Miaya Summers

• Responded to provider and member service inquiries via Zendesk, consistently resolving tickets with accuracy and efficiency.
• Maintained and updated provider profiles using Fountain and JIRA, ensuring accurate records across onboarding platforms.
• Executed end-to-end clinical onboarding using JIRA and Admin systems, improving new provider integration timelines.
• Documented all member and provider interactions accurately in electronic records in alignment with state, regulatory, and organizational requirements.
• Scheduled provider availability in Admin system and activated accounts, ensuring readiness to deliver services.
• Conducted an average of 3 onboarding sessions per day via Zoom, delivering 30-minute, individualized training to help new clinicians navigate Brightside systems, policies, and workflows.
• Connected members to appropriate health plan programs and local community resources to address clinical and non-clinical needs, including SDOH-related support
• Communicated daily via Slack to collaborate with team members, respond to internal department requests, troubleshoot provider issues, and answer time-sensitive questions.

• Delivered timely and compassionate support to members and providers through phone, email, and live chat channels.
• Managed end-to-end care coordination tasks, including updating patient records, rescheduling appointments, processing prescription authorizations, and handling medical documentation requests.
• Troubleshot and resolved technical issues submitted by users, ensuring minimal disruption to care services.
• Performed high-volume outreach to members to support care plan next steps, assist with scheduling, and provide education on available health plan and community resources.
• Worked cross-functionally with other operations teams to ensure seamless communication and consistent support for provider/member needs.
• Served as a front-line point of contact for members, providers, and internal teams, resolving inquiries, explaining procedures, and ensuring a clear understanding of care plan expectations.
• Connected members to appropriate health plan programs and local community resources to address clinical and non-clinical needs, including SDOH-related support.
• Applied working knowledge of health plan policies, resources, and service workflows to assist members and providers efficiently.
• Collaborated with care management teams to support ongoing coordination, improve member engagement, and enhance overall service delivery.

• Connected members to appropriate programs, benefits, and local community resources to address clinical, social, and SDOH-related needs.
• Maintained and tracked outreach contacts using internal databases to measure engagement goals and service outcomes.
• Conducted outreach to members to support care plan next steps, answer questions, and guide them through available health plan and community resources.
• Conducted psychosocial assessments to identify barriers to care and coordinated appropriate support services to address individual needs.
• Assisted with member onboarding by sending welcome letters, correspondence, and educational materials to ensure a smooth and informative introduction to services.
• Provided telephonic case management, including appointment scheduling, education on member rights, and care plan follow-through.
• Guided members through the grievance and appeals process, representing their interests and facilitating resolution with internal departments.

Provided case management and benefit support to vulnerable populations, helping clients access housing, food assistance, and Medicaid services.

• Coordinated in-home care services, scheduled visits, and ensured compliance with care plans for elderly and disabled clients.

• Supported medical staff with scheduling, patient documentation, and front desk operations in a fast-paced hospital setting.

• Managed appointments and follow-ups for outpatient services, ensuring accurate calendar management and insurance verification.

• Booked paratransit rides, resolved service issues, and provided excellent customer service to seniors and individuals with disabilities.

• Assisted Medicaid clients with non-emergency transportation scheduling and navigated state systems for eligibility verification.