Laura Leiva
Brandon,FL
Summary
Dynamic Care Resource Coordinator II at Centene Corporation with strong leadership skills and a proven ability to build trust. Expert in Medicaid and Medicare health plans, I excel in multitasking and fostering positive relationships, ensuring compliance and member satisfaction. Recognized for enhancing community connections and effectively resolving member concerns.
Overview
11
11
years of professional experience
Work History
Care Resource Coordinator II
Centene Corporation
Tampa, FL
10.2024 - Current
- Conduct telephonic outreach to assist the members with their benefits, connect with the community, and care resources in an effective manner.
- Support, provide, and coordinate resources available to members, and promote awareness of care/services.
- Conduct daily follow-ups, and keep them updated to meet compliance requirements, maintaining ongoing communication with members who accept the program, making them feel heard and committed to their mental and physical health care.
- Prioritize follow-up with members who receive daily reports of hospitalizations for mental and physical issues, as well as emergency room visits. Complete the respective assessments, assist the members with their follow-ups with psychiatrists, PCPs, specialists, and transportation.
- Conduct field visits for those members who need special care, or locate them if we don't have a successful contact by phone.
- Be attentive, and answer the calls and texts we receive from our members in a timely manner.
- Supports member-related correspondence and educational materials to assist in the facilitation of a successful community connection.
- Resolve concerns on members' behalf, and gather information for medical providers and staff working within the organization.
- May make visits to community organizations.
- Working knowledge of social determinants of health (SDOH) barriers.
- Performs other duties as assigned.
- Complies with all policies and standards.
Manager
Carelon Behavioral Health
Tampa, Florida
05.2023 - 12.2023
- Manage a team of Customer Service Associates, ensuring efficiency and compliance with policies and procedures.
- Ensuring associates faced with extenuating circumstances obtain and utilize appropriate resources when necessary.
- Regularly monitor, correct, and approve associate timesheets.
- Provide clear, easily understood, and consistently applied guidelines and best practices for optimal performance.
- Workday: Review daily entry data to ensure accurate and timely payment of associates.
- Workstation: Monitoring all associates’ schedules daily.
- CMS: Monitoring the queue, checking the associates' skills, and verifying they are available following their schedules to avoid having calls in the queue.
- Chat: Supporting the floor questions in the chat, guiding the associates, finding solutions, and assisting with supervisor calls.
- Facilitate 1:1 and team huddle every month.
- Monitoring calls, making sure the team is following the correct processes, providing coaching as needed, and assisting the team with the QA reconsiderations.
- Develop all associates and encourage them to pursue their goals.
- Keep team motivated, constantly recognizing individual and team achievements and excellent individual results.
Operation Expert (Team Lead)
Anthem/Simply Health Care Plans
Tampa, Florida
11.2018 - 05.2023
- Provide knowledgeable responses to associates, members, and providers regarding Medicaid and Medicare issues related to benefits, claims, prior authorizations, eligibility updates, plan change, organization determination, urgent OHI updates, grievances, appeals, cancelations, and LEP.
- Assist associates with answering questions, escalate calls, conduct coaching sessions, and write and administer performance reviews for skill improvement.
- Also conducted post-call survey reporting, research, and coaching to develop agent expectations regarding individual & team metrics, as well as, behavior.
- Support new hires, and provide Medicaid and Medicare training, LTC refresher training, Claims refresher training, and Lighthouse crossover to Simply Health Care to Miami and Tampa associates.
- Monitor service level, quality, and production of call center associates.
- Assist calls on the Help Desk, answering associates’ questions for the FL Medicare members in the General Chat.
- Encourage and foster a positive team work environment.
Customer Care Representative III
Anthem/Amerigroup/Simply Health Care Plans
Tampa, Florida
03.2017 - 11.2018
- Provide knowledgeable responses to members and providers regarding pharmacy issues related to benefits, claims, prior authorizations, lock-in & vacation overrides, eligibility updates, and urgent OHI updates.
- Also assist members with primary care physician changes, benefits, and appeals.
- Proactively submit Knowledge Management updates resulting in approval, helping to ensure our department had access to the most up to date information.
- Always exceeded quality and productivity goals.
Member Services Representative
Simply Health Care (acquired by Anthem)
Tampa, Florida
04.2014 - 03.2017
- Medicaid Member & Provider calls.
- Assist callers with PCP changes, eligibility, ID cards, pharmacy rejections, authorizations, and claims.
- Complete follow-up calls in a timely manner.
- Selected as Outbound Call project specialist (welcome call, health fair, and Medicare).
Member Services Representative
General and Dynamics
Riverview, Florida
02.2014 - 03.2014
- High volume call handling for Affordable Care Act.
- Provide professional assistance to initial and escalated priority telephone inquiries.
- Register qualified Members for health benefits.
Education
AS - Medical Office Administration
Southern Technical College
Brandon, FL10.2015
Skills
- Strong leadership skills
- Ability to work under pressure
- Focus on deadlines
- Building immediate trust and confidence
- Ability to build strong and positive relationships
- Influencing others
- Strong multitasking skills
- In-depth knowledge of Medicaid and Medicare health plans
- Proficient in TruCare Classic
- Proficient in Express Script
- Proficient in Compass
- Proficient in facets
- Proficient in Macess
- Proficient in ESI
- Proficient in Marx
- Proficient in Medisys
- Proficient in Word
- Proficient in Excel
- Proficient in PowerPoint
- Proficient in Outlook
- Proficient in Microsoft Teams
Recognition And Awards
- Top Team Customer Satisfaction Score March 2019 through August 2019
- Selected as Simply Healthcare peer Trainer in November & December 2018
- Certificate of Achievement, Employee of the Month, February 2018
- Selected as New Hire peer-coach at both Anthem & Simply
Timeline
Care Resource Coordinator II
Centene Corporation
10.2024 - Current
Manager
Carelon Behavioral Health
05.2023 - 12.2023
Operation Expert (Team Lead)
Anthem/Simply Health Care Plans
11.2018 - 05.2023
Customer Care Representative III
Anthem/Amerigroup/Simply Health Care Plans
03.2017 - 11.2018
Member Services Representative
Simply Health Care (acquired by Anthem)
04.2014 - 03.2017
Member Services Representative
General and Dynamics
02.2014 - 03.2014
AS - Medical Office Administration
Southern Technical College
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