Vanessa Gutierrez

Screen and evaluate healthcare members for state program eligibility, specifically Medicare, Medicaid, and SNAP, to facilitate access to essential assistance programs. Responsible for partnering with advocates to prepare, review, and audit all mandated application forms and supporting documentation prior to submission to state agencies. Manage the high-volume exchange of verifications and provide technical guidance on state-specific requirements to ensure application packets are comprehensive, accurate, and ready for official state review.

Initiate and maintain proactive follow-up with both members and government agency caseworkers to prevent bottlenecks and ensure the timely processing of all documentation. Leverage a background in Medicare Advantage and Medicaid case management to navigate complex regulatory systems, troubleshoot obstacles, and advocate for successful member enrollment. Provide comprehensive oversight of the application lifecycle, from initial screening to final agency approval, to reduce administrative barriers and secure vital benefits for the members served.

• Screen and evaluate members for state programs while assisting with the completion and filing of all necessary applications. Initiate and maintain proper follow-up with members and government agency caseworkers to ensure timely processing and completion of all mandated applications and accompanying documentation. Act as a primary liaison between members and state agencies to troubleshoot obstacles, verify document accuracy, and ensure successful enrollment in eligible benefit programs.

• Daily tasks include handling bilingual inbound/outbound calls to assist Medicare and Medicaid Managed Care Plan Members determine which benefit(s) best suit them and assist them through the enrollment process. Assistance with Community programs (transportation, meals, energy discounts), Medicare Savings Program, Medicaid, and Veteran’s coordination of care. Also ensuring a high level of service and satisfaction while matching members needs to products and services.

• Led, mentored and trained up to 10 wait staff professionals engaged in providing exceptional customer service for patrons of this high-volume, fast paced restaurant. Assisted manager in developing employee schedules. Committed to guest satisfaction and developed an ongoing relationship with guests; responded to patron concerns with tact and professionalism.

• Assist current members, providers, plan sponsors in describing the benefits and coverage associated with different types of health care plans and describe exclusions and non-covered treatments. Interpreting the terms of individual policies and comparing different covered treatment options. Responsible for learning about the specific nature of the pre-authorization request, investigating policy coverage and fully explaining the findings to callers. Facilitate the process of providing a letter confirming authorization for services and verifying coverage to a member’s health care provider. Provide claim status and payment information for callers requesting such information. Respond in a timely fashion to email correspondence from providers, members requesting benefit or claim information.

• Responsible for assisting bus drivers on a daily basis with special needs students. Job duties included, transporting the children from home to school and ensuring their safety. Safety measures included fastening seat belts, and making sure the kids were not harming each other. Monthly fire exit routines were also performed, in case a fire would ever take place. I also had to take row calls before the children would load the bus, and after the children were dropped off at school. In some cases, I would speak to the parents and teachers to keep them up to date on their child’s behavior.

• Assisted program manager with all aspects of program management. Facilitated and delivered effective product and system training to incoming TSR’s. In addition, provided refresher training and revised policy and regulatory training. Assist in TSR development through monitoring to ensure Telerx goals and client goals were met.

• Supervised up to fifteen customer service representatives engaged in providing outstanding customer service for a high call volume program. Assisted in creating and implementing daily, weekly and monthly tracking which measures profitability, outage, attendance, performance metrics and employee schedule adherence. Analyzed daily and monthly reporting to ensure client expectations were met and or exceeded. Maintained the highest level of quality through daily monitoring and data integrity audits. Provided feedback and performance action plans to team members to ensure they were meeting goals and showed individual progress. Investigated pending cases or escalated issues and forwarded them via email to proper points of contacts for further review. Daily maintenance of the filing system which included: reporting, personal and training files.

• Guided, assisted up to twelve team members with providing excellent customer service to consumers with technical support issues due to equipment failure, troubleshooting via satellite and other resources available, handled routine and escalated phone calls on a daily basis. Conducted training in conjunction to technical support, programming, equipment sales and ensured accuracy of knowledge and data entry. Assisted supervisor with call monitoring and coaching sessions.

• Served food to consumers at designated tables or counters and/or catered function, arranged food for serving, cleaned counters, equipment and general work.