Dana AL Rihani
Albuquerque,NM
Summary
Motivated Health Services Assistant in a fast-paced, team-based environment. Quick learner with proven ability to handle increased responsibility. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
9
9
years of professional experience
Work History
Health Services Assistant (Delegation Care Coordination.)
Presbyterian Health Plan Services
03.2024 - Current
- Professionally Process Delegated and CareLink Referrals, adeptly handling both urgent and non-urgent cases with efficiency and accuracy.
- Skillfully coordinate and participate in Monthly meetings, demonstrating expertise in agenda preparation, minute-taking, and distribution.
- Effectively manage Delegated Inbox and multiple Jiva worklists, ensuring seamless workflow and timely responses.
- Provide prompt and comprehensive responses to Care Coordination inquiries via email and telephone, demonstrating strong communication skills.
- Proficiently utilize Excel spreadsheets to document and send pre-manage reports on a daily basis, showcasing advanced analytical abilities.
- Swiftly and accurately process PCP changes, demonstrating attention to detail and organizational skills.
- Handle various requests including ABP Exempt, EPSDT, NFLOC, IP referrals, OP referrals and VAS with professionalism and precision.
- Facilitate effective collaboration between Delegates and PHP Care Coordinators, ensuring seamless communication and coordination.
- Demonstrate proficiency in uploading documents to the Jiva platform, maintaining accurate and organized records.
- Meticulously document activities and interactions in Jiva, HRP, and DMC systems, ensuring compliance and accuracy.
- Facilitated smooth transitions between healthcare providers and health plan by coordinating and sharing vital information as needed.
- Contributed to a positive work environment by consistently demonstrating professionalism and a commitment to teamwork.
- Supported clinical research efforts by accurately documenting data collection processes related to specific projects.
- Enhanced the efficiency of time sensitive tasks by diligently prioritizing and managing administrative tasks.
- Documented patient information and care activities in electronic health record.
- Effectively managed patient records, ensuring confidentiality and accuracy throughout continued communication with delegates.
- Coordinated with insurance companies to verify coverage details using various systems.
- Managed incoming communications from various sources, ensuring timely responses and proper routing of information to relevant parties.
Health Services Assistant (LTC UM Dept.)
Presbyterian Health Plan Services
06.2020 - Current
- Professionally review prior authorization requests submitted by care coordinators, ensuring compliance with established guidelines and protocols.
- Thoroughly screen prior authorization requests to verify adherence to specified criteria and standards.
- Initiate and facilitate the collection and submission of additional information required for prior authorization approval, demonstrating attention to detail and proactive communication skills.
- Coordinate benefits by closely monitoring limitations for all members, ensuring optimal utilization of available resources.
- Serve as a primary point of contact for providers and facilities, addressing member needs and resolving issues effectively via telephone communication.
- Initiate requests for additional information (RFI) from Care Coordinators to ensure the completeness of prior authorization requests.
- Collaborate within an interdisciplinary care team setting, engaging with care coordinators, providers, and reviewers to ensure comprehensive care delivery and fulfillment of member needs.
- Verify member eligibility through the New Mexico Medicaid Portal, ensuring accurate and up-to-date information is maintained.
- Assess nursing facility level of care and budgets, contributing to informed decision-making regarding member care plans and resource allocation.
- Prioritize and expedite urgent prior authorization requests, demonstrating adaptability and responsiveness in critical situations.
- Collaborate closely with HSD (Human Services Department) and ISD (Income Support Division) to ensure timely completion of deliverables and special projects, recognizing and addressing time-sensitive priorities with precision and efficiency.
- Review and process a diverse range of long-term care prior authorization requests, including but not limited to environmental modifications, agency transfers, model of care changes, respite care, and assisted living requests, demonstrating proficiency in managing complex cases.
- Managed incoming communications from various sources, ensuring timely responses and proper routing of information to relevant parties.
Member Services Representative
Presbyterian Health Plan Services
11.2016 - 02.2017
- Served as a valuable team lead assistant and mentor, providing guidance and support to team members and assisting in maintaining adherence to established processes.
- Trained extensively in Government programs including Medicare, Medicaid, DSNP, and proficient in handling Provider calls.
- Demonstrated subject matter expertise in Medicare, Medicaid, and DSNP lines of business, providing comprehensive support and guidance to both team members and members alike.
- Conducted thorough member assessments during inbound calls, identifying gaps in care through Health Risk Assessments and ensuring timely interventions.
- Offered personalized assistance to members, addressing inquiries and concerns related to care, providers, and delivery systems with professionalism and empathy.
- Proactively identified and referred members to care coordination for comprehensive case management of identified gaps in care.
- Offered constructive feedback to team leads to ensure consistent adherence to processes, facilitating ongoing coaching and training as needed.
- Directed team members to relevant resources to enhance member and provider support during calls.
