Eilyn Molina
Jasper,GA
Summary
Compassionate Case Manager Specialist experienced in manage care setting. Hardworking and dedicated to achieving desired case outcomes. Offers excellent problem-solving, conflict resolution and communication abilities. Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
27
27
years of professional experience
Work History
Temp Non Clinical Staff Support
Northside Hospital Supplemental Staffing
09.2024 - Current
- Kept work areas clean, organized, and safe to promote efficiency and team safety.
- Established positive relationships with customers and other staff members.
- Responded sensitively and competently to service customers with diverse cultural backgrounds.
- Managed phone system effectively, routing calls appropriately while maintaining a polite and professional demeanor at all times
- Scheduling appointments through Revenue Cycle System
Manager I Customer & Provider Services
Anthem
01.2018 - 02.2024
- GBD Medicaid Provider Experience
- Manage team of 30 associates handling inbound PAA and Member calls
- Display teamwork, integrity and leadership
- Motivate team to meet monthly goals, as well as daily goals
- Handled complaints, provided appropriate solutions and alternatives within appropriate timeframes, and followed up to achieve resolution.
- Supervised daily operations and sales functions to maximize revenue, customer satisfaction and employee productivity.
- Delegated tasks to existing support team members and used cloud-based tools to help solve complex business issues.
- Built client relationships by responding to inquiries, identifying and assessing clients' needs, resolving problems, and following up with potential and existing clients.
- Performed duties and provided service in accordance with established operating procedures and company policies.
- Organized daily workflow and assessed appropriate staffing to provide optimal service.
- Partnered with business leaders to deliver services that support company objectives and consistent with corporate values.
- Conducted training and mentored team members to promote productivity, accuracy and commitment to friendly service.
- Managed customer relations on ongoing basis to maximize customer retention.
- Monitored metrics and developed actionable insights to improve efficiency and performance.
- Accomplished multiple tasks within established timeframes.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Cross-trained existing employees to maximize team agility and performance.
Supervisor of Transition of Care
Anthem / Simply Health Care
09.2013 - 01.2018
- Managers Clinical and non clinical staff
- Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Improved customer satisfaction with timely response to inquiries, addressing concerns, and finding effective solutions.
- Increased team productivity by implementing efficient workflows and setting clear expectations for staff members.
- Monitored/ Audited Calls -Provided detailed documentation on audit findings and coached staff on findings.
Frontline Leader of Inpatient and Case
Humana
01.2006 - 09.2013
- 20 Direct Reports
- Responsible for managing and overseeing operations of Case Management Programs and Inpatient Department teams
- Provided training, guidance, coaching to direct reports
- Participated in Inpatient and Case Management Vendor meetings
- Oversight of Case and Disease Management Programs including, but not limited to: Congestive Heart Failure, Diabetes, Oncology, Transition of Care
- Covered for Out of Area nurses when on PTO or out with obtaining clinical notes to support inpatient stay / discussed with MD in daily rounds, processed DC orders/ or transfers to SNF's or Acute setting and negotiated rates with OOA vendors for services needed.
- Exhibited high energy and professionalism when dealing with clients and staff.
- Promoted superior experience by addressing customer concerns, demonstrating empathy and resolving problems swiftly.
- Trained new personnel regarding company operations, policies and services.
Oncology Case Manager
Humana
01.2004 - 01.2006
- Coordination of care for Oncology members for Chemo, Radiation, follow up visits or testing
- Processed all authorizations Oncology members need
- Partnered with physicians, social workers, activity therapists, nutritionists and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
- Evaluated treatment plans against individual goals and healthcare standards.
- Managed support services and fostered communication among social workers, therapists, hospital staff and patients.
- Used coordination and planning skills to achieve results according to schedule
- Demonstrated respect, friendliness and willingness to help wherever needed
Claims Specialist
Humana (CarePlus Health Plans)
04.2003 - 01.2004
- Review and processed insurance claims
- Coordinating or conducting investigations on insurance claims, identifying claims with possible recovery from third parties, Process payments
- Conducted full claim investigations and reported updates and legal actions.
- Escalated files with significant indemnity exposure to supervisor for further investigation.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
Inpatient Coordinator
Humana (CarePlus Health Plans)
02.2001 - 04.2003
- Processed Inpatient admissions, entered them in our system
- Participated in daily rounds, worked hand in hand with CCR Nurse for clerical support
- Processed DC orders, arranged transportation for members, processed authorizations for outpatient services needed after DC.
Outpatient Coordinator
Humana ( PHP/CarePlus Health Plans)
01.1998 - 02.2001
- Processed outpatient referrals coming in via fax for all outpatient services ( wound care , HHC, office visits, radiology, ect)
- Worked with Provider Relations on Letter of agreements for Single case agreement on OOA member needing services.
- Provided excellent customer service, addressing concerns and answering questions from patients and family members.
- Managed referrals from primary care providers, facilitating seamless transitions into specialty care services as needed.
Education
Case Management Specialist Certification
Florida Risk Management Institute
Fort Lauderdale, FL09.2002
High School Diploma -
Miami Jackson Senior High School
Miami, FL06.1990
Skills
- Assessment skills
- Empathy Development
- Caseload Management
- Influencing, leading, and delegating abilities
- Medical Terminology, ICD9 Coding
- Case Management, Discharge Planning
- Managing Operations and Efficiency
- Employee Coaching and Motivation
- Performance Tracking and Evaluations
- Verbal and Written Communication
- Call Center Operations
- Customer service expertise
- Scheduling and Coordination
- Cultural Competency
- Skilled Nursing placement experience
Affiliations
Looking for a position where I can utilize my experience and skills to grow within a company.
Languages
English
Full Professional
Spanish
Full Professional
Timeline
Temp Non Clinical Staff Support
Northside Hospital Supplemental Staffing
09.2024 - Current
Manager I Customer & Provider Services
Anthem
01.2018 - 02.2024
Supervisor of Transition of Care
Anthem / Simply Health Care
09.2013 - 01.2018
Frontline Leader of Inpatient and Case
Humana
01.2006 - 09.2013
Oncology Case Manager
Humana
01.2004 - 01.2006
Claims Specialist
Humana (CarePlus Health Plans)
04.2003 - 01.2004
Inpatient Coordinator
Humana (CarePlus Health Plans)
02.2001 - 04.2003
Outpatient Coordinator
Humana ( PHP/CarePlus Health Plans)
01.1998 - 02.2001
Case Management Specialist Certification
Florida Risk Management Institute
High School Diploma -
Miami Jackson Senior High School
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