LIZ GARCIA

Subject matter experts bridging the gap between the special needs’ population enrolled in United Healthcare Dual complete plan with Medical and Behavioral health providers in the state of New York

• Document all member interactions for quality and metrics reporting through various customer relationship management applications (Maestro, Corral &Facets)
• Evaluate in network participation of providers and medical facilities upon prospective enrollees, current members or sales agent request, discrepancies are sent to the credentialing department for further investigation
• Verify Medicare and Medicaid eligibility for NYS United Healthcare Dual complete plans (full or partial benefits)
• Review authorization request and claims processing for DME, medical procedures and medication.

A network of not-for-profit community health centers providing Medical, Dental and Social Services for the low income along with the uninsured population throughout New York City

• Collaborate with Center staff to ensure that all uninsured patients are appropriately screened and marketplace applications are submitted (if applicable)
• Create, process and submit applications on the New York State of Health Marketplace a for qualifying consumers on perspective enrollments
• Conserve and monitor a daily/monthly list of consumers with no insurance coverage to provide them with information regarding the Affordable Care Act or other in office grants (FPBP’s, PCAP’s and PE’s)
• Update and manage a weekly calendar available to management detailing interactions with clients notated in submitted, educated or successfully enrolled applicants.

A multi subspecialty Ophthalmology serving the community of Brooklyn and Queens with comprehensive evaluations or treatment of the Retina, Cornea, Glaucoma, Oculoplastic and pediatrics

• Utilize EMR software (SAMMY USA) to enter patient information such as demographics, insurance and primary care physicians with proper disclosure according to HIPAA guidelines
• Prepare patient medical records for follow up visits, verify member eligibility also petition referrals for Specialist visits when necessary
• Explain or translate any in office procedures with specific treatment consents following an adequate list of medications based upon MD’s indication, collect and prepare laboratory specimen for further review
• Conserve exam rooms inventory of medical supplies, proper instrument count and arrange sterilization as required.