Leslie M. Rivera

834 Outreach – Enrollment

CRM Resolution

Responsible for receiving, reviewing, processing, and maintaining new member(s) enrollment information

Responds to member eligibility questions

Submits files to relevant internal teams; as needed to meet deadline requirements

Maintains compliance with HHSC contractual requirements and URAC standards

Understands written communications from Manager concerning the necessary operations of the department and changes that may need to be implemented

Provides administrative support to ensure efficient operation of office

Ensure all initial screening calls are addressed and completed in a timely manner

Assists with initial telephonic outreach to STAR Kids Member/LAR

Assist with outreach calls to those CMW Members that have been identified through claims, state report files, or by other means

Knowledge of Medicaid managed care processes

Microsoft Excel

Microsoft PowerPoint

Insurance Verification - Eligibility

Assist with other duties as delegated by the STAR Kids Manager of Service Coordination Services

Maintains utmost level of confidentiality at all times

Adheres to hospital and Health Plan policies and procedures

Performs other duties as requested

Provides administrative support to ensure efficient operation of office

Scheduling/Confirming patient appointments

Patient Intake

Recalls – F/U with patients who missed their appts

Billing and Coding – Chiropractic – Atty/Ins

Auditing Narratives

Data entry

Microsoft Excel

Record Management

Front Desk

File Review

Medical Records

Insurance Verification

Assistance in the back office – Therapies

Patient intake

File Review

Data entry

Organize patient charts

Filing charts

Maintaining patient confidentiality

Record Management

Prepare patient charts for billing

Lost job due to covid-19

Provides administrative support to ensure efficient operation of office

Scheduling/Confirming patient appointments

Organize patient charts

Billing and Coding

File Review

Data entry

Record Management

Front Desk

Medical Records

Insurance Verification

Assistance in the back office – Therapies

Front desk

Billing and coding – MRI’s, X-Ray, CT Scans, Ultrasounds and ESI’s

ICD-10 and CPT Codes

Scheduling/Confirming patient appointments

Organize patient charts

Posting payments

Balancing

File Review

Data entry

Microsoft PowerPoint

Microsoft Excel

Claims Update

Record Management

Certified Coding Specialist for Alliance Billing and Collections

Case Coordinator for Exclusive Provider Network - Scheduling for Imaging, Pain Management, Ortho and Physical Therapy

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