Vanessa Bernal
Huntington Park,CA
Summary
Over ten years of professional experience working in the healthcare industry, providing advocacy, education, and assistance to individuals. Meet and exceed my current department standards, by working and building relationships with colleagues, while creating a positive work environment. Pursuing a new career goal where I can grow professionally, and apply my current knowledge, experience and abilities.
Overview
12
12
years of professional experience
Work History
Customer Solution Center Member Navigator
L.A. Care Health Plan
09.2015 - Current
- Handle and coordinate the identification, documentation, investigation, and resolution of complex cases in a timely manner.
- Provide coordination of care for complex cases which may involve benefit coordination, continuity of care, access to care issues, quality of care issues, Member eligibility and assignment.
- Identify and triage cases to our Compliance Department. regarding suspected fraudulent activities.
- Communicate with collection agencies, billing business offices, regarding delinquent and problematic Member accounts due to claims issues.
- Work with Cultural and Linguistics Department to provide translation to Member's correspondence into the appropriate languages, process interpreter requests for in person and telephonic appointments.
- Process disenrollment requests from Members, Providers, Internal Departments, and Plan Partners.
- Handled inbound calls and provide assistance via our Escalation queue.
- Stationed and available to to provide support to Members at designated LA Care Community Resource Centers and HQ Walk in Center.
- Support Community Resource Centers in events and activities.
Member Service Representative L.A. Care Covered
L.A. Care Health Plan
09.2013 - 09.2015
- Answered calls, web inquiries, and TTY/TDD request's from Members, potential Members, Providers, and Agents.
- Assisted Members in registering in L.A. Care Covered's Member portal and account maintenance.
- Provided back up support for Call Center Supervisors via Supervisor queue and handled escalated calls.
- Processed premium payments using Benaissance, Velocity, and Pay Near Me payment systems.
- Assisted Providers in verifying Member eligibility and benefits.
Member Services Representative
L.A. Care Health Plan
10.2011 - 09.2013
- Provided explanation of benefits for all Product Lines of Business: Medical, Medicare, Healthy Kids, PASC-SEIU.
- Processed PCP and Plan Partner transfers.
- Verified eligibility for Plan Partners, Providers, and Members.
- Processed Member requests for ID Cards, Welcome Packets, Evidence of Coverage (EOC), Provider Directory.
- Troubleshoot and directed calls to appropriate departments (i.e. Provider Network Unit, Claims, Membership Liaison, Direct Response Unit, Utilization Management, Pharmacy)
Education
High School Diploma -
Ford Park Adult School
Bell Gardens06.2007
Skills
- Excellent communication skills, oral and written
- Bilingual, English and Spanish
- Outstanding customer service skills (in-person and telephone calls)
- Computer literate; Microsoft Suite, and internal software programs ( QMEIS, QNXT, CCA, Syntranet)
Timeline
Customer Solution Center Member Navigator
L.A. Care Health Plan
09.2015 - Current
Member Service Representative L.A. Care Covered
L.A. Care Health Plan
09.2013 - 09.2015
Member Services Representative
L.A. Care Health Plan
10.2011 - 09.2013
High School Diploma -
Ford Park Adult School
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