Summary
Overview
Work History
Education
Skills
References
Languages
Timeline
Generic

Yaquelin Garcia

Homestead,FL

Summary

Dedicated to streamlining operations and promoting organizational efficiency. Strong leader and problem-solver. Independent decision-making skills and sound judgment positively impact company success. Strategic call management and process improvements enhance team performance and maximize customer satisfaction. Top-notch abilities in program management, interpersonal communication, and administrative oversight contribute to success. Extensive experience in handling complex claim collections and appeals utilizing analytical skills to resolve disputes and secure favorable outcomes. Deep knowledge of effective communication practices and a collaborative approach to achieving results.

Overview

12
12
years of professional experience

Work History

Bilingual Pilot Navigator

United Healthcare
09.2021 - Current
  • Identify and close gaps in care for members.
  • Coordinate outpatient care between primary care providers, specialists as well as in-patient care.
  • Guide to community based organizations to meet daily and social needs. If health plan is unable to meet those needs
  • Identity potential pain points for our members prior to it becoming a concern.
  • Test applications and processes in both the developmental and live phases.
  • Identify and develop best practices for more efficient navigation within application for advocates
  • Independently manage PILOT projects collaborating with internal dept gathering data to endure / create the most efficient process via test scenarios to be added to our knowledge base for advocate guidance
  • Identify trends and create content to up-train current navigators ensuring understanding of a wide array of current processes.
  • Assist trainers as a Delivery Assistant delivering and demonstrating best practices for both soft and hard skills as the Subject Matter Expert.
  • Overseeing call audits coaching and developing an attainable action plan to develop confidence in our New hire advocates.
  • Completing follow up to identify gaps in knowledge, resulting in less member abrasion and higher NPS/UES scores.
  • Processed and finalized appeals and grievances within agreed-upon turnaround time.
  • Actively participated in quality improvement initiatives aimed at enhancing the overall member experience within the organization''s healthcare services offerings.
  • Optimized departmental workflow through periodic assessment of current processes, identifying areas for improvement to increase overall effectiveness.
  • Provided outreach for additional information for appeals and grievances.
  • Improved member satisfaction by efficiently managing and resolving appeals and grievances cases.
  • Demonstrated high-level attention to detail when reviewing medical records, provider contracts, and other relevant documents during case assessments.
  • Increased staff efficiency through comprehensive training programs focused on best practices in appeals and grievances processing.
  • Provided exceptional customer service when interacting with individuals involved in each appeal or grievance situation, demonstrating empathy and professionalism at all times.
  • Reduced turnaround times for case resolutions by effectively prioritizing workload based on urgency levels designated by regulatory standards.
  • Contributed to organizational goals by consistently meeting or exceeding established performance metrics related to appeals and grievances management.
  • Supported team members in understanding complex regulatory requirements, ensuring compliance with all relevant policies and procedures.
  • Ensured timely submission of required reports to regulatory agencies by diligently monitoring deadlines and maintaining accurate records.
  • Completed in-depth investigations into issues pertaining to discipline and grievance management and recommended strategies.
  • Expedited resolution times by proactively communicating with members, providers, and other stakeholders throughout the grievance process.
  • Entered appeal requests in appeals module.
  • Enhanced internal processes for handling complaints by developing standardized guidelines and documentation templates.
  • Reduced grievances and arbitration needs by educating frontline managers on techniques for enhancing interactions between labor and leadership.
  • Served as a key resource for colleagues seeking guidance on case-specific issues or regulatory requirements, fostering a cooperative team environment.

Bilingual Care Coordinator

United Healthcare
04.2020 - 09.2021
  • Improved communication among healthcare providers, streamlining the coordination of services for patients.
  • Created customized care plans, working with hospital staff and families to assess and meet individual needs.
  • Defined testing protocols, quality assurance initiatives and clinic policies and procedures.
  • Educated patients on self-care strategies, promoting independence and empowering them to manage their health conditions.
  • Completed resident assessments in accordance with current regulations and guidelines.
  • Contributed to the development of organizational policies and procedures related to care coordination, ensuring alignment with industry standards and best practices.
  • Enhanced patient care by developing and implementing comprehensive care plans.
  • Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
  • Organized educational workshops for staff members on topics related to effective care coordination processes and best practices.
  • Facilitated appointments and transportation for patients, streamlining access to essential medical services.
  • Used company software and databases to maintain records of services performed and patient conditions.
  • Liaised with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care.
  • Advocated for patients'' rights within the healthcare system, working diligently to address concerns or barriers to care.
  • Monitored, tracked, and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
  • Assessed patient needs and connected them with appropriate resources to ensure optimal health outcomes.
  • Maintained accurate and up-to-date documentation of patient records in accordance with HIPAA regulations.
  • Skilled at working independently and collaboratively in a team environment.
  • Developed strong organizational and communication skills through coursework and volunteer activities.
  • Applied effective time management techniques to meet tight deadlines.
  • Developed and maintained courteous and effective working relationships.

