Milton O. Fonseca
Bronx,USA
Summary
Dynamic individual with hands-on experience in health services and talent for navigating challenges. Brings strong problem-solving skills and proactive approach to new tasks. Known for adaptability, creativity, and results-oriented mindset. Committed to making meaningful contributions and advancing organizational goals.
Overview
14
14
years of professional experience
1
1
Certification
Work History
NYS Marketplace Facilitated Enroller
Metroplus Health Plan , NYC Health & Hospital
New York, NY
08.2015 - Current
- Assessed New York State residents for eligibility and facilitated enrollment in suitable health plans through NY State of Health Marketplace.
- Coordinated efforts with staff at NYC Health & Hospitals and regional private hospitals to assess and assist patients in need of essential health services.
- Established and grew referral networks, significantly boosting health plan membership and extending organizational influence.
- Identified community health service needs across age groups, income levels, households, and immigration or citizenship demographics within assigned territories.
- Advocated for health plan at community events and through strategic partnerships to enhance brand visibility.
- Facilitated training for new marketing representatives on policies, procedures, and best practices.
- Contributed to training effectiveness by providing insights on materials and engaging in Q&A sessions with multiple new hire classes.
- Identified and pursued new markets and opportunities, consistently achieving team production targets.
- Applied comprehensive knowledge of NYS DOH, NYS CMS, and NYC HRA regulations to ensure compliance with state-sponsored insurance plans.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Worked flexible hours across night, weekend, and holiday shifts.
- Demonstrated respect, friendliness, and willingness to help wherever needed.
Contact Center Administrative Supervisor
New York State of Health Marketplace / Maximus Inc.
New York, NY
07.2013 - 04.2015
- Managed enrollment agents to ensure New York State residents received appropriate coverage through effective technical guidance.
- Evaluated and updated contact center materials to ensure accuracy regarding deadline extensions and regulatory changes related to Affordable Care Act (ACA) for NYS Marketplace Exchange.
- Guided enrollment agents in implementing HIPAA, NYS DOH, and ACA standards to enhance consumer support across phone, online, and e-chat platforms.
- Analyzed productivity metrics thoroughly to inform strategies aimed at boosting overall effectiveness of individuals and teams.
- Assessed agent call recordings, online sessions, and e-chat transcripts to reinforce commitment to high-quality service delivery.
- Conducted monthly team meetings aimed at resolving issues, collecting input, and educating staff on policy changes.
- Engaged with senior management to formulate staffing schedules, ensuring alignment with projected contact center demands.
- Demonstrated expertise in documentation requirements for citizenship, immigration status, and income sources to assess eligibility under ACA.
- Reviewed and processed consumer applications daily, ensuring all required documents were submitted to verify coverage eligibility accurately.
- Knowledgeable in NYS and federal health programs, including Medicaid, Medicaid Managed Care, Child Health Plus, Medicare Parts A, B, C, and D, as well as specialized programs such as Spend Down, Buy-In, and Premium Assistance.
Clinical Management Administrative Supervisor
United HealthCare Group
New York, NY
02.2012 - 05.2013
- Optimized workflow processes through design and enhancement using flowcharts, Visio, and memos.
- Compiled and analyzed weekly productivity reports for departmental and individual performance evaluation.
- Organized and facilitated open forum teleconferences to enhance communication between management and staff.
- Implemented guidelines for staff on member data management and record keeping to ensure compliance with HIPAA and NYS DOH regulations.
- Coordinated training sessions to equip staff with comprehensive knowledge of critical processes, fostering expertise in both internal and external systems.
- Supervised payroll administration and designed staff schedules to meet the evolving demands of the department.
- Delivered expert assistance in call center environment, addressing and resolving intricate escalated issues to enhance customer satisfaction.
Education
A.A.S Degree - Video Arts Technology
C.U.N.Y Borough of Manhattan Community College
New York, NYProduction & Post Production Intern
C.U.N.Y Television Channel 75
New York, NY12.2008
Bachelor of Science - Health Information Management
CUNY School of Professional Studies
New York, NY05-2028
Skills
- Proficient with PC, Mac, Linux, UNIX, Sybase, Oracle, AS400, Novell, Cisco, Citrix, and a wide range of desktop, network, and back office systems
- Experienced in diverse networking environments and skilled with video hardware and software applications
- Friendly, positive attitude
- Teamwork and collaboration
- Customer service
- Organization and time management
- Excellent communication
- Critical thinking
- Problem resolution
- Decision-making
- Flexible and adaptable
- Multitasking
Certification
- Certified Marketplace Facilitated Enroller, New York State of Health MarketPlace / MetroPlus Health - Current
Languages
Spanish
Native or Bilingual
Timeline
NYS Marketplace Facilitated Enroller
Metroplus Health Plan , NYC Health & Hospital
08.2015 - Current
Contact Center Administrative Supervisor
New York State of Health Marketplace / Maximus Inc.
07.2013 - 04.2015
Clinical Management Administrative Supervisor
United HealthCare Group
02.2012 - 05.2013
A.A.S Degree - Video Arts Technology
C.U.N.Y Borough of Manhattan Community College
Production & Post Production Intern
C.U.N.Y Television Channel 75
Bachelor of Science - Health Information Management
CUNY School of Professional Studies