Monique Benitez
Bronx,New York
Summary
Knowledge of Microsoft word, Access, Excel, Outlook, Medical database, Facets, Macess, Member 360, FUSE, Psyckes, Salesforce, Workforce, Care Compass ACMP, AUMI. Excellent telephone communication skills
Overview
21
21
years of professional experience
Work History
Outreach Care Specialist
Anthem Blue Cross Blue Shield
01.2018 - Current
- Responsible to Track ER daily admissions
- Monitor OP mailbox
- Monitor fax queue and send email to team
- Identify POP members that did not consent to bridge and send to CM Harp team
- Maintain and Track outreach related to BH or PH admission to OP providers and outcomes of efforts
- Assist Clinicians in outreaching providers for member appointment outcomes
- Send FUH outcomes to team
- Track discharges assigned to Clinicians
- Coordinate and identify members that consented to bridge and send referrals to bridge providers
- Responsible for ensuring turnaround time is being met per plan contract requirements
- Establishes and maintains relationships with Bridge providers
- Track bridge referrals and outcomes
- Create Authorization in AUMI and Member letter in ACMP
- Outreach member to confirm bridge services
- Track AOT orders for members in PROS, ACT, CDT; expiration dates for provider outreach;
- Bump up and ID Gaps in fill for members in PROS, ACT, CDT, Antipsychotic reports and send to Team
- Performs other duties as assigned
Outreach Specialist
Health Plus-Amerigroup
03.2011 - 02.2018
- Responsible in scheduling and coordinating medical record reviews at hospitals, health centers, and private physician offices
- Responsible for data entry of Member Satisfaction Survey and Provider Satisfaction Survey results
- Responsible for data entry of medical record collected for QARR/HEDIS
- Maintain database and excel spreadsheets for various Quality Improvement projects
- Maintain Provider Recredentialing database and medical charts review analyses.
- Responsible for coordinating and tracking QI chart review projects
- Provide administrative support to the QM Coordinators during field visit related chart revies
- Maintain Relationships with providers to obtain medical records needed for all chart reviews
- Generate and mail various letters to Health Plus members and providers
- Performs other duties as assigned
Community Outreach
Health Plus
02.2011 - 03.2011
- Conduct phone outreach in English and Spanish to Medicaid and Medicare plan members to encourage health screenings and compliance with medications
- Facilitate health promotion messages on topics such as mammography, diabetes, annual doctor’s visits, cervical cancer prevention and proper use of anti-depressants
- Connect plan members with services and care coordination
Parent Coordinator
Board of Education
08.2003 - 01.2011
- Responsible for providing a welcoming environment to Parents
- Act as a Liaison between Parents and School
- Provide Educational workshops
- Refer Parents to Community Board Organizations
Education
Cornell University
Family Development and Credentialing Program Certificate -
Universidad InterAmericana de Puerto Rico
01.1991
Skills
- Healthcare Navigation
- Empathy Development
- Cultural Competency
- Referral management
References
References are available on request.
Timeline
Outreach Care Specialist
Anthem Blue Cross Blue Shield
01.2018 - Current
Outreach Specialist
Health Plus-Amerigroup
03.2011 - 02.2018
Community Outreach
Health Plus
02.2011 - 03.2011
Parent Coordinator
Board of Education
08.2003 - 01.2011
Cornell University
Family Development and Credentialing Program Certificate -
Universidad InterAmericana de Puerto Rico
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