WENDY GARCIA

• Lead daily operations for the Transition of Care Service team, supervising case assignments, workload distribution, and quality control.

• Provide coaching, training, and mentorship to team members, fostering skill growth and adherence to performance standards.

• Monitor operational metrics, analyze trends, and implement process improvements to enhance efficiency and member outcomes.

• Partner with cross-functional departments, providers, and facilities to ensure seamless care transitions and coordinated service delivery.

• Ensure compliance with internal policies, state and federal regulations, and department quality benchmarks.

• Coordinated care for complex, high-risk member populations, ensuring timely authorizations, accurate case documentation, and service delivery.

• Monitored queues and workloads, proactively identifying and resolving barriers to efficient case processing.

• Acted as a liaison between providers, members, and internal departments, maintaining clear communication and problem resolution.

• Consistently achieved departmental productivity, quality, and compliance targets.

• Screened patients for eligibility programs, guided them through the application process, and connected them with supplemental resources.

• Maintained high levels of customer service while balancing caseload demands.

• Audited billing data for accuracy, managed account reclassification, and ensured compliance with hospital contracts.

• Provided performance reports to leadership, identifying operational trends and recommending improvements.

• Facilitated patient enrollment in medical assistance programs, ensuring complete and accurate documentation.

• Entered details into computer systems and managed database of information.