Yensy Cundumi-Zuniga

• Complete electronic physician orders to coordinate completion of Liberty Assessment for Home care services.
• Process prior authorizations for home care services such as personal care and skilled nursing.
• Verifies patient insurance eligibility and enter patient information into system.
• Delivers support to nursing staff in completion and signature of patients' orders and Plan of care for DC Medicaid compliance.
• Follow up and troubleshoot denials or reduction of care with case and clinical managers, and schedule peer-to-peer reviews and appeals if needed.
• Efficient and effective navigation of DC Care Connect, AXXESS, Comagine, DC Health care finance portal, NPI registry, Navinet, Unitedhealth, Crisp, and other web portals and systems.

• Advocated for pregnant and postpartum women of diverse backgrounds with cultural sensitivity and compassion.
• Enrolled patients in DC Mother-Baby Wellness Program.
• Conducted maternal mental health and postpartum screenings such as EPDS, PHQ 2 and 9, GAD.
• Provided appropriate responses for identified needs around social determinants of health.
• Provided care coordination support for families experiencing difficulties getting their needs met by ensuring optimal patient coordination and collaboration between teams and partners, with a focus on family experience and outcomes.
• Provide bilingual support (native Spanish speaker).

• Provide health education at primary, secondary, and tertiary prevention levels on subjects of Healthy sexuality, reproductive health, Puberty, nutrition, cancer, smoking cessation, Asthma, Diabetes, Liver health, and cardiovascular health.
• Provide culturally, linguistically, and age-appropriate education on STI, HIV, education, counseling, testing, and referrals.
• Support participants with chronic conditions to enter and stay engaged within the MyHealth, Socios de Salud/Partners in Health, Centering, Asthma IMPACT, and any other programs at Mary’s Center.
• Participated in interdepartmental collaborative projects or workgroups on population health, and quality improvement.
• Promoted available resources and connected individuals with services.
• Conducted research to stay up-to-date on health trends and health-related issues.

• Assist telephonic triage nurses by listening to patient's concerns, and determining if a medical appointment is needed, or if the concern should be reported to the appropriate triage nurse or primary provider.
• Schedule medical appointments.
• Provide clear patient information: lab results; responses and recommendations from primary care providers and nurses.
• Collaborate with nurses, providers, and pharmacy staff to ensure participants' medication requests and prior authorizations are processed in timely manner.
• Collaborate with referral specialists to ensure authorization needs are met for participants seeking specialty care.
• Document telephonic participant encounters in the Electronic Medical Record.

• Provided intake and development of Plan of Services for Medicaid Waiver and Community First Choice and Medical Assistance Personal Care programs.
• Coordinated medical eligibility determinations and redeterminations.
• Recorded case notes in the Maryland State Long Term Services Support System LTSS.
• Engaged individuals in person-directed planning.
• Assisted applicants residing in a nursing facility with developing a transition plan to live in the community.
• Identified potential barriers in the community and coordinated available services that addressed the needs of clients.
• Collaborated with the Local Health Department , Department of Aging, and Nursing Homes concerning the operation of the program.

• Dean's List- Fall 2012
• Dean's List -Spring 2014

2 years of education (incomplete).

Graduated from High School with a Baccalaureate in Elementary Education.