Damica O'Neal

• Implement creative solutions to address the unique challenges faced by underserved communities seeking healthcare services.
• Coordinate and manage follow-up care plans for individuals with chronic unmanaged conditions
• Educate and provide advocacy for clients navigating complex healthcare systems. Answer questions pertaining to benefit coverages, referrals , transportation and community resources.
• Provide resources to reduce social determinants of health and reduce return visits to facilities and primary care offices.
• Monitor and troubleshoot pharmacy dashboard under the direction of Registered Nurse and Pharmacy team. Report and tally program evaluations, and statistical data collection efforts.
• Maintain, document and update all client interactions. Safeguard clients protected medical information and adhere to HIPPA guidelines and company privacy policies.
• Build trusting relationships with diverse community members through active listening, empathetic communication, and cultural competence practices.
• Coordinate care by working closely with: Integrated Social Workers, Behavioral Health Professionals, Primary Care Physicians, Insurance Companies and Congregational Care.

• Answered questions for Commerical insurance holders pertaining to ; Medical coverage, claim adjudication, utilization management , grievance and appeals, recoupment, cobra, transition of care and pharmacy benefits.
• Mentored junior staff members, empowering them with the skills needed to excel in their roles as Member Services Representatives.
• Streamlined team workflow by developing and implementing efficient processes for task management.
• Built strong relationships with internal and external clients by maintaining consistent follow-up and providing personalized support services tailored to their needs.
• Provided regular coaching and feedback to team members, fostering a culture of continuous improvement.
• Led monthly staff meetings, promoting open communication and collaboration within the team.
• Assisted members with correcting account, service, and system issues by educating on required forms and technical processes.
• Secured patient data related to personal details and billing for entry into the system.
• Managed and followed up promptly to escalated customer concerns, ensuring timely resolution and positive outcomes.

• Established positive customer relationships and answered questions regarding utilization management and benefit inquires.
• Responsible for providing non-clinical support to the Medical Management and Operation areas for the Governmental State health insurance plan Medicaid and Medicare.
• Responded to telephone and written inquiries from clients, providers, facilities and other internal departments regarding NICU inpatient stays.
• Assisted care team with complex cases regarding collection of insurance and prior authorizations verification .
• Determined appropriate areas to refer or escalate cases electronically to internal departments
• Explained denials, and usual and customary rates to OON or non contracted providers. Collected pertinent billing information for authorizing UB-04 claim forms.
• Acted as a liaison between providers, patients, Medical Management and internal departments.
• Maintained and updated tracking databases. Prepared reports and documented all actions in database.
• Managed incoming faxes and placed outbound calls to collect medical records to expedite approval for services . Verify benefits for facility based treatment.

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