Ramona A. Bristo
Austin,TX
Summary
Seasoned professional with 10 years of experience in healthcare coordination and customer service roles, currently serving as a Care Coordinator II. Demonstrated expertise in insurance verification, medical recordkeeping, and data management, ensuring compliance with HIPAA regulations. Seeking to leverage strong organizational skills and patient-centered approach in a Care Coordinator position.
Overview
11
11
years of professional experience
Work History
Care Coordinator 2
Centene, Superior Health Services
Dallas, Texas
04.2024 - Current
- Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephonically or through home-visits and documents the plan for care/services of activities.Provides outreach to members via phone or home visits to engage members and discuss care plan/service plan including next steps, resources, questions or concerns related to recommended care, and ongoing education for the member throughout care/service, as appropriate.
Coordinates care activities based on the care plan/service plan and works with healthcare and community providers and partners, and members/caregivers to accommodate changes or progress, as needed.
Serves as support on various member and/or provider inquiries, requests, or concerns related to care plan/service plan.
Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care/service.
May support performing service assessments/screenings for members and documenting the member’s care needs.
Supports documenting and maintaining member records in accordance with state and regulatory requirements and distribution to providers as needed.
Follows standards of practice and policies compliant with contractual requirements and regulatory guidelines and standards.
Ability to identify needs and make referrals to Care Manager, community based organizations, and Disease Manager.
Provide education on benefits and resources available.
Performs other duties as assigned.
Complies with all policies and standards.
Program Coordinator
Dean’s Professional Services
Austin, TX
04.2023 - 04.2024
- Oversee and facilitate patient care coordination, ensuring effective communication between healthcare providers, patients, and insurance representatives to optimize care plans and resource utilization at Superior Health Plan Inc.
- Provides outreach to members via phone or home visits to engage members and discuss care plan/service plan including next steps, resources, questions or concerns related to recommended care, and ongoing education for the member throughout care/service, as appropriate
- Coordinates care activities based on the care plan/service plan and works with healthcare and community providers and partners, and members/caregivers to accommodate changes or progress, as needed
- Serves as support on various member and/or provider inquiries, requests, or concerns related to care plan/service plan
- Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care/service
- May support performing service assessments/screenings for members and documenting the member's care needs
- Supports documenting and maintaining member records in accordance with state and regulatory requirements and distribution to providers as needed
- Follows standards of practice and policies compliant with contractual requirements and regulatory guidelines and standards
- Ability to identify needs and make referrals to Care Manager, community based organizations, and Disease Manager
- Provide education on benefits and resources available
- Performs other duties as assigned
- Complies with all policies and standards
Senior Patient Service Representative
Livanta
05.2021 - 03.2023
- Managed patient inquiries and complaints, ensuring resolution and delivering exceptional customer service, while maintaining strict adherence to HIPAA regulations.
- Processed over 50 daily inbound calls, efficiently verifying insurance eligibility and documenting patient demographic information in an electronic medical record system.
- Collaborated effectively with team members to maintain program objectives, streamline processes, and facilitate access to accurate, up-to-date program data.
- Delivered knowledgeable support across multiple software applications and communication channels, consistently meeting or exceeding benchmarks for call speed, accuracy, and volume.
Prior Authorization Customer Service Representative
CVS Healthcare
02.2019 - 05.2021
- Responded to patient and family member inquiries, ensuring their needs were promptly addressed and resolved with empathy and efficiency.
- Managed sensitive information by obtaining necessary authorization for the release of medical records, maintaining confidentiality and compliance.
- Processed new enrollments and coverage requests efficiently, using specialized software and handling cases primarily via phone and occasionally fax.
- Coordinated with Clinical Pharmacists and Management to identify and rectify process issues, while also interpreting various forms of professional documentation and adhering to regulatory standards.
Event Coordinator
Big Luthas BBQ & Catering
01.2014 - 02.2019
- Managed comprehensive event planning tasks, including booking reservations, securing transportation, and venue acquisition to ensure seamless execution of corporate luncheons, dinners, conferences, and special events.
- Fostered partnerships with sponsors and hosts, effectively promoting and coordinating events to meet organizational objectives and client expectations.
- Maintained open and effective communication with clients to resolve service issues and guarantee satisfaction, while orchestrating event production in conjunction with internal teams.
Education
Associate of Arts - Liberal Arts and General Studies
Austin Community College
Austin, TX08.2023
Certified Electronic Health Records Specialist - Electronic Health Records Specialist
Central Texas Allied Health Institute
Austin, TX06.2022
Skills
- Catering Coordination
- Communications
- Recordkeeping and Data Input
- Ability to Type 40 WPM
- Time Management
- Strong Interpersonal Skills
- Critical Thinker
- Strong Problem Solver
- Customer Service-Oriented
- AS400 System
- RXClaims
- MHK
- PeopleSafe
- LexisNexis
- Works Well Independently
- Medical Recordkeeping
- Organizational Skills
- Insurance Verification
- Multitasking
- PPE Use
- Patient Interviewing Skills
- Typing 45 WPM
- Office Administration
- Scheduling Appointments
- Microsoft Office
- Good Work Ethic
- Program Setup
Timeline
Care Coordinator 2
Centene, Superior Health Services
04.2024 - Current
Program Coordinator
Dean’s Professional Services
04.2023 - 04.2024
Senior Patient Service Representative
Livanta
05.2021 - 03.2023
Prior Authorization Customer Service Representative
CVS Healthcare
02.2019 - 05.2021
Event Coordinator
Big Luthas BBQ & Catering
01.2014 - 02.2019
Associate of Arts - Liberal Arts and General Studies
Austin Community College
Certified Electronic Health Records Specialist - Electronic Health Records Specialist
Central Texas Allied Health Institute