Pui Ying Au
Jamaica,NY
Summary
Friendly and engaging team player. Detail oriented and experienced in audits for non-financial Operational process for internal employee and vendors to ensure compliances with policies, procedures, and quality standards.
Overview
20
20
years of professional experience
Work History
Network Coordinator
Oscar Health Insurance
New York, NY
06.2025 - 12.2025
- Facilitated cross-collaboration on problem definition, acute error remediation, and root cause solution development.
- Cultivated trusting relationships with internal and external stakeholders through strategic communication and collaboration.
- Managed provider database accuracy by ensuring timely updates in credentialing and compliance with regulatory standards.
- Spearheaded collaboration with senior team members to address provider inquiries and resolve contract and service-related issues.
- Documented provider feedback and concerns to enhance process efficiency and communication materials.
- Coordinated communication between internal teams and external stakeholders to ensure alignment on network strategies.
Operational Audit - Quality Assurance Auditor
Healthfirst Health Plan
New York, NY
08.2017 - 06.2025
- Performed detailed evaluations of health plan operations, focusing on compliance with established regulatory standards.
- Designed and enforced quality assurance standards aimed at improving service delivery outcomes.
- Assisting with interpreting Clinical Care Manager call handling, and outsourced vendors (EyeMed, Nation Hearing, CVS, Modivcare) to ensure compliance with polices, procedures and quality standards.
- Perform routine random/target audits of operational process (e.g. Call Center, Enrollment/Terminations, Invoicing/ Dunning Letter, Member/Provider Notification, Sales/Retention, etc.) across multiple lines of business and products ( Medicaid, CHP, EP/QHP, Commercials).
- Ensured employee compliance with company policies and state and federal regulations.
- Conducted thorough investigations and audits to analyze root causes, driving process improvements and performance enhancements.
- Identified quality issues in operational efficiency and production goals to drive continuous improvement initiatives.
- Ensured adherence to established time frames and performance standards for quality and quantity of work.
- Performed compliance audits to uphold adherence to contracted and regulatory guidelines for member and provider accounts.
- Evaluated accuracy and efficiency of current training materials to enhance learning outcomes.
- Ensured compliance with HIPAA guidelines while safeguarding confidentiality of employee, member, and provider medical information.
Senior Health Partner - Medical Record Coordinator
Healthfirst Health Plan
New York, NY
03.2016 - 08.2017
- Performed quality checks to maintains the integrity of events and criteria for reporting purposes. Processed members' electronic documents proof data for inaccuracies or missing information.
- Resolved discrepancies identified using standard procedures and/or returning incomplete documents to their respective departments for correction and resolution.
- Responded and Coordinated field assignments for Interpreters by checking availability and assigning staff as appropriate , taking location into consideration.
- Facilitated manual mailings for Clinical Services.
- Provided environment support of items and various forms for Intergraded Products
- Provided administrative support to Care Management Clinical Eligibility Team including Date Entry for outsourced assessment, validating invoices, project tracking and attaching documents into various Electronic Information System (EIS) included CCMS.
Carvel Ice Cream - Store Owner
Carvel Ice Cream Store
Valley Stream, NY
12.2013 - 03.2016
- Managed daily operations, ensuring high customer satisfaction and efficient service delivery.
- Handled and supervised all the daily process and activities that are carried out in the store.
- Monitoring six staff's training and schedule, product inventory, store presentation, sales volumes and closing.
- Responding to customers comments and complaints.
- Managed cost control, budgeting, Total P&L accountability, weekly inventory control.
- Award: Carvel - Top Year over Yea Gallon Performance 2015 (Increased 70% of sales from 2014)
PHSP Enrollment Senior Representative
Healthfirst Health Plan
New York, NY
02.2013 - 12.2013
- Executed daily loading of membership rosters and files from HRA, ensuring accurate data management.
- Updated member eligibility in MHS request from Member Services or another departments through MACESS.
- Managed daily operations with expertise in regulatory compliance and auditing processes.
PHSP Enrollment - Quality Improvement Auditor
Healthfirst Health Plan
New York, NY
06.2009 - 02.2013
- Responsible for understanding and accurately applying the requirements for application submission for each product lines and administering an inspection of the application, documents and information submitted for successful processing.
- Conducted annual state CHP Audit utilizing Healtfirst's products, policies and procedures.
- Handle daily work with knowledge's of regulatory policies and procedures and how to affect the enrollment and auditing process.
- Audited enrollment application received monthly all products line.
PHSP Member Service Representative
Healthfirst Health Plan
New York, NY
04.2007 - 06.2009
- Responded to inbound calls, providing assistance with deferral advertising and addressing general inquiries from PHSP members.
- Scheduled home appointments for clients to facilitate on-site assistance. Coordinated referrals for members requiring in-person support.
- Managed daily operations utilizing Healthfirst system expertise to deliver accurate benefits and service information to members.
- Assisted in managing special project for 15 days policy. Collaborated with clients and sales manager to gather missing documents and finalize application process.
Patient Representative
Charles B Wang Community Health Center
Flushing, NY
04.2006 - 01.2007
- Registered patients into different department (Internal Medicine, Pediatric Care, Women Health and Mental Health etc)
- Verified insurance, eligibility, PCP for patients, Discharged patients and schedule future appointments. Assisted patient in completed forms.
- Answered and directed inbound and outbound telephone calls, and input patients date into EMR.
Education
Bachelor of Science - Geography
Hunter College
New York, NY01-2006
Bachelor of Arts - Chinese Language Literature
Hunter College
New York, NY01-2006
Skills
- Customer support
- Microsoft Office/Google Suite
Timeline
Network Coordinator
Oscar Health Insurance
06.2025 - 12.2025
Operational Audit - Quality Assurance Auditor
Healthfirst Health Plan
08.2017 - 06.2025
Senior Health Partner - Medical Record Coordinator
Healthfirst Health Plan
03.2016 - 08.2017
Carvel Ice Cream - Store Owner
Carvel Ice Cream Store
12.2013 - 03.2016
PHSP Enrollment Senior Representative
Healthfirst Health Plan
02.2013 - 12.2013
PHSP Enrollment - Quality Improvement Auditor
Healthfirst Health Plan
06.2009 - 02.2013
PHSP Member Service Representative
Healthfirst Health Plan
04.2007 - 06.2009
Patient Representative
Charles B Wang Community Health Center
04.2006 - 01.2007
Bachelor of Science - Geography
Hunter College
Bachelor of Arts - Chinese Language Literature
Hunter College