Milagros Hernandez
Harrisburg ,PA
Overview
12
12
years of professional experience
Work History
Care Navigator
United Healthcare Group
Remote
01.2022 - Current
- Consistently maintained confidentiality while handling sensitive patient information in accordance with HIPAA guidelines.
- Reduced hospital readmissions for patients through proactive follow-up and continuous communication.
- Maintained detailed documentation of patient interactions, treatment plans, and progress notes for accurate recordkeeping.
- Identified potential barriers to care, implementing tailored solutions to improve outcomes.
- Completes telephonic outreach to DSNP members utilizing auto dialer and manual dialing
- Educates member on gaps in care and assists with scheduling provides
- Assists members with social determinants of health and links to community
- Identifies gaps in care and assists in closure of gaps
- Outreaches members on caseload consistent with program guidelines
- Consistently meets metrics, both quality & performance
- Provides excellent customer service to both members and providers
- Constantly maintains schedule adherence and good attendance
- Maintains confidential health information according to state and federal regulations including HIPAA
- Act as a Subject Matter Expert for other team members
- Manage the intake of members or the admission/discharge information post notification
- Work with hospitals, clinics, facilities and the clinical team to manage requests for services
Front Office Assistant
Patriot Home Care
Harrisburg, PA
03.2021 - 10.2021
- Answered and managed incoming and outgoing calls while recording accurate messages for distribution to office staff.
- Maintained a professional and welcoming environment for clients, contributing to an overall positive experience.
- Responded to inquiries from callers seeking information.
- Directed phone inquiries, answered customer questions, and scheduled appointments.
- Monitored Call Dashboard System in HHA Exchange and handled high inbound call volumes.
- Provided assistance and communication with Spanish-speaking caregivers and clients.
- Supported filing tasks and contributed to the smooth operation of the office.
Care Management Associate
Aetna
New York, NY
12.2018 - 03.2020
- Completed weekly scheduling and monthly department reports for case managers.
- Reduced hospital readmissions by closely monitoring patients'' progress and adjusting care plans as needed.
- Coordinated post-discharge care by communicating with outpatient clinics, community resources, agencies and families around patients' transitional care.
- Worked with insurance carriers to obtain authorization approvals for medications, supplies and equipment.
- Promoted and supported the quality and effectiveness of healthcare services.
Customer Service Representative
Garden Court Health Supplies
Brooklyn, NY
12.2012 - 07.2016
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
Education
Bachelor Of Business Administration And Management - Health Administration
Southern New Hampshire University
Hooksett, NHSkills
Medical insurance
Document filing
Medical record keeping
Teamwork and Collaboration
Appointment Scheduling
Clerical Support
Flexible and Adaptable
Attention to Detail
Good Telephone Etiquette
Critical Thinking
Dependable and Responsible
Active Listening
Problem-Solving
Team building
Timeline
Care Navigator
United Healthcare Group
01.2022 - Current
Front Office Assistant
Patriot Home Care
03.2021 - 10.2021
Care Management Associate
Aetna
12.2018 - 03.2020
Customer Service Representative
Garden Court Health Supplies
12.2012 - 07.2016
Bachelor Of Business Administration And Management - Health Administration
Southern New Hampshire University