. Created strong relationships with Providers and other CBOs. Special Project (I performed CMS flipchart presentations at events for entire team). Adhered to all Compliance and HIPAA Regulations. Applied high level Customer Service for clients and Providers. Maintained responsibilities as a Team Leader as well as a consistently a Top Producer. Sustained healthy enrollment to disenrollment ratio.
Clerical Associate II
NYC Health & Hospital Corp. (Woodhull & Elmhurst Hospital)
New York
08.1998 - 02.2003
- Coordinated registration and performed administrative activities. Greeted patients and verified their identification, insurance and medical records. Logged and sent off critical laboratory samples. Facilitated inter-hospital transfers. Translated for Spanish speaking patients. Controlled flow of fast-paced Level 1 Trauma Center.
Education
High School Diploma - Biology
Long Island University
Brooklyn, NYSkills
- Utilized strong presentation skills to engage audiences and facilitate understanding of key concepts
- Led project teams through all phases of development to achieve timely and cost-effective results Oversaw resource allocation and task assignments to optimize project delivery Fostered collaboration across departments to enhance project outcomes
- Executed strategic planning and development processes to enhance operational efficiency
- Developed and implemented strategies to optimize client experience through data analysis
- Designed and delivered training sessions aimed at improving employee skills and knowledge
- Utilized advanced skills in Excel, PowerPoint, and Word to support project documentation and presentations
- Oversaw critical decision-making initiatives to enhance operational efficiency Guided teams in assessing risks and opportunities to drive informed choices Championed a culture of independent judgment among team members to foster innovation
- Developed comprehensive understanding of planning frameworks to enhance project execution
- Applied knowledge of Medicare and MLTC statutes to ensure compliance with healthcare standards
Certification
- Florida State Health, Life and Annuities
- New York State Emergency Medical Technician
Accomplishments
Part of a launch of Managed Long Term for WellCare of NY as a pilot program that was absolutely successful and grew exponentially.
Languages
Spanish
Native or Bilingual
Timeline
Executive Account Relations Representative
Independent Living Solutions – Florida Community Care
04.2022 - Current
Ancillary Provider Field Services Representative
WellCare/Centene – Sunshine Health
09.2018 - 04.2022
Professional Experience Network Management Representative
Alignment HealthCare
01.2018 - 08.2018
Senior Provider Relations/Business Development NY MLTC
WellCare Health Plan of NY
02.2010 - 11.2017
Senior Marketing/Community Outreach Specialist
WellCare Health Plan of NY
02.2010 - 11.2017
Medicare Benefit Consultant
WellCare Health Plan of NY
11.2005 - 02.2010
Clerical Associate II
NYC Health & Hospital Corp. (Woodhull & Elmhurst Hospital)
08.1998 - 02.2003
High School Diploma - Biology
Long Island University