- Demonstrated prompt and effective communication within the team via Skype chat, ensuring timely resolution of queries and issues.
- Handled calls promptly and efficiently, maintaining a focus on providing exceptional member service.
- Utilized probing questions to identify underlying issues and address member concerns effectively.
- Provided accurate benefit quotations based on the member's plan, and addressed inquiries regarding claims, payments, prior authorizations, and covered benefits.
- Consistently upheld the Presbyterian promise by striving for first-call resolution and ensuring member satisfaction.
- Transferred calls to appropriate departments when necessary, ensuring seamless continuity of support.
- Thoroughly documented each call for comprehensive account management and auditing purposes.
- Effectively promoted the company's services and values at the beginning and end of each call, reinforcing brand identity and commitment to excellence in member service.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Provided exceptional service through active listening, understanding member needs, and offering appropriate solutions.
- Responded to customer calls and emails to answer questions about benefits and services.
- Enhanced customer satisfaction by efficiently addressing and resolving inquiries and concerns.
- Maintained high-quality service by adhering to company policies and standards in all member interactions.
- Verified customer identification and documentation for compliant transactions.
- Handled complaints with prompt, courteous service to uphold professional reputation.
- Maintained and managed customer files and databases.
- Learned and maintained in-depth understanding of benefits and service information to offer knowledgeable and educated responses to diverse customer questions.
- Built rapport with members by engaging in genuine conversations and demonstrating a commitment to their medical wellbeing.
- Promoted a positive work environment by fostering open communication between colleagues and supervisors.
- Consistently met or exceeded performance metrics through proactive management of workload and effective prioritization.
- Served as a mentor for new hires sharing best practices contributing towards increased productivity among team members.
- Collaborated with team members to ensure seamless operations during peak hours or staff shortages.
- Ensured compliance with regulatory requirements during all member interactions safeguarding the organization's reputation.
- Partnered with other departments facilitating smooth resolution of complex cases resulting in improved member experience.
Customer Service Representative
Sitel-Directv
09.2015 - 09.2016
- PST- (worked for 6 months) Premium Saves Team, helping customers find the best programming needs for their households
- CRG/CLG- (worked for 6 months) Customer Retention Group/ Customer Loyalty Group, retaining customers that are wanting to cancel their Directv services due to different reasons
- Determines requirements by communicating with the customer to find out the wants, interests, and needs
- Resolves problems by clarifying issues, researching and finding options as well as alternative answers to best resolve the issue
- Sell additional services by recognizing opportunities to up-sell accounts
- Maintains call center database by entering up to date information on the account and submitting correct information based on customers needs
- Keep equipment operational by following procedures and reporting malfunctions
- Provided an elevated customer experience to generate a loyal clientele.
Education
Social Work
New Mexico Highlands University
Las Vegas, NM05.2025
Associate of Applied Science - Integrated Studies Focused On Social Work
Central New Mexico Community College
Albuquerque, NM05.2021
Skills
- Handling high call volume
- Strong client relations
- Exceptional communication skills
- Quick learner
- Creative problem solver
- Data entry skills
- Bilingual (Arabic)
- Computer Skills; Jiva, Facets, Word, PowerPoint, Excel, and Outlook
- Multitasking efficiency
- Continuous Learning Attitude
- Organizational Skills Development
- Decision-Making Competence
- Patient Care Coordination
- Detail-oriented approach
- Patient Confidentiality Maintenance
- Conflict resolution techniques
- Team Collaboration Aptitude
- Adaptability in Healthcare Settings
- Cultural Sensitivity Awareness
- Professionalism in Workplace
- Interpersonal Skills Enhancement
- Empathy and Compassion Display
- Computer Literacy Improvement
- Patient Safety
- Healthcare management
- Training and education
- Workflow Management
- Interpersonal and written communication
- Quality Assurance
- Policy Implementation
- Time Management
- Attention to Detail
- HIPAA Compliance
- Client documentation
- Electronic Charting
- Patient relationship building
Education Certificates
- AAS, Integrated Studies, 2021, Central New Mexico Community College, Albuquerque, NM
- Health, Wellness, and Public Safety, 2020, Central New Mexico Community College, Albuquerque, NM
- High School Diploma, 2014, Eldorado High School, Albuquerque, NM
Timeline
Health Services Assistant (Delegation Care Coordination.)
Presbyterian Health Plan Services
03.2024 - Current
Health Services Assistant (LTC UM Dept.)
Presbyterian Health Plan Services
06.2020 - Current
Member Services Representative
Presbyterian Health Plan Services
11.2016 - 02.2017
Customer Service Representative
Sitel-Directv
09.2015 - 09.2016
Social Work
New Mexico Highlands University
Associate of Applied Science - Integrated Studies Focused On Social Work
Central New Mexico Community College
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