Judith Nunez

• Provides support to the Manager and other staff in the resolution of member related issues.
• Communicates with members and their families regarding information about MA, FIDA and MAP products and services.
• Provides summary reports, analysis and support for care coordination related activities.
• Participates in non-clinical customer service for members enrolled in the VNS Health Plans MA, MAP, FIDA plan in collaboration with Care Management department and other healthcare professionals.
• Works under general supervision. Licensure: Valid driver's license or NYS Non-Driver photo ID card, may be required as determined by operational/regional needs.

• Delivered outstanding service by interacting with customers, answering customer inquiries and handling customer complaints.
• Completed order transactions and generated travel documentation and detailed itineraries.
• Searched for and located available seats, cabins and flights for passengers, LEO, pilots, crew members and Marshals
• Gave public address announcements regarding vehicle and aircraft arrivals and departures.
• Checked luggage and directed passengers to concourses and piers.
• Tagged checked baggage with appropriate destination with 100% accuracy rate.
• Greeted crew members, flight attendants and passengers.
• Responded politely to passenger complaints regarding ticketing and baggage handling.
• Delivered exceptional service to every customer through active engagement, effective listening and well-developed interpersonal skills.
• Processed various forms of payment and applied travel vouchers to help customers obtain tickets.

Receive inbound calls directly from members/prospects or transfers from member services

● Educate and respond to inquiries from members about plan benefits, enrollment, and renewal options ● Present to, follow up and sell Individual Medicaid, Essential Plan, QHP and CHP products on a direct sales basis ● Assist and enroll individuals by completing an, appropriate application forms, obtain required documentation necessary for enrollment, and meeting necessary enrollment targets ● Assist individuals by completing appropriate forms and/or renewal applications for NYSOH or LDSS (via phone or direct basis) ● Function as a liaison between all Fidelis's departments to help identify and capture prospect's issue resolution or concerns ● Work with Neighborhood Care and HUB (member services) teams to maintain and improve Fidelis's image as High Quality and Affordable health plan within the community ● Maintain appointments, develop community marketing sites, establish relationships with community-based organizations, participate in health-related activities / special events including in person evening and weekend activities, create self-generated leads, and provide services to onsite walk-ins

Assist QHP, EP, Medicaid & Child Health Plus members with billing inquiries, enrollment inquiries and PCP assignments ● Utilize automated tools such as Avaya, Facets, SalesForce, Sales Cloud, Service Cloud & ePACES to perform daily duties and conduct telephonic outreach when necessary ● Develop and maintain appropriate understanding of the health care products related to job functions ● Responsible for making outbound calls to previous/current QHP, EP, Medicaid & Child Health Plus membership due to special projects, and renewal on a telephonic approach

• Discuss financial options with patients who are considering additional services at Memorial.
• Provide patients with information regarding hospital billing and other administrative procedures.
• Follow up a=er the patient’s consult visit to determine status of ac-ons taken and decisions made about consultation treatment at MSKCC.
• Inform patients about their financial responsibilities and options to be taken.
• As a patient account representative our objective is to assure productivity is consistent with the established standards & policies necessary to resolve insurance and patient balance
• Managed the funds for the self – pay international patients from regions of Asia, Canada and Africa, for their medical services.

• Assisted the care/case managers with non-clinical activities such as creating cases and events; provided telephonic outreach to members, providers and community-based organization.
• Handled calls to and from members to assist with benefit questions/issues.
• Screened assessments to identify risk factors which need closer intervention.
• Documented accurate member information in compliance with internal procedures.
• Managed an average case load of 350 cases.
• Contacts members from assigned campaign lists to instruct them in the appropriate preventive health screenings as indicated by age, gender, line of business and other demographics.
• Conducted Health Risk Assessment screenings as appropriate.
• Worked with members to facilitate appointments with Providers to expedite receipt of services as needed.
• Recorded findings of each encounter to include patient identifiers, relevant information and results of the phone call within the current computer application.
• Summary Highlights Professional Experience.
• Contacted Provider sites/offices to set up dates to review/retrieve medical records for QARR/HEDIS (Quality Assurance Reporting Requirements/Healthcare Effectiveness Data and Information Set) reviews.
• Documented information related to these tasks in appropriate systems or databases.

• Obtained Authorizations for DME products and all outpatient services as requested.
• Processed member enrollment and change of coverage requests.
• Verified provider contractual status.
• Corresponded with contacts regarding member and provider data.
• Resolved problems with automated transmission of authorizations.
• Entered accurate keying of authorizations in client systems.

