Veronica Alexandra Echeverri

• Handled inbound and outbound customer service calls related to scheduling and sales inquiries.
• Addressed patient inquiries in alignment with ChenMed core care model.
• Conducted follow-ups with patients to assess service satisfaction and resolve issues.
• Made timely decisions adhering to departmental standards and policies.
• Documented all interactions accurately using web-based technology.
• Provided prompt, accurate service to maintain strong business relationships and loyalty.
• Collaborated with cross-departmental teams to enhance VIP customer service experiences.
• Executed additional duties as assigned by management.

The Bilingual Grievances & Appeals Representative 3 manages client concerns by conducting and responding to complaints, grievances and appeals in a consistent fashion, adhering to all regulatory, accreditation and internal processing timelines. Collect, analyze, and interpret trend information to address and resolve non-routine business-related concerns.

Responsibilities consist of

• Reviewing customer complaints
• Outreach to providers and members
• Customer conflict resolution
• Conflict prevention
• 1 or more years of experience in a telephonic customer service environment
• Strong data entry skills
• Experience with Microsoft Word, Excel & Outlook
• Fully Bilingual English/Spanish. Able to speak, read and write in both languages without limitations or assistance.
• 1 year of grievance and appeals experience
• Experience with Medicare
• Experience working with the geriatric population
• Experience in a production driven environment
  

The Call Quality Professional 1 monitors and evaluates the quality of inbound and/or outbound customer service calls. Documents quality issues and performance measures. The Call Quality Professional 1 work assignments are often straightforward and of moderate complexity. Reviews documentation to assess that appropriate system entries have been thoroughly completed to mitigate risk associated with external audit reviews.

Responsible for driving accuracy and quality assurance, compliance to all established policies and procedures, and sound documentation for all activities. Serve as a subject matter expert and make process recommendations.

Responsibilities consist of:

• provides information to assist in the feedback and formal education process of individuals on the phone.
• May assist in the development of monitoring standards.
• May act as subject matter expert. Understands own work area professional concepts/standards, regulations, strategies and operating standards.
• Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.
  

• Gathers complete patient information accurately and enters into the patient electronic medical record (EMR).
  
• Verifies insurance eligibility, benefits coverage, patient financial responsibility, and requests prior authorizations (where indicated per health plan contract terms) prior to processing order.
  
• Manages patient documents promptly and accurately received in the patient EMR.
  
• Processes orders in a timely manner to meet customer expectations and health plan service level agreements.
  
• Obtains necessary information and enters data into patient EMR to ensure compliance with state and federal regulatory agencies and ACHC standards.
  
• Communicates, coordinates, and documents referrals with outside pharmacies and referral sources.
  
• Understands diversity of contracts to handle referrals in a timely manner to meet health plan SLAs.
  
• Coordinates the start of care with the patient/caregiver, referral source, and other providers of care.
  
• Coordinates time of initial delivery.
  
• Cancels Pending/No-Go referrals when appropriate.
  
• Documents patient related activities/information in the patient’s EMR.
  
• Consults with other company personnel on difficult or unusual referrals, as appropriate.
  
• Works with pharmacy billing to assure prior authorization tracking and receipt occurs.
  

Responsibilities Consist of dependent on the size of the branch,  Specialist responsible for part or all of the following:

• Carrying out the day to day personnel recruiting, paraprofessional scheduling and general office functions of the 6 branches Coral Gables, Ft Lauderdale, Pompano, West Palm Beach, Boca, Jupiter. 
• Scheduling ensures that requests for homecare service are filled promptly , and scheduled into computer in a timely manner. Ensures that homecare schedules are complete and accurate in computer reviews santrax records daily to ensure that all staff are at clients as scheduled. 
• Follows up immediately on any discrepancies. Reviews all scheduled homecare daily in preparation for payroll, and billing approvals by manager reports any client or staff issues to supervisor promptly. 
• Performs initial phone screening with potential applicant per Humana at Home-SeniorBridge guidelines Ensures that all required pre-employment documentation is completed by prospective candidates per company hiring guidelines and accurately data enters the information into Rosalind system.
• Schedules, coordinates and performs administrative portion of orientation for approved candidates. 
• Data enters all information for new paraprofessional hires into Rosalind and maintains the Associate's physical employee file as appropriate.
• Managed the schedules and payroll of a team of HHA/ CNA / RN/ LPN personnel.

Daily responsibilities consist of:

• Scheduling meetings and data entry.
• Efficiently utilizes calendaring software to schedule and track individual appointments and group meetings.
• Able to send confirmations and cancellations electronically; regularly update the system to ensure current information is always available.
• Performance Improvement and HEDIS Department monthly reports consist of editing and splitting reports individually to various groups of providers that pertain confidential member information.
• Specific emails created to send individually to providers with a secure notification to prevent privacy breaches. 
• Working closely with the Quality Department started new PPO Virtual Project alongside the QIN team, was provided to learn more detail around the HEDIS measures and the necessary activities needed to close member open gap's. 
• Work on increasing volume of calls on a monthly basis.
• Role requires to validate understanding and if not ask questions to leader when changes are made, attention to detail is highly important due to handling PHI.

Daily responsibilities consist of:

• Received requests for expenditures and assessed inclusion based on budgetary parameters. 
• Assisted with the development of regulatory compliance systems. 
• Developed and implemented policies and procedures for the facility.
• Assisted the executive staff by providing extensive support for healthcare programs.
• Monitored employee and provider credentials and immunization statuses.
• Oversaw the on-boarding and training of new healthcare team members.
• Coordinated financial operations, including budgeting, accounting, expenses, and financial reporting.
• Completed daily rounds of nursing department to verify that all nursing service personnel were performing work assignments in accordance with acceptable nursing standards.
• Built strong network of outside referral sources within the community.
• Observed strict confidentiality and safeguarded all patient-related information.
• Developed and managed budget and revenue expectations while actively seeking ways to eliminate or reduce expenses.
• Audited job postings for old, pending, on-hold and draft positions.
• Organized employee schedules, department phone lists and business card orders.
• Managed communication regarding employee orientation and open enrollment for benefits.
• Contributed to new talent acquisition, interviewing, selection and employee termination with emphasis on project-related labor and budget planning.
• Planned, implemented, and conducted training for RN's/LPN's/Specialists  in the hiring process.  
• Explained human resources policies and procedures to all employees.
• Conducted new hire orientations making new employees feel welcome and ready to succeed.
• Maintained up-to-date department organizational chart.

Daily responsibilities consist of:

• Answering questions of concern regarding Medical Procedures and preparation for procedures.
• Insurance verification in order to create insurance authorizations for the patient's.
• Make outbound calls to engage members and/or providers to verify clinical information.
• Document all calls and attach clinical information received.
• Schedule patients with specialist and providers in our list of providers.
• Confirm future appointments for patients and provide transportation.
• Humana Benefits Mocha Mentor for my team of associates.
• Developed productive working relationships with numerous insurance company representatives.
• Selected by supervisor to train new hires on departmental processes and software.

Daily responsibilities consist of:

• Welcoming patients and visitors by greeting with a smile to make them feel comfortable.
• Optimize patient's satisfaction, provider time, and treatment room utilization by scheduling appointments in person or by telephone.
• Keeps patient appointments on schedule by notifying provider of patient's arrival
• Reviewing service delivery compared to schedule; reminding provider of service delays.
• Comfort patients by anticipating patient's anxieties; answering patient's questions; maintaining the reception area.
• Ensuring availability of treatment information by filing and retrieving patient records.
• Maintains patient accounts by obtaining, recording, and updating personal and financial information.