Maria Bejarano
San Jose,CA
Summary
Outstanding and dedicated Case Manager with 27 years experience providing Low-Income families application and enrollment assistance into health care programs. Extremely knowledgeable in all Medi-Cal, Kaiser C-Chip and Medicare programs. Excellent communicator. Committed at ensuring client wellness by actively listening to assess their needs and determine eligibility. Dedicated to conflict resolution. Excellent at multi-tasking. Successfully maintained a 98% approval rating on all applications processed.
Overview
34
34
years of professional experience
Work History
Intake Patient Advocate Supervisor
Elevate Patient Financial Solutions
Palo Alto, CA
02.2019 - 08.2024
- Managed employee supervision, work delegation, and instruction on proper procedures. Collaborated on the development and revision of department processes.
- Educated and mentored new staff members
- Asses patient's personal and financial information to determine eligibility for state or federal medical insurance programs.
- Complete appropriate applications and redeterminations, and follow case until approved.
- Partnered with hospital physicians, Social Workers and Case Managers to support timely processing of critical referrals.
- Utilized all available resources to verify patient information.
- Effectively communicate with county Medi-Cal offices, Health Care Options and State Ombudsman to troubleshoot and resolve complex patient's situations.
- Complete and distribute a Daily Report of pin-house patient's status, to hospital team.
- Complete home visits
- Adapt quickly to constant program changes.
- Recognized by hospital for providing exceptional customer service.
Delivery Dispatcher at Amazon
A-1 Express Delivery Service Inc.
Atlanta, GA
04.2018 - 02.2019
- Managed 35+ Delivery Associates during vehicle load, depart, package delivery and safe returns to warehouse.
- Monitored, logged and reported the status of all delivery routes to management, while effectively solving problems throughout the workday.
- Cultivated a positive culture to boost company morale and promote employee retention.
- Acted as sight manager while handling employees hiring, administration, scheduling, discipline and payroll.
- Coordinated fleet maintenance, repairs, scheduled service of vans on a routine basis to ensure availability and coverage.
- Enforced the on-time departure and return time.
- Handled incoming calls and emails from customers regarding issues with deliveries and guaranteed successful delivery re attempt.
Delivery Associate at Amazon
A-1 Express Delivery Service Inc.
Atlanta, GA
01.2018 - 04.2018
- Sorted, organized and loaded delivery vehicle with 180+ packages with strict time restraints.
- Provided excellent customer service while delivering to Amazon customers.
- Assisted other drivers who were behind their routes
Member Service Representative
Santa Clara Family Health Plan
Campbell, CA
12.2007 - 10.2016
- Answered customer and provider calls and assist with Medi-Cal, Medicare and Healthy Kids eligibility and benefits questions, grievance and appeals, primary care physician assignments and changes, prescription status and troubleshoot program and/or system errors.
- Processed Medi-Cal and CAlMediConnect Provider Claims and Authorizations inbound calls to verify claims and authorizations status, claim approvals and payment information, provide a detailed explanation of denials, appeals and corrected claims and provided corrective action needed for successful transactions.
- Read, interpreted and implemented rules and regulations, and policies and procedures for Medi-Cal, Healthy Kids, Kaiser Child Health Plan, C-Chip and Medi-Cal expansion programs and applied accordingly.
- Obtained, verified and evaluated financial and personal information of applicants and recipients of Medi-Cal, Healthy Kids, Kaiser Child Health Plan and C-Chip programs and determined eligibility.
- Processed applications and annual renewals through One E App, Health E App and CalWin systems.
- The key representative for all outreach community events and health fairs and established long-term relationships with other community agencies.
- Primary representative to assist all customer walk-ins by evaluating their needs and resolve their inquiries and complaints in a timely and empathetic manner.
Eligibility Worker II
Santa Clara County Social Services Agency
San Jose, CA
04.1990 - 04.2006
- Managed 200 specialized Medi-Cal cases.
- Read, interpret and implemented programs rules and regulations and policies and procedures for Medi-Cal and other public assistance programs and applied accordingly.
- Obtained, verified and evaluated applicants and recipients financial and personal information and updated Medi-Cal and other Public Assistance budgets accordingly and determined monthly eligibility.
- Processed Quarterly status reports within the specified deadlines.
- Reviewed and processed case error reports, and provided corrective action.
Education
San Jose City College
Skills
- Expertise in Medi-Cal program
- Excellent leadership and interpersonal communication
- Adept at analyzing problems and synthesizing solutions
- Established Excellent relationships with Hospitals and Community Resource agencies
- Professional while working in a stressful environment and adapt to sudden changes
- Primary to manage the difficult clients
- Ability to communicate professionally and empathetically with members and providers
- Primary Coordinator for Community Outreach and Health Fair Events
- Excellent team player
- Certified Application Assistant (CAA)
Timeline
Intake Patient Advocate Supervisor
Elevate Patient Financial Solutions
02.2019 - 08.2024
Delivery Dispatcher at Amazon
A-1 Express Delivery Service Inc.
04.2018 - 02.2019
Delivery Associate at Amazon
A-1 Express Delivery Service Inc.
01.2018 - 04.2018
Member Service Representative
Santa Clara Family Health Plan
12.2007 - 10.2016
Eligibility Worker II
Santa Clara County Social Services Agency
04.1990 - 04.2006
San Jose City College
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