Reina Cedeño

•Processing Post Retirement Death Workflows

• Sending requests for documents,

• Updating proof documents,

• Updating Tax and EFT elections,

•Working the function button to send to QU.

• Responding to call center workflows

• Required responses depend upon what the payee is inquiring about.

•Working incoming mail workflows

• Much like call center workflows the response depends upon the mail received.

• Demographic Change Workflows

• Sending requests to eligibility to get member/beneficiary/OIP information updated or corrected and confirming the request was completed correctly.

•Citizenship Approval Workflows

• Review record of payee that has moved outside the United States to determine if their tax withholding needs to change.

• Beneficiary Death Workflows

• Reviewing and closing beneficiary Death Workflows

•Reclamation Requests

• Complete paper request to have funds reclaimed from a member.

•Investigation Requests

• Sending paper request to Finance to investigate if an electronic payment was successfully received.

•Disability Recertifications and 85-90 Recertifications in Alternating years.

• Reviewed history records to determine benefit eligibility for services.
• Analyzed contracts and claim systems to apply appropriate benefit amounts
• Examined claims, records and procedures to grant approval of coverage
• Transcribed data to worksheets and entered data into computer to prepare documents andadjuar accounts
• Maintain and log certified mail, COB, eligibility spreadsheets using Excel
• Open, Date, stamp, sort , count and number, distribute incoming mail to the appropriate management staff within the Department
• Prepare , sort and deliver inventory to mail room
• Access Medical Claims(QNXT) and V3 to verify and record member eligibility, provider records and claim history
• Retrieve and distribute claim images from DMS Queues

• Pulling Medical Records for PCT's and Providers
• Collecting Medical Records from all floors at the beginning and end of the day
• Sending up next day appointment Medical Records to their respectful floors
• Sorting and Filing of Medical Records, lab reports, results and any other forms that need to be added to Medical Records
• Handling in and out request for Medical Records
• Answering phones daily
• Patient registration
• Prescription Refills
• Mail Sorting for all doctors
• Receiving of faxes on a daily bases
• Communicating with doctors daily by Electronic Medical Records.

• Supervising teenage resident girls 16-20
• Responsible for making sure residents follow curfew and house chores
• Preparing residents for college and housing opportunities
• Maintaining a safe and secure environment for the residents.

• Supervising youth ages 12-18
• Responsible for safety and well being of residents
• Accompany residents during outside activities.

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