• Communicated scheduled surgeries, services, and meetings to doctor and nurses' stations in a timely manner.
• Directed patients, visitors, and vendors to relevant areas of hospital.
• Processed birth and death certificates.
• Answered phones and worked with hospital staff to handle inquiries, patient intake, and assign patients to rooms accordingly.
• Retained and corresponded updated bed censuses and facility services information to the appropriate departments and staff.
• Ensured that all the patients filled the required registration forms and evaluated it for accuracy of information.
• Prepared and maintained the medical charts and updated regularly.
• Evaluated the insurance card and kept a copy of the same in the records.
• Monitored all the financial payments for the clinic such as payments made by the patients.
• Maintained the copayments in accordance to the necessary guidelines.
• Scheduled all appointments with the doctors for the patients.

• Taking 50-70 Phone calls a day from clinics and families.
• Scheduling patients for MRI's, CT's, Nuclear Medicine, Ultrasound's and Fluoroscopy test's.
• Helping Nursing staff and sedation Doctors to schedule children that need sedation.
• Coordinating several tests with multiple different departments.
• Receiving all orders from outside clinics and entering them into our scheduling system for future scheduling.
• Sort, organize and coordinate patient orders for Radiology procedures.
• Call patients and schedule Ultrasound, CAT Scans, Mammogram, and Bone density related exams.
• Follow up with referring physicians on orders that need correction or clarification.
• Work hand in hand with insurance department to ensure authorizations are submitted for exams.
• Work with radiologist in clarifying diagnoses and submitted recommendations to referring physicians.
• Maintained all medical records both in the filing room as well as on the electronic medical records system.
• Complied with all laws regarding release of information.
• Coordinated compliance with subpoena requests with the office’s Legal counsel.
• Accessed the electronic record for diagnostic and pharmacological information and medical reports.
• Maintained client confidentiality at all times.
• Ensured any release of information requests were HIPAA compliant.
• Burned all images being requested on to DVD.

• Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
• Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
• Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
• Notified ordering providers of denied authorizations.
• Coordinated resolutions for issues and appealed denied authorizations.
• Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
• Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
• Scheduled patient appointments, diagnostic specialty appointments, tests and procedures.
• Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
• Checked documentation for appropriate coding, catching errors and making revisions.
• Organized information by using spreadsheets, databases or word processing applications.

• Admit, transfer, and discharge patients for all in-patient units within the hospital.
• Register out-patients for various departments throughout the hospital.
• Collected and entered demographic and insurance information as well as initiated, reviewed, and processed visit encounter forms into database.
• Documented prior authorizations obtained through third party insurances to ensure payment of special procedures.
• Counsel patient regarding payment options Medicaid eligibility and determines qualifications for charity care.
• Process information with which to ensure that third party bills are submitted timely and comprehensively.
• Review, monitor, correct and resubmit all cases where billed amount and paid amount create variances.
• Perform all job functions in a manager, which provides respect of privacy as well as excellent customer services to patients and co-workers.

• Establish positive, lasting relationships with vendors, patients and the community, and uphold a positive image of Cure outside the organization, thereby enhancing future success.
• Monitor, coach and evaluate staff performance in accordance with standards.
• Collaborate with other departments to ensure personnel policy development.
• Communicate with staff effectively to achieve consistency in labor and employee relations.
• Coordinate a safe, orderly environment and maintain a sufficient stock of office supplies.
• Creating monthly staff schedule to provide daily front desk coverage.
• Provides onsite necessary support to Office Leads and Clinical Leads in all aspects of operations, escalating and reporting issues to the Director of Operations and HR Manager appropriately.
• Coordinates and conducts New Hire on-site training to ensure successful transition for staff.
• Processes and assigns Coverage requests, providing “Urgent” coverage as needed.
• Verify insurance information and obtain changes at patient check-in to establish accurate financial records.

• Coordinated inpatient and outpatient care by scheduling surgeries, arranging diagnostic procedures and coordinating requests for consultation among other medical specialties by following established protocols.
• Pre-certified all outpatient and inpatient surgeries.
• Ensuring accuracy of current week's booking schedule and requesting whether our services are needed for future cases.
• Ensuring accuracy of data entered E-clincal with exceptional attention to detail.
• Participate in rotating on call schedule for after-hours/holiday coverage.
• Triage incoming urgent scheduling matters (add ons, cancelations, time changes) and dispatch to corresponding management as necessary.
• Occasional administrative office tasks as dictated by supervisor.

• Performed administrative office duties for two Internal Medicine Doctors in a busy private practice, which included medical records management, answering phones, general clerical duties, ordering supplies, data entry of patient information and demographics and end-of-day closing.
• Verified insurance and provided patients with referrals.
• Provided HIV counseling and testing.
• Obtained pre-certifications and referrals for diagnostic testing.
• Phoned in patient prescription authorization Legacy, York, NY High School Diploma.