Michele Lopez Cecilio
Barnegat
Summary
Over 20 years of proven success in medical environments, recognized for reliability and strong organizational skills. Expertise in Health Care Administration, call center operations, and customer outreach initiatives. Demonstrated ability to enhance customer relations through effective service and multitasking. Committed to delivering exceptional experiences for all customers.
Overview
34
34
years of professional experience
Work History
Outbound Caller Center Representative
MVP Health Care
Tarrytown
04.2021 - Current
- Certified application counselor for the New York State of Health Marketplace, and facilitated enrollment specialist for the Department of Social Services.
- Provide accurate information and screenings about insurance affordability programs, like Medicaid and Child Health Plus, as permitted under federal and state guidelines.
- Assisted with applications for state-funded health insurance programs available to individuals and families through the New York State of Health Marketplace, including those eligible for advanced premium tax credits, cost-sharing reductions, and subsidies.
- Ensure timely and accurate completion of applications in compliance with state and federal regulations, eligibility, and enrollment guidelines/requirements.
- Handling of all customer care service inquiries and prompt issue resolution, including billing and translation services for the Spanish community.
- Assist the Outreach call center when needed.
- Providing orientation for new members.
- Conduct outbound campaigns for all lines of business.
- Conducting assessments for the LFP campaign.
- Simultaneously access multiple databases while addressing customer needs.
- Assisted our CDPAP members with the change to the new Statewide Fiscal Intermediary, Public Partnerships, Ltd. (PPL).
Quality Care Representative
MVP Healthcare
Tarrytown
02.2020 - 04.2021
- Handle members' escalation calls.
- Review prior authorization requests for services.
- Create monthly reports of representative stats
- Review application submission to NYSOH
- Research information given to respond to customer concerns
- Explain the policies and procedures for all lines of business.
- Complete the application for medical coverage through NYSOH and Direct MVP QHP.
- Simultaneously access multiple databases while addressing customer needs.
- Follow through with consumers and NYSOH to ensure documents submitted were approved.
- Workflow service forms with member issues are sent to the appropriate departments.
- Conducts outbound campaign calls for government programs.
Enrollment and Retention and Representative
MVP Healthcare
Tarrytown
12.2018 - 02.2020
- Provide clear, concise information to others in a variety of formats (verbal, written, electronic, etc.).
- Provide prompt and courteous service.
- Provide solutions that are directly related to customers' requests or anticipated needs.
- Act and make decisions independently, and work effectively without immediate supervision.
- Obtain stats, summarize, and create reports of data.
- Review the documents submitted by members.
Customer Services Representative for MVP Health Care
Execu-search Temp
New York
04.2016 - 08.2016
- Answered customer service inquiries through a specialized inbound queue.
- Made outbound calls for preventative services MVP provides.
- Assisted with coverage in the reception area.
Administration Assistant, Metro Plus Health Plan
Distinctive workforce solutions
New York
11.2015 - 04.2016
- Assisted in well care visit project and outreach to maintain children health.
- Participated in the Rango project and outreach for members in the special needs program to utilize a new health application.
- Data entry for CD4 blood work and viral loads into the DCMS database.
- Responsible for maintaining medical records in the special needs program.
Administrative Associate
Distinctive workforce solutions
New York
03.2014 - 11.2015
- Filed all progress notes and lab reports.
- Entered CD4 and Viral loads into DCMS.
- Supported the Rango Project.
- Assisted in Well Care Visit project.
- Booked Surgical procedures for the Orthopedics Clinic at Bronx Lebanon.
- Processed all new patients in the Enterprise program.
- Requested authorization from insurance on services needed.
- Verified insurance was active using Epaces.
- Filed and maintained all medical documentation.
- Confirmed member PCP.
- Created and Processed orders for PCP to Sign.
Registrar/ Health Information Clerk
Our Lady of Mercy
Bronx
05.1991 - 10.2006
- Handled all cash transactions.
- Registered all patients for visits.
- Scheduled and verified daily appointments.
- Obtained and managed all information related to referrals and admission.
- Sorted and processed any medical documentation for filing.
- Prepared charts for visits.
Education
Associate - Medical Administration
Monroe college
Bronx, New York05.2010
Skills
- Microsoft Office
- Excel
- PowerPoint
- Outlook
- Bookings software
- Power Stepp
- DCMS
- Medical manager
- Practice Partner
- Citrix Workspace
- Care Radius
- Facets
- Maces
- Dynamics
- Salesforce
Languages
Bilingual: English/Spanish
Timeline
Outbound Caller Center Representative
MVP Health Care
04.2021 - Current
Quality Care Representative
MVP Healthcare
02.2020 - 04.2021
Enrollment and Retention and Representative
MVP Healthcare
12.2018 - 02.2020
Customer Services Representative for MVP Health Care
Execu-search Temp
04.2016 - 08.2016
Administration Assistant, Metro Plus Health Plan
Distinctive workforce solutions
11.2015 - 04.2016
Administrative Associate
Distinctive workforce solutions
03.2014 - 11.2015
Registrar/ Health Information Clerk
Our Lady of Mercy
05.1991 - 10.2006
Associate - Medical Administration
Monroe college
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