Summary
Overview
Work History
Education
Areas of Expertise
Timeline
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Janay Gales

Brooklyn,NY

Summary

Experienced with eligibility processes and regulations. Utilizes strong communication and organizational skills to manage and resolve complex cases effectively. Knowledge of compliance standards and system optimizations to enhance operational efficiency.

Overview

8
8
years of professional experience

Work History

Medical Eligibility Coordinator

VNS Health
02.2024 - Current
  • Provided support to prospective members, members and their families including community resource planning, advocacy, skill building, linking patient/families to community resources and providing assistance with entitlements
  • Used Salesforce and Electronic Medical Systems to maintain written and verbal communication records according to VNS Health policies
  • Arranged transportation and/or appointments for members to relevant offices/ sites, as needed.
  • Screened financial records of clients/families to assist in assessment of enrollment eligibility
  • Contacted the appropriate program staff to recommend third party reimbursement, entitlements and community resources for clients/families to ensure that they have access to the adequate entitlement benefits

Operations Coordinator

Healthfirst
10.2018 - 10.2023
  • Coordinates field assignments for interpreters by assessing their availability and assigning staff based on location
  • Manages the transfer of existing members' auto-enrollments and disenrollment to and from the relevant line of business lists in the centralized NY State Uniform Assessment System (UAS) for integrated projects
  • Fosters cross-functional collaboration with multiple departments to acquire and validate necessary documents, ensuring seamless setup within the Electronic Medical System (EMS) database
  • Conducts meticulous and comprehensive quality checks on automated reports, scans documents, and maintains accurate electronic filing for assigned products and associated members
  • Streamlines the processing of electronic document collections for members, conducting thorough data accuracy verifications and promptly addressing any missing information
  • Resolves discrepancies by utilizing established protocols, swiftly returning incomplete documents to the respective departments for correction and resolution

Office Administration Coordinator

NYU College of Dentistry
10.2017 - 10.2018
  • Oversaw and meticulously managed information for a cohort of 700 students within the college
  • Coordinated and streamlined office procedures, proactively communicating any changes to staff
  • Maintained an organized system for electronic and paper correspondence, including memos, letters, faxes, and forms, for efficient dissemination to office personnel
  • Developed internal requirements and standards to minimize regulatory risks and liability across programs.
  • Coordinated office events and meetings, ensuring smooth communication between departments and stakeholders.

Education

Bachelor Degree - Professional Studies

LIM College
New York, NY
05.

Areas of Expertise

Operations Leadership | Project Management | Quality Assurance | Cross-Functional Collaboration | Customer Service & Experience Documentation Management | Data Accuracy & Integrity | Confidentiality | Process Improvement | Operational Efficiencies | Electronic Filing | Communication | Systems Configuration & Setup | Report Management

Timeline

Medical Eligibility Coordinator

VNS Health
02.2024 - Current

Operations Coordinator

Healthfirst
10.2018 - 10.2023

Office Administration Coordinator

NYU College of Dentistry
10.2017 - 10.2018

Bachelor Degree - Professional Studies

LIM College

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Janay Gales