Vanessa Saenz
Summary
Developed management skills in collaborative and fast-paced environment, focusing on team leadership and operational strategies. Seeking to transition into new field where these skills can be applied to drive efficiency and success. Dedicated to adapting and thriving in diverse professional settings.
Overview
17
17
years of professional experience
Work History
CES Manager- Enrollment & Outreach Operations
Pairteam Inc
11.2023 - Current
- Lead a team of 21 community engagement specialists who support the daily enrollment and outreach operations
- Ensured team efficiency: enrollment of 50% conversion and 85% retention
- Guided the team to meet KPI's, by setting clear objectives, monitoring performance, and coaching
- Ensured the team was meeting the Medicaid and Medicare health plan process and contractual obligations (LA Care, Healthnet, Molina, IEHP, Community Health Group CHG, Health Plan of San Joaquin, Alameda Alliance of Health, Central California Alliance Health CCAH)
- Maintained collaborative relationships with partners such as clinics, community based organization and health plan/payers
- Maintained a strong motivated team with high morale.
- Built trust with assigned referral coordinators, billing department and care team support
- Completed daily QA of patients charts to ensure accurate billing for outreach and encounters
- QA of accurate data entry
- Provide 1:1 management and coaching and daily team check ins
- Complete daily/weekly QA audits of team work to ensure high quality patient care
- Act as first point of contact for escalations and troubleshooting
- Assist with development and implementation of new hire and ongoing trainings assist with the team interview and onboarding process as hiring manager
- Own the upkeep and auditing of assigned Health plan SOPs
- Responsible for employee attendance and conduct performance evaluations, through Ripping
CES Lead- Enrollment & Outreach Operations
Pairteam Inc
03.2023 - 11.2023
- Conduct team meetings: daily, weekly and bi-weekly to update on team performance and metrics
- Monitor dashboards daily to ensure the team is meeting KPI's and metrics are trending in the right direction. 1200 submissions and 15000 calls
- Provide consistent updates on funnel stages including delays and blockers to Manager
- Conduct QA on calls and engagement documentation for billing purposes
- Assisted with onboarding new hires
- Reviewed determination letters and communicated health plan decisions to patients and informed them of the option to appeal decisions
- Collaboratively worked with billing to reconcile billing discrepancies, insurance verification and eligibility
- Submit authorization requests for ECM services using plan codes
Community Engagement Specialist (CES) - Enrollment & Outreach Operations
Pairteam Inc
07.2022 - 03.2023
- Identify viable patients to outreach using health plan rosters
- Verified patient insurance eligibility and entered patient information into system.
- Submit referrals and authorizations to health plans portals (LA Care, Healthnet, Molina, IEHP, Community Health Group CHG, Health Plan of San Joaquin, Alameda Alliance of Health, Central California Alliance Health CCAH)
- Monitor referral status for approval and rejections
- Maintain a collaborative relationship with partnerships
- Enhanced patient experience by coordinating timely and efficient referrals to healthplans for approvals
- Verified patient insurance eligibility and entered patient information into system.
- Served as a liaison between patients, providers, and insurance companies during the referral process, addressing any concerns or questions that arose along the way.
Sr Manager
Cherokee Federal
05.2021 - 10.2021
- Company Overview: Team Hope Shelter for Unaccompanied minors Department of Health and Human Services project
- Oversaw discharge operations and ensured safe and timely release of Unaccompanied youth and families
- Oversaw and managed the daily operations of the case management department, ensuring efficient and effective family reunification's
- Led a team of 75 case managers, providing guidance, training, and support to ensure youth and family safety
- Implemented performance metrics and tracking systems to monitor individual and team performance, leading to accurate security checks
- Collaborated with interdisciplinary teams to develop comprehensive care plans for youth and families, addressing their medical and social needs
- Established strong relationships with stakeholders such as DHHS and community hospitals to ensure transitions of care for youth and families
- Conducted regular audits of documentation processes to ensure accuracy, completeness, and adherence to legal requirements
- Provided ongoing education/training opportunities for staff members on best practices in family reunification and case management
- Collaborated with healthcare providers across different specialties/units/departments within the organization on complex cases requiring multidisciplinary coordination
- Conducted regular performance evaluations for case management staff and counselors, providing constructive feedback and identifying areas for growth
- Team Hope Shelter for Unaccompanied minors Department of Health and Human Services project
Case Manager/Unaccompanied Minors- Family Reunification
Insight Global
05.2021 - 10.2021
- Conduct initial assessments/interviews with youth and contact family to obtain information (face to face)
- Assess youth to identify needs and services to develop individualized services plans
- Identify youth's case category for placement or sponsor identification
- Submit cases to ORR for release requests
- Complete SIR reports and other documentation related to the treatment and progress of UC's in the program and report to ORR
- Assist in audits, reviewed remanded files and reported findings/case updates to Director of Case management
- Assist/train other case managers with case assessments and completion of documentation
- Assisted as needed and directed by Director of Case Management
- Sheltered unaccompanied migrant children at the Pomona Fairplex
- Connected children with their families in the U.S
- Provided compassionate care for the children
- Kept the children safe and under supervision
Immigration Case Manager
The GEO Group, Inc.
