Jocelyn Rios
Philadelphia,PA
Summary
Knowledgeable and professional care provider with solid foundation and expertise in birth and postpartum care, providing compassionate support to families during significant life transitions. Successfully guided numerous families through childbirth and postpartum period, ensuring emotional and physical support. Demonstrated expertise in communication and empathy, fostering trust and confidence in clients. As well as, effective collaboration with healthcare teams and adaptability to changing needs, ensuring optimal outcomes for clients.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Certified Birth and Postpartum Doula
PHILADELPHIA DEPARTMENT OF PUBLIC HEALTH DIVISION OF MATERNAL, CHILD & FAMILY HEALTH
08.2023 - Current
- Assisting over 100 clients in preparing for labor and delivery through tailored birth plan consultations and childbirth education classes.
- Maintaining detailed records of client interactions and progress, allowing for seamless collaboration among the support team members and continuity of care.
- Managing client needs during labor with effective pain relief techniques such as massage, Improved family dynamics by fostering open communication between partners during pregnancy, birth preparation, and postpartum phases.
- Educating expectant families on the benefits of various childbirth methods, empowering them to make informed decisions about their birth experience.
- Supporting parents with complex medical needs, substance use disorder, housing insecurities or other crises that require extended postpartum support.
- Empowering new parents by offering expert guidance on breastfeeding initiation, infant care, and bonding practices.
Community Birth & Postpartum Doula
MATERNITY CARE COALITION
01.2022 - 01.2024
- Guided birthing person through their pregnancy by providing child birth education, benefits of various childbirth methods, and empowering them to make informed decisions concerning their birth plan.
- Managed client needs during labor with effective pain relief techniques such as massage, breathing exercises, and positioning adjustments.
- Supported birthing persons in achieving their desired birth experience by creating a calm and nurturing environment.
- Promoted maternal well-being through comprehensive postpartum care plans that included mental health support resources and self-care strategies.
- Provided compassionate care for high-risk pregnancies or traumatic birth experiences through specialized trauma informed bereavement doula support services.
- In addition, providing coaching for first time parents and preparing for the nesting process. Including but not limited to decluttering, organizing and interior decorating.
Appeals Specialist
HEALTH PARTNERS PLANS
07.2018 - 10.2021
- Keeps current with all rules, regulations, policies, and procedures relevant to the Complaints, Grievances, and Appeals Unit.
- Completed Health Plan Business unit processes, workflows, and system requirements, including but not limited to authorizations, billing, regulatory compliance, and plan benefits.
- Worked closely with Medical Directors and other Health Plan staff to resolve Grievances (i.e.) appeals timely and accurately.
- Managed caseloads, multiple systems, and plans appropriate allocation of resources to provide a quality assessment of assigned Complaints and Grievances.
- Handled multiple issues and prioritized appropriately with the ability to organize work to meet deadlines.
- Performed outreach calls to members, head of household, and authorized representatives.
- Identified and analyzed various member issues/concerns and ensured that well-documented resolution(s) were entered in real-time.
- Outreached to provider offices to obtain responses to member complaints involving primary care physicians, specialists, hospitals, ancillary services/durable medical equipment, delegated vendors, and their staff.
- Reviewed and interpreted Health Care Management case notes, medical records, and pharmacy profiles and drafted comprehensive case summaries to forward to external and internal physicians, pharmacists, nurses, and other Plan staff for review and present to committee members for hearings.
- Drafted well-written acknowledgment, review notification, and decision letters timely in response to member complaints and grievances.
- Facilitated written and verbal communications, schedules as well as/preparations for 1st and 2nd Level member Complaint committees and Grievance hearings.
- Prepared and presented Complaints and Grievances to the Complaint and Grievance Committees under the Health Choices Agreement, including coordination with a legal representative when an attorney is representing a member.
- Maintained corporate policies and procedures and other formal documents pertinent to the Complaint and Grievance function/option in conjunction with the Department of Health and or Pennsylvania Insurance Department.
Claims Examiner
HEALTH PARTNERS PLANS
03.2015 - 07.2018
- Maintain minimum performance standards as specified by departmental policies, such as claim production and accuracy.
- Keep current with Claims Department policies and procedures.
- Adjudicate medical claims, review suspended claims, process, edit and refer high dollar claims as needed to the supervisor for review.
- Accurately complete service forms for suspended claims and route to designated areas for resolution.
- Review audit results on a weekly basis correcting errors in the claims processing systems within designated timeframes.
Member Relations Representative
HEALTH PARTNERS PLANS
06.2013 - 03.2015
- Maintained call records, logs and other documentations in accordance with departmental standards and requirements.
- Collaborated with internal departments to facilitate resolutions to member’s issues and concerns.
- Responded to member and member related calls in a courteous, professional and efficient manner providing timely follow-up to requests for information and services.
- Knowledgeable of CCMS, MHS, On Contact, Argus, Macess, DPW and Caps systems.
Medical Receptionist
ROY N. GAY, M.D.
09.2008 - 06.2013
- Process all arriving patients and screen all incoming telephone calls.
- Manage patients documents that detail all patient appointments in and out of office, insurance verification and collect of financial co-pays.
- Process all medical referrals, pre-authorizations, hospital reservations, blood transfusions and other departmental clerical duties.
- Knowledge of Navi-net and Medrium computer software system.
Education
Certificate - Herbalism For Birthworkers
Birth Arts International
Spencer, VA02-2025
Certificate - Birth & Postpartum Doula And Lactation Counselor
Maternity Care Coalition
Philadelphia, PA01-2022
Certified Life Coach - Coaching And Training Institute
A.R.T. Of Training And Development LLC
Burlington, NJ04-2022
Certificate - Trauma Healing & Group Facilitator
A.B.S. Trauma Healing Institute
Philadelphia, PA03-2018
High School Diploma -
Thomas Edison High School
Philadelphia, PA06-1990
Skills
Prenatal care
- VBAC support
- Childbirth education
- Birth advocacy
- Gentle cesarean support
- Infant soothing techniques
- Postpartum recovery support
- High-risk pregnancies
- Breastfeeding support
- CPR certified
Certification
- Certified PCB Perinatal Doula, PA Certification Board - 5/16/2024
- Certified HIPAA, Biologix Solutions - 1/29/2024
- Certified Infant Massage Instructor, Infant Massage WINC- 2/08/2024
Languages
Spanish
Professional Working
Timeline
Certified Birth and Postpartum Doula
PHILADELPHIA DEPARTMENT OF PUBLIC HEALTH DIVISION OF MATERNAL, CHILD & FAMILY HEALTH
08.2023 - Current
Community Birth & Postpartum Doula
MATERNITY CARE COALITION
01.2022 - 01.2024
Appeals Specialist
HEALTH PARTNERS PLANS
07.2018 - 10.2021
Claims Examiner
HEALTH PARTNERS PLANS
03.2015 - 07.2018
Member Relations Representative
HEALTH PARTNERS PLANS
06.2013 - 03.2015
Medical Receptionist
ROY N. GAY, M.D.
09.2008 - 06.2013
Certificate - Herbalism For Birthworkers
Birth Arts International
Certificate - Birth & Postpartum Doula And Lactation Counselor
Maternity Care Coalition
Certified Life Coach - Coaching And Training Institute
A.R.T. Of Training And Development LLC
Certificate - Trauma Healing & Group Facilitator
A.B.S. Trauma Healing Institute
High School Diploma -
Thomas Edison High School
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