YENIFFER X. MARTINEZ
Miami Lakes,FL
Summary
An organized and motivated individual, eager to utilize time management and organizational skills across diverse settings.
Overview
17
17
years of professional experience
Work History
Engagement Coordinator
Care Bridge Medical Group
Remote
11.2023 - Current
- Perform telephonic outreach, and potentially outreach through other channels, to eligible members receiving home and community-based services
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
- Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
- Apply appropriate engagement tactics to drive higher engagement and a good understanding of the 24/7 program value proposition.
- Identify, document, and resolve member concerns to ensure interest and participating in the program
- Use multiple systems to track and record participant information using clear and concise notes
- Work collaboratively with clinical staff, social workers, and pharmacists to ensure CareBridge members receive individualized and timely care. Monitor, label, and distribute faxes related to participant medical records.
- Maintain excellent punctuality and attendance during work hours and schedule adherence
- Manage large amounts of inbound and outbound inquiries, and document all interactions.
- Meet personal/team metrics
- Other duties as assigned
- Maintained accurate documentation on all pre-authorization requests, denials and appeals.
Service Team Coordinator
Chen Med Senior-Member Solution Center
Remote
10.2022 - 10.2023
- Ensures a high level of customer service while working in a fast-paced structured call center environment
- Makes appropriate and timely decisions according to department standards, procedures, and policies.
- Documents interactions using web-based technology
- Interacts and collaborates with employees of varying levels across multiple departments.
- Follows up with patients to ensure they are satisfied with service
- Maintains business relationship by providing prompt and accurate service to promote loyalty.
- Provides responses to patient inquiries based on the ChenMed core model for care.
- Performs other duties as assigned and modified at manager's discretion
- Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
OR Surgical Coordinator
Palmetto General Hospital
HIALEAH, USA
10.2019 - 10.2022
- Completed insurance claim forms or other required paperwork
- Compiled medical reports covering specific patient or general office data
- Coordinated patient admissions through proactive communication with hospital personnel
- Coordinated patient appointments and hospital admissions
- Transcribed physician notes, detailing diagnoses or recommendations
- Completed all tasks promptly and with minimal oversight
- Responsible for performing general secretarial and clerical duties in surgical services core desk and rescheduling
- Interact with physicians and physician offices continually, schedule surgical procedures for all the operating rooms, GI and special Procedures
- Work in collaboration with materials management to order and ensure special instrumentation and supplies are ordered for the scheduled procedures
- Answer telephones for the surgical services department
- Call surgeons' office to confirm procedures
OB/GYN Surgical Coordinator
Jackson Memorial Hospital
Miami, USA
08.2015 - 03.2018
- Schedule all surgical cases for assigned Patients
- Work with OR scheduling office to ensure all OR cases are scheduled in a timely manner as according physician direction
- Contact insurance companies to obtain eligibility and pre-certifications for surgical procedures including authorizations for radiological procedures
- Maintain database to ensure all pre-surgical forms, medical clearance documents, patient radiological exams and laboratory work is completed in a timely manner within the guidelines of OR scheduling
- Work with clinical operations manager to improve utilization of OR block-time and release unused OR time
- Review surgical and clinical forms for completeness and accuracy for all surgical procedures
- Answer incoming calls, retrieve messages from various sources (telephone, facsimile, e-mails), and deliver messages to physician, nurse, and other parties
- Seek approvals surrounding physician schedule(s) in order to utilize and accommodate additional OR time; communicate approved changes with various staff members, identify conflicts with physician clinic/academic and OR schedule, provide suggestions and assist in the resolution of conflicts
- Work on special projects; perform other related duties as assigned or requested
Administrative Assistant/Credentialing Coordinator
Care Resource
Miami, USA
11.2014 - 08.2015
- Help in researching and processing new health plans applications for the agency and its provider
- Enter providers and agency information using OneApp Providers, consistent, accurate, and timely support for agency's credentialing process and all health plans and agency and its providers
- Provider's document's verifications of the information provided by new applicants as well current providers
- Prepares and maintain reports on all credentialing activities, working closely with grants dept, to prepare and execute all nonprofit grants
Credentialing Supervisor
MICC division of Jackson Memorial Hospital
Miami, USA
01.2008 - 12.2012
- High-profile management position accountable for soliciting business accounts and developing strategic alliances with clientele
- Contracting New Providers, Negotiate Contracts
- Develop tactics to increase assets and profitability
- Update doctors' status-CAQH/NPI/MEDICAID/MEDICARE License/DEA update
- Credentials/Re-Credentialing, HCA online Credentialing
- Providing information to insurance
- Case Analyst
- Medicare/ Medicaid
- Manage project, Manage teams
Education
Associate of Science - Clinical Nurse Specialist
Miami-Dade Community College0
Miami, FL12-2025
Full Specialist License -
Beauty School of America
Miami Beach, FL08-2014
Diploma -
US Christian Academy High School
Miami, FL01.2006
Skills
- Insurance Verifier
- Remote working
- Claims / Authorizations
- Obtain Eligibility
- Call Center Quality Assurance
- Medical Insurance
- Customer Service/Data Entry
- Collections / Billing
- Determination
- Quality assurance
- Appointment scheduling
- Insurance Verification
References
References are available on request.
Languages
Fluent in reading and writing of both English and Spanish languages.
Languages
English
Professional
Spanish
Professional
References
References available upon request.
Timeline
Engagement Coordinator
Care Bridge Medical Group
11.2023 - Current
Service Team Coordinator
Chen Med Senior-Member Solution Center
10.2022 - 10.2023
OR Surgical Coordinator
Palmetto General Hospital
10.2019 - 10.2022
OB/GYN Surgical Coordinator
Jackson Memorial Hospital
08.2015 - 03.2018
Administrative Assistant/Credentialing Coordinator
Care Resource
11.2014 - 08.2015
Credentialing Supervisor
MICC division of Jackson Memorial Hospital
01.2008 - 12.2012
Associate of Science - Clinical Nurse Specialist
Miami-Dade Community College0
Full Specialist License -
Beauty School of America
Diploma -
US Christian Academy High School
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