Nicauris Santiago

• Conducted interviews with applicants to gather information and verify eligibility for public assistance programs (e.g., SNAP, Medicaid, TANF).
• Processed applications and caseloads efficiently, adhering to federal and state regulations and deadlines.
• Analyzed complex financial information and income verification documents to determine program eligibility.
• Accurately applied program rules and policies to make eligibility determinations.
• Maintained accurate and complete case files for assigned cases.
• Identified and reported suspected fraud or misrepresentation of information.

Client Support:

• Provided clear and concise information to applicants and recipients regarding program policies, benefits, and deadlines.
• Assisted clients with completing applications and forms, ensuring completeness and accuracy.
• Responded to client inquiries and concerns promptly and professionally.
• Developed positive rapport and built trust with diverse client populations.
• Offered referrals to other community resources as needed.

Data Management and Reporting:

• Utilized computer-based eligibility systems to process applications and maintain case records.
• Entered and updated data accurately and efficiently, ensuring data integrity.
• Generated reports and compiled statistics on casework activities and program outcomes.
• Monitored key performance indicators (KPIs) and identified areas for improvement.

Additional Responsibilities:

• Participated in ongoing training and professional development to stay informed of program changes and best practices.
• Maintained confidentiality of all client information in accordance with HIPAA regulations.
• Collaborated with other team members to achieve program goals and objectives.
• Contributed to a positive and supportive work environment.

Communication & Liaison:

• Served as a central point of contact for internal and external stakeholders, including healthcare providers, members, and naviHealth staff.
• Responded promptly and professionally to inquiries and requests via phone, email, and other communication channels.
• Escalated complex issues to appropriate team members for resolution.
• Facilitated communication and information flow between different departments and teams.
• Documented all interactions and communication accurately and efficiently.

Administrative Support:

• Processed and managed inbound and outbound data and communication (e.g., faxes, emails, electronic notifications, letters).
• Maintained accurate and complete member information in the naviHealth database and other platforms.
• Prepared and processed administrative documentation for member records, including enrollment, disenrollment, and transitions.
• Coordinated appointments, scheduling, and logistics for various activities.
• Performed general administrative tasks including filing, data entry, and reporting.

Data Management & Reporting:

• Entered and updated data into various databases and platforms accurately and efficiently.
• Extracted and analyzed data to generate reports and track key performance indicators (KPIs).
• Monitored and identified data discrepancies and errors, taking corrective action as needed.
• Contributed to the development and implementation of data management processes and standards.

Additional Responsibilities:

• Adhered to Optum's policies, procedures, and confidentiality guidelines.
• Participated in ongoing training and professional development to stay informed of industry best practices.
• Collaborated effectively with team members to achieve common goals and objectives.
• Demonstrated strong problem-solving and critical thinking skills.

Patient Interaction & Support:

• Provided compassionate and empathetic support to patients regarding their medical bills and financial concerns.
• Educated patients about insurance plans, benefits, and coverage limitations.
• Responded to patient inquiries and concerns promptly and professionally.
• Developed and presented financial counseling plans to patients, including budgeting and payment options.
• Negotiated payment arrangements and addressed hardship situations with sensitivity.
• Assisted patients with applications for financial assistance programs and charity care.
• Maintained patient confidentiality and adhered to HIPPA regulations.

Administrative & Financial Tasks:

• Processed insurance claims and verified patient eligibility.
• Collected copays, deductibles, and co-insurance payments.
• Posted payments and reconciled accounts accurately.
• Audited and researched billing discrepancies to ensure accuracy.
• Prepared reports and maintained records in accordance with departmental and regulatory requirements.
• Utilized various financial and healthcare software applications efficiently.

Additional Skills & Responsibilities:

• Strong communication and interpersonal skills, both written and verbal.
• Problem-solving and conflict resolution skills.
• Ability to work independently and as part of a team.
• Time management and organizational skills.
• Proficiency in Microsoft Office Suite and other relevant software.
• Understanding of medical terminology and billing practices.
• Commitment to patient confidentiality and ethical practices