ROCIO FERGUSON
Fullerton,CA
Summary
Highly individual with skills and experience make me an ideal candidate for a bilingual sales support representative position on the sales team, excellent communicator with in-depth expertise in Microsoft Excel, OneNote, Word, PowerPoint, Mkh, MARx, and Aves. Dedicated to completing patient assessments, HRAs and care plans in a timely and accurate manner, working effectively with Medical Groups UM teams to achieve results.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Care Coordinator HSC
SCAN HealthPlan
07.2023 - Current
- Develop individualized care plan - HRA for new and existing member
- Deliver ongoing care coordination/care management by navigating an referring to the appropriate care.
- Complete timely and accurate manner documentation in multiple computer systems to record assessments and progress notes
- Enhanced my skills by participating in a CRTT/COC team in case conferences and training.
- Completed and Certified - Mental Health First Aid USA, expires 3/29/2027.
- Adhere to all quality, compliance and regulatory standards.
- Strong interpersonal, critical thinking, with positive communication to members.
- Excellent organization skills, decision-making and multi-tasking.
- Used company software and databases to maintain records of services performed and patient conditions: MhK, IKA Claims.
Enrollment Bilingual Coordinator
SCAN HealthPlan
03.2021 - 07.2023
- Strong working knowledge of Medicare and Medicaid.
- Assisting Brokers/Agents with CMS guidelines.
- Respond Enrollment Inbox about 70 -100 emails to internal and external clients.
- Research and updating eligibility discrepancies or errors in accordance followed guidelines CMS Chapter 2.
- Documented all communication with applicants and inputted information into system using [Gateway and IKA Claims.
- Used IKA Claims/Gateway and Microsoft Excel/Word, PowerPoint, Access.
- Updating members demographics.
- Resolve member inquiries on late enrollment penalties (LEP), LIS, BAE.
- Process enrollment application - electronic, paper,
- Prepare daily basis - Follow-up/denials, Venture MA-OEP, DSNP-CSNP reports.
- Work Dental application/trigger enrollment letters.
- Process dental withdrawal and disenrollments.
- Organized and detail-oriented with strong work ethic.
- Skilled at working independently and collaboratively in team environment.
- Proven ability to learn quickly and adapt to new situations.
Quality Performance Auditor
Optum Rx
07.2008 - 07.2017
- Provided onsite training on Quality guidelines to new employees, and developed reports to improved employee performance.
- Audited HIPPA violation to prevent possible fraud.
- Trained as Subject-Matter Expert.
- Collaborated with black belts teams to increase productivity,
- Assisted members ordering their refills, request new prescriptions, and initiating prior authorization, formulary verification.
- Lead “Employee Engagement Quality Day” project for four consecutive years to 400 employees to enhance productivity.
- Awarded as Performance Award and Innovation for two consecutive years [creating training modules and check list forms]
- Trained employees Basic Excel thru Virtual Class (WebEx).
- Review and audited claims following CMS guidelines for three years.
- Assisted translating documents and call [English to Spanish]
- Created PowerPoint presentations for business development purposes.
- Supported efficient meetings by organizing spaces and materials, documenting discussions and distributing meeting notes.
- Developed, updated spreadsheets and databases to track, analyze and report on performance.
- Interacted with vendors, contractors and professional services personnel to receive orders, direct activities and communicate instructions.
Education
PowerPoint certificate -
ABC Adult School
Cerritos, CA2014
Medical Terminology - Medical Terminology
ABC Adult School
Cerritos, CA05.1997
Excel Beginning and Advance – Certificate -
ABC Adult School
Cerritos, CA1996
Word Advance -
ABC Adult School
Cerritos, CA1996
Bilingual Administrative Assistant - Administrative Assistance And Secretarial Science
Simon Bolivar Technical School
Quito-Ecuador06.1986
Skills
Enrollment Assistance -MARx, AVES
Medicare and Medicaid knowledge
Bilingual, Spanish-English
Multi-Tasker
Call Center Customer Service
Self Starter
Administrative Support
Microsoft Office, IKA, MHk
Flexible
Certification
Certificate Mental Health First Aid USA 3/2024-ScanHealthplan
Languages
Spanish
Native or Bilingual
Timeline
Care Coordinator HSC
SCAN HealthPlan
07.2023 - Current
Enrollment Bilingual Coordinator
SCAN HealthPlan
03.2021 - 07.2023
Quality Performance Auditor
Optum Rx
07.2008 - 07.2017
PowerPoint certificate -
ABC Adult School
Medical Terminology - Medical Terminology
ABC Adult School
Excel Beginning and Advance – Certificate -
ABC Adult School
Word Advance -
ABC Adult School
Bilingual Administrative Assistant - Administrative Assistance And Secretarial Science
Simon Bolivar Technical School
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