Summary
Overview
Work History
Education
Skills
Certification
Relevant experience
Timeline
Generic
Winnie Nyamapfumba

Winnie Nyamapfumba

The Colony,USA

Summary

Capable and patient representative dedicated to providing superior support for patients seeking reliable information on insurance coverage, finance options and documentation requirements. Proficient in scheduling and data management, ensuring streamlined communication and reduced correspondence backlogs. Excels at identifying client needs and concerns to improve engagement strategies and overall service.

Professional Care Coordinator with 8 years of experience in devising successful media strategies and orchestrating special events. Meticulous in managing and carrying out special events by arranging for media presence, composing written documents, booking photographers, reserving event venues and preparing eye-catching graphics. Highly adept in authoring speeches, press releases, and marketing materials.

Overview

8
8
years of professional experience
1
1
Certification

Work History

Care Engagement Specialist

Centene Corporation
11.2025 - Current
  • - Provide a concierge service to most vulnerable Medicare members to improve member experience.
  • - Removing social determinants of health and improve health outcomes.
  • - Scheduling appointments with Medicaid and Medicare members.
  • - Inbound and outbound call monitoring using Webex.
  • - Health Risk Assessment completion
  • - Care Gap Assessment and completion
  • - Adherence to schedule as needed
  • - Consistent engagement with members and team using Cloud Dialer Power BI report.

Customer Service Representative (Remote)

Centene Corporation
11.2025 - 01.2026
  • - Managed inbound calls from customers inquiring about insurance benefits.
  • Handled claims, denials and queries from Medicare customers. Eligibility verification of customers for insurance benefits and rewards.
  • - Investigated customer concerns, addressed issues and resolved them.
  • - Guided customers through the Medicare application process and documentation.
  • - Maintained accurate customer information and documented calls in system.
  • - Routing complex issues to specialized departments when needed.

Patient Care Coordinator (Remote)

Texas Health Resources
07.2022 - 11.2025
  • - Coordinating patient care with healthcare providers, hospitals, and insurance companies
  • - Communicating with patients to schedule appointments, follow-ups, and procedures
  • - Maintaining patient records and updating patient information as needed
  • - Ensuring that patient insurance information is accurate and up to date
  • - Verifying insurance coverage for medical procedures and services
  • - Obtaining prior authorizations for medical procedures and services from insurance companies

Referral Coordinator (Remote)

USMD/CSI Companies
03.2021 - 07.2022
  • - Accurately input new referrals into the computer system and updated information in the computer system
  • - Communicated to the Authorization department the necessary information to obtain benefit information, authorization, reauthorization, and reimbursement by emailing and scanning pertinent medical information
  • - Addressed insurance issues that required alternate funding
  • - Registered and/or opened patients with manufacturer reimbursement programs, as needed
  • - Followed-up on authorizations to ensure they are achieved prior to dispensing - Managed telephone queues and assisted callers with scheduling appointments.
  • - Coordinated with referral sources and all necessary information needed to initiate services for new patient referrals
  • - Oriented and educated patients and their families by meeting them; explaining the role of the patient care coordinator; initiating the care plan; providing educational information in conjunction with direct care providers related to treatments, procedures, medications, and continuing care requirements

Clinical Care Coordinator (Remote)

Streamline Solutions
04.2020 - 03.2021
  • - Reviewed and sorted all incoming PA (Prior Authorization) request cases that required medical records
  • - Prioritized the cases based on urgency and the timeline of the request
  • - Reached out to various sources such as medical providers, hospitals, and clinics to obtain the necessary medical records
  • - Communicated with patients, providers, and other relevant parties to obtain the necessary information for the case
  • - Uploaded the received medical records into the system for further processing and review
  • - Aimed to complete 40 outreaches per day or 800 per month to ensure that all PA requests are processed in a timely manner
  • - Provided support for RightFax, which is a system used for sending and receiving faxes electronically, with a goal of handling 120 archives and uploads daily
  • - Prioritized meeting the guidelines set by CMS (Centers for Medicare and Medicaid Services) and health plan regulations for medical record outreaches in PA cases
  • - Made sure the patient has nothing that may potentially cause harm to self or others

Customer Service Advocate/Payment Poster (Remote)

Texas Health Resources
03.2018 - 04.2020
  • - Posted and adjusted payments electronically
  • - Maintained accurate billing records
  • - Documented revenue from patient payments and insurance reimbursements
  • - Posted, declined and processed appeals
  • - Managed inbound and outbounds calls from customers with queries.

Education

Bachelor of Science - Nursing

Nightingale College
Ogden, UT
03-2027

Associates of Science - undefined

Richland College
01.2020

Certified Nurse Assistant - undefined

Centric Nursing School
01.2018

Skills

  • - Patient Education
  • - Patient Care Coordination
  • - Data Science Orientation
  • - Patient Scheduling and Relations
  • Cross-functional coordination
  • Problem-solving abilities
  • Public relations strategies

Certification

  • Certified Nurse Aid
  • BLS/CPR
  • Data Science Orientation

Relevant experience

6+ years, 6+ years, 6+ years, health insurance, medical billing, scheduling, inbound and outbound phone calls, assisting patients, collecting copays, prior authorizations, patient care medical terminology, multiple EMR's, HIPAA, ASAP.

Timeline

Care Engagement Specialist

Centene Corporation
11.2025 - Current

Customer Service Representative (Remote)

Centene Corporation
11.2025 - 01.2026

Patient Care Coordinator (Remote)

Texas Health Resources
07.2022 - 11.2025

Referral Coordinator (Remote)

USMD/CSI Companies
03.2021 - 07.2022

Clinical Care Coordinator (Remote)

Streamline Solutions
04.2020 - 03.2021

Customer Service Advocate/Payment Poster (Remote)

Texas Health Resources
03.2018 - 04.2020

Associates of Science - undefined

Richland College

Certified Nurse Assistant - undefined

Centric Nursing School

Bachelor of Science - Nursing

Nightingale College

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