07.2016 - 05.2021
- Meeting with participants in person and telephonically, regularly as required by government contractual obligations
- Conducting intake interviews and orientation sessions with each ISAP Program Participant within contractual timeframes
- Provide direct supervision and report to Department of Homeland Security for case load of up to 225 adults and families
- Enroll and interview assess new participants for mental health, essential needs and provide crisis support
- Provide extensive case management supervision: assess living conditions, essential needs, and conduct compliance/welfare checks
- Assess the needs and vulnerabilities of participants, and connect them with appropriate resources within the community (housing, social/community supports and mental health)
- Developing and maintaining accurate and complete case records for all program participants for Department of Homeland Security and court proceedings
- Assisting Program Participants with acquiring travel documents from the countries of origin
- Evaluating English proficiency of ISAP Program Participants to determine resources necessary to promote clear communication between ISAP staff and the participants
- Maintain monitoring device in working order by troubleshooting or providing maintenance as needed
- Report tampering of monitoring device to local Deportation Officer
- Provide referrals/resources to the Participants to be stable in the community
- Notify Department of Homeland Security of participant termination/transfers/violations
- Report arrest to Department of Homeland Security
- Conduct inmate search
- Develop and maintain accurate and complete case records for all supervision program Participants from entry to release, maintaining confidentiality of all records
Office Supervisor - Unaccompanied Minors
David and Margaret YFS
01.2011 - 06.2016
- Coordinate and supervise residential office support staff
- Prepare monthly school lunch meal report for district
- Accountable for timely delivery of quality reports to DCFS and Probation to ensure timely payments
- Track residential admissions and discharge to prepare monthly billing statement for DCFS and LA County Probation
- Responsible for employee attendance through Paycom database
- Work alongside with Intake/Admissions department to prepare and maintain residential files
- Interpret/Translate for families, Mental Health Dept and case managers during decision making meetings
- Request, coordinate, type and review residents' initial/quarterly/ discharge reports-Needs and Service Plans for court purposes
- Review and maintain court records in residential files
- Record minutes for meetings
- Update Manual/Policy book as needed, Create and revise agency forms
- Prepare days of care schedule, daily census report, monthly occupancy reports
- Notify staff of resident discharge/transfers
- Maintain resident records according to HIPPA
Case Manager/ Counselor Unaccompanied Minors
David and Margaret YFS
01.2011 - 06.2016
- Maintain policy and procedure manual up to date
- Supervised and trained new Care Counselors according to policy
- Assisted with identifying qualified sponsors and family reunification
- Intake support/Admission support: conduct interview and orientations
- Conduct initial and weekly assessment and provide updates to Program Director/ORR
- Administer annual audits and assist in year around community care licensing investigations
- Assess for mental health needs as necessary and serve as crisis intervention/support
- Created customized needs and services plans for each UC's based on needs
- Develop, plan and initiate methods of exposing clients to healthy lifestyle activities designed to alter former lifestyles, attitudes and other negative behavioral patterns
- Completed daily client notes, SIR reports and other documentation related to the treatment and progress of UC's in the program and report to ORR
- Maintained a clean, safe and well organized environment for minors and staff
- Attended and participated in meetings regarding UC's case
Optical Technician
US Vision Optometry
04.2008 - 12.2010
- Completed billing and coding functions on a daily basis and verified insurance eligibility
- Explain deductible and financial responsibility to the patient
- Filed claims with vision and medical insurance companies to garner payment for optical services.
- Ensured accuracy in billing practices by verifying insurance information for each patient encounter.
- Schedule/Register patients
- Supported company objectives with consistent performance meeting or exceeding sales targets on a regular basis.
- Assisted with insurance questions, eligibility, and prior authorizations of glasses.
Education
Bachelor of Science - Criminal Justice
La Verne Ca
12-2010
Skills
- Case management
- Skilled in intake interviewing
- Team leadership
- Case documentation
- Cross-functional collaboration
- Training and coaching
- Counseling
- Recordkeeping skills
- Data-driven decision making
- Operations planning
- Quality and compliance
- Referral coordination
- Dispute resolution
- Accuracy and precision
- Insurance verification
- Patient account management
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
CES Manager- Enrollment & Outreach Operations
Pairteam Inc
11.2023 - Current
CES Lead- Enrollment & Outreach Operations
Pairteam Inc
03.2023 - 11.2023
Community Engagement Specialist (CES) - Enrollment & Outreach Operations
Pairteam Inc
07.2022 - 03.2023
Sr Manager
Cherokee Federal
05.2021 - 10.2021
Case Manager/Unaccompanied Minors- Family Reunification
Insight Global
05.2021 - 10.2021
Immigration Case Manager
The GEO Group, Inc.
07.2016 - 05.2021
Office Supervisor - Unaccompanied Minors
David and Margaret YFS
01.2011 - 06.2016
Case Manager/ Counselor Unaccompanied Minors
David and Margaret YFS
01.2011 - 06.2016
Optical Technician
US Vision Optometry
04.2008 - 12.2010
Bachelor of Science - Criminal Justice
La Verne Ca
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