Norma Avila

• Submit renewal Medicaid recertification applications to Health and Human Services for yearly Medicaid benefits
• Prepare and submit emergency Medicaid applications for undocumented individuals' coverage for say while hospitalized
• Utilize system application to view and retrieve production reports
• Use Claims 2 billing system to submit monthly services rendered by physicians to individuals for reimbursement by Medicare
• Participate in Department of Justice (DoJ) visits by assisting with department audits
• Advise staff of medical durable equipment available for individuals
• Contact guardians for current guardianship letters
• Prepare and distribute monthly status and guardianship reports.

Respond to high volume of routine to complex calls regarding products and services.

• Calmly attempt to resolve and de-escalate any issues.

• Managed requests for assistance and/or possible processing of credit card transactions.

• Upsell products and services

• Answered over 100 calls, while conducting initial assessments to determine the appropriateness of eligibility for services
• Obtained pertinent demographic, insurance and financial information while simultaneously entering data into the system with attention to detail and accuracy
• Contacted health care providers for supporting documentation on patient diagnosis, as required by Medicaid.

• Facilitated coordination of care to the home setting to prevent hospital readmission
• Increased customer satisfaction by achieving daily customer inquiries, concerns, and providing members with community related programs
• Reassigned high-risk members to clinical, non-clinical support, or department representative for further assistance.

• Managed over 100 calls, while confirming insurance eligibility, and scheduling dialysis office visits
• Acquired documentation for admission requests and delivered accordingly
• Liaison for discharge planners, clinic managers, and social workers.