Rosa Justo
Brooklyn
Summary
Bilingual professional with a background in healthcare and extensive customer service experience, skilled in building trusted relationships, educating clients, and resolving complex issues. Proven ability to assess individual needs, communicate complex information clearly, and deliver personalized solutions while consistently meeting performance goals. Strong analytical, problem-solving, and relationship-building skills, with a commitment to providing exceptional client experiences and helping individuals make informed decisions. Adaptable, results-driven, and eager to contribute to a client-focused organization while continuing to grow professionally.
Overview
1
1
Certification
11
11
years of professional experience
Work History
CS3
Maximus
New York
03.2023 - Current
- Guided customers through Medicaid eligibility, enrollment, renewals, and benefits processes, enhancing understanding and access to services.
- Assisted customers throughout the application lifecycle, from enrollment through benefit determination and ongoing eligibility.
- Educated customers on Medicaid policies, program requirements, covered services, and available community resources.
- Assisted individuals in completing healthcare applications and resolving issues related to eligibility and coverage.
- Investigated and resolved complex customer inquiries, collaborating with stakeholders to ensure timely and effective resolutions.
- Provided exceptional customer service to Medicaid members, applicants, and healthcare providers via inbound and outbound calls.
- Consistently achieved quality assurance, productivity, attendance, and customer satisfaction performance metrics.
- Collaborated with cross-functional teams to support customer needs and improve service delivery.
- Maintained compliance with HIPAA, privacy regulations, and company policies while safeguarding Protected Health Information (PHI).
- Supported special projects and outreach initiatives to enhance member engagement and increase program participation.
Case Investigator / Monitor
Unitedhealthgroup
New York
07.2020 - 12.2022
- Case Investigator refers to someone who will interview the case, elicit names and contact information of the contacts to be monitored, and provide guidance and resources to support people who are in isolation.
- They may also be the person who initially notifies a patient of a positive test result.
- Conducted investigations into healthcare claims and fraud allegations, ensuring adherence to regulatory standards.
- Collaborated with cross-functional teams to develop and implement investigation protocols and procedures, improving investigation efficiency.
- Analyzed data trends to identify compliance issues in healthcare services, enhancing oversight and accountability.
Front Desk Receptionist
SL TAX CENTERS
Brooklyn
01.2019 - 05.2019
- Greeted visitors, determined purpose of visit, and directed them to appropriate staff to ensure positive experiences.
- Schedule and confirm appointments for customers.
- Delivered customer service by answering phones and processing payments efficiently.
- Supported staff by providing information to the public, enhancing communication and service delivery.
- Performed daily tasks efficiently with the use of office equipment including computers, fax machines, copy machines.
Medical Assitant
HOSPITAL DR ARISTIDES FIALLO CABRAL
LA ROMANA
01.2016 - 01.2017
- Assessed the patient and participated in all aspects of care, including history and physical exams, diagnostic planning, and procedures.
- Took and recorded vital signs, including blood pressure and heart rate, to assist in patient assessments.
- Assisted patients with exams for more than 2,000 patients from over 600 families.
- Managed multi-line phone system, directing calls to appropriate staff and scheduling appointments for over 25 patients daily.
- Performed routine cleaning and maintenance of outpatient exam rooms, ensuring a hygienic environment by disposing of medical waste and organizing medical equipment.
- Observation and hands-on practice of EKG, ETC procedures with the orientation and supervision of a highly trained medical team.
Education
Doctor - MEDICINE
UNIVERSIDAD CENTRAL DEL ESTE
Dom Rep01-2018
Skills
- Eligibility determination support
- Medicaid eligibility verification
- EMR systems expertise
- Medical records management
- Patient care excellence
- Vital signs assessment
- Patient education
- Customer service optimization
- Client engagement strategies
- Client case coordination
- HIPAA compliance awareness
- Data entry accuracy
- Computer skills
- Cloud collaboration tools
- Multitasking efficiency
- Detail orientation
- Problem-solving skills
- Conflict resolution strategies
- Active listening
- Effective communication
- Organizational skills
- Verbal communication skills
- Bilingual proficiency
- Patient education
Personal Information
Authorized To Work: Yes
Certification
Primary care and Emergencies, Dominican Society of Otorhinolaryngology, 06/01/17, 06/30/17
Timeline
CS3
Maximus
03.2023 - Current
Case Investigator / Monitor
Unitedhealthgroup
07.2020 - 12.2022
Front Desk Receptionist
SL TAX CENTERS
01.2019 - 05.2019
Medical Assitant
HOSPITAL DR ARISTIDES FIALLO CABRAL
01.2016 - 01.2017
Doctor - MEDICINE
UNIVERSIDAD CENTRAL DEL ESTE