Lead Trainer on the United Health Care Campaign

ALORICA
08.2019 - 04.2020
  • Assess training needs for new and existing Advocates
  • Identify internal and external training programs to address competency gaps
  • Facilitate modules pertaining services and products knowledge
  • Develop a schedule to assess training needs
  • Completed Daily/Weekly/Monthly Reporting based on the client requirements pertaining to training as well as Compliance
  • Consult with other trainers, managers, and leadership
  • Conceptualize training materials based on data and research
  • Track and compile collected data
  • Provided floor support for advocates during the ABAY development
  • Provided one on one coaching to discuss opportunities and reinforce identified strengths
  • Provided training certification for off site trainers.
  • Worked with vendors to customize courseware to accommodate business needs.
  • Utilized candidate sourcing and recruitment via networking, cold calls and online recruiting resources to search for qualified individuals.
  • Increased employee retention rates by providing ongoing support and mentorship to new hires during their onboarding process.
  • Managed a team of trainers, effectively delegating tasks and monitoring performance to maintain high-quality training delivery.
  • Improved employee skill sets by developing comprehensive training programs tailored to individual needs.
  • Facilitated learning through classroom instruction, on-the-job coaching and virtual training for 30 employees.

Training Assistant College Board Campaign

ALORICA
04.2019 - 08.2019
  • Assisted lead trainer with new hire classes
  • Completed Daily/Weekly/Monthly Reporting based on the client requirements
  • Provided up training to current agents, ensuring production provide the most recent and updated information.
  • Organized training materials inventory, streamlining access to resources for trainers and participants alike.
  • Assisted in the evaluation of training effectiveness through data analysis, leading to continuous improvements in course content.
  • Enhanced employee skillsets by developing comprehensive training materials and resources.
  • Assessed skill gaps for employees and developed training courses to meet identified needs.
  • Monitored employee progress throughout training programs using various assessment tools; identified areas for improvement and provided additional support as needed.
  • Optimized scheduling logistics for multi-location training sessions, minimizing travel costs and maximizing attendance rates.
  • Supported trainers in facilitating engaging workshops, improving overall participant satisfaction levels.
  • Managed the coordination of training schedules, ensuring timely delivery of all programs and events.
  • Coordinated cross-functional collaboration between departments to identify common skill gaps and develop targeted solutions accordingly.

Customer Satisfaction Specialist

ALORICA
07.2017 - 04.2019
  • Assist and provide customer with any corporate level specific needs/request of documentation
  • Provide assistance and resolutions for any billing needs/request
  • Escalate customer’s precise needs/request to proper department
  • Provide resolutions for requested needs via phone/email/fax.

Training Assistant

ALORICA
03.2017 - 07.2017
  • Assess training needs for new and existing employees
  • Identify internal and external training programs to address competency gaps
  • Facilitate modules pertaining services and products knowledge.

Quality Assurance Representative

ALORICA
04.2013 - 03.2017
  • Draft quality assurance policies and procedures as per client request
  • Interpret and implement quality assurance standards to all agents
  • Evaluate adequacy of quality assurance standards
  • Devise sampling procedures and directions for recording and reporting quality data
  • Created monthly productivity trackers for all lines of business
  • Agent development through coaching
  • Pace Trained and Certified.
  • Presented findings from audits to management teams, driving improvements in overall operational performance.
  • Maintained detailed records of test results, providing valuable data for future process improvements.
  • Streamlined QA processes for increased efficiency, reducing time spent on repetitive tasks.
  • Performed call audits to monitor regulatory compliance.
  • Managed multiple projects simultaneously, ensuring timely completion of all QA tasks and deliverables.
  • Contributed to cost reduction initiatives by identifying opportunities for process improvements related to product design or manufacturing methods that could impact overall quality levels positively.
  • Evaluated supplier performance, ensuring adherence to strict quality requirements and timelines for delivery of components or materials.
  • Assisted in the development and implementation of automated testing tools for improved efficiency and accuracy in QA processes.
  • Reviewed and scored calls made utilizing company-defined quality monitoring standards
  • Developed training materials for new hires, fostering a culture of continuous improvement within the QA team.
  • Improved product quality by implementing comprehensive testing procedures and documenting results.
  • Assisted with developing and implementing quality assurance improvements based on call evaluation results.
  • Drafted performance and quality assurance reports and presented findings at weekly and monthly quality meetings.

Education

High school Diploma -

Miami Job Corps
02.1995

Skills

  • Administrative and Office Support
  • Claims Evaluation
  • [English/Spanish] Fluency
  • Team Building and Leadership
  • Problem-Solving
  • Quality Assurance
  • Training and coaching
  • Microsoft Outlook, Word, and Excel
  • Time and task management
  • Documentation skills
  • Claims investigation

References

References are available upon request.

Languages

English
Native or Bilingual
Spanish
Native or Bilingual

Timeline

Bilingual Pilot Navigator

United Healthcare
09.2021 - Current

Bilingual Care Coordinator

United Healthcare
04.2020 - 09.2021

Lead Trainer on the United Health Care Campaign

ALORICA
08.2019 - 04.2020

Training Assistant College Board Campaign

ALORICA
04.2019 - 08.2019

Customer Satisfaction Specialist

ALORICA
07.2017 - 04.2019

Training Assistant

ALORICA
03.2017 - 07.2017

Quality Assurance Representative

ALORICA
04.2013 - 03.2017

High school Diploma -

Miami Job Corps

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Yaquelin Garcia