
Dynamic Quality Outreach Representative at Jefferson Health Plans with a proven track record in customer relationship building and problem-solving. Expert in Medicare and Medicaid benefits, successfully managing high productivity rates while ensuring compliance. Recognized for adaptability and strong communication skills, enhancing member engagement and satisfaction.
•Outbound call center
•Front line liaison for members
• Handling inquiries regarding benefits, Eligibility and providers
•Appropriately documenting multiple systems
•completing various projects and task/ working on multiple task daily
• Scheduling and closing HEDIS Care gaps
•Strong knowledge of Medicare, Medicaid, CHIP and ACA plans and benefits
•Strong ability to work independently
• Assisting with onboarding of new hires to the department when needed
•High productivity rates
•Leading team of 15 Employees
•Maintaining caseload of 200 Patients
•Maintaining caseload of 200 plus Caregivers
•Monitoring entire departments caseload of 1500 patients
•Home assessments for new patients
•Creating and submitting EMI’s
•Compliance Coordination
•Verify and document general health and safety concerns to state standards
•Conduct follow-ups on adult protective service cases
•Perform quarterly assessments and Re-evaluations for internal employees
•Retention Specialist
•Advocate for durable medical equipment request
•Ride along with Care coordinators for home visits
•State mandated reporter
•Employment Verification
•Monitoring and Maintaining all employees internal and external files
•Completing Criminal Background checks
•Completing Sex offender check and clearances
•Completing Child Abuse clearances
•Receiving and Verifying Service Authorization forms
•Conducting and sitting in on interviews
•Dispatching HHA’s to Patients homes
•Working hand and hand with payroll and assisting with issues
•Inbound/outbound Call Center
•Scheduling and delivery of medical equipment
•Scheduling Maintenance of Equipment
•Insurance Verification
•Collecting Co Payments
•Verification of Prescriptions
•Oxygen and Tracheotomy set-up
•Strong knowledge of medical terminology
•Fitting of Diabetic/ Prosthetic shoes and inserts
•Fitting of Mastectomy prosthetic Bras
•Bank teller responsibilities
•Cash Handling
•High volume loan referrals
•Assisting Consumers
•Monitoring line of credits and bank loans
•Answering phones
•Multi outlet set-up and design
•Training and supervision
•Inventory maintenance and controls
•Customer service
•Large amount of cash Handling
•Providing customer experience to Players and Family members