Yisuris Pena
Kissimmee,FL
Summary
Organized and dependable candidate adept at managing multiple priorities with a positive attitude and willingness to take on additional responsibilities to achieve team goals. As a Supportive Eligibility Specialist, I bring extensive experience in application engagement and dedicated service. My bilingual proficiency allows me to maintain accurate records, and handle various administrative tasks.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Enrollment and Eligibility Specialist
Brighton Health Plan Solutions
2023.02 - Current
- Case Management: Create, audit, process and update the member and eligible dependents’ profile(s) into the enrollment database & update the database with changes.
- Data Analytics: Reconciling eligibility discrepancies, analyzing transactional data & submitting retroactive eligibility changes.
- Troubleshoot Enrollment and Eligibility related inquiries from the Call Center Representatives and Employers.
- Works directly with the Finance team to review, process, and resolve inquiries from the employers and premium related issues: including outreach to employers, the client and State officials as needed.
- Contact Employers regarding delinquencies and late file submissions –when applicable.
- Communicate effectively with individuals/teams in the program to ensure high quality and timely expedition of requests from the client, employers, and members.
- Participate in activities designed to improve customer satisfaction and business performance.
- Solve problems that are sometimes out of the ordinary and that may require reliance on conceptual thinking. Maintain broad knowledge of client requirements, procedures and key contacts.
- Support projects and other departments in completing tasks/projects.
Health Care Advisor
U.S. Health Advisors
2022.04 - 2023.01
- Help clients understand and choose the right insurance policies for their needs.
- Streamlined communication with other healthcare professionals to ensure a comprehensive approach to patient care.
- Provided compassionate support during difficult health decisions, guiding patients through available treatment options.
- Improved patient satisfaction by providing personalized healthcare advice and addressing individual concerns.
Registration Representative
Children Specialized Hospital
2016.08 - 2021.09
- Register patients ensuring that all information in Meditec, Electronic medical records is accurate and complete
- Obtain all necessary consent signatures for all patients registered
- Collects referral forms and co-pays
- Determines registrations status and financial clearance for upcoming patients, pre-register accounts and determines which patients need to be seen for registration, collection of copay/referral forms and or financial counseling
- Communicates with parents regarding insurance regulations, benefits and payment issues
- Insurance verification
- Appointment scheduling
- General oversight of work area to ensure adequate patient flow.
Field Member Service Representative
Health First
2013.08 - 2016.07
- Health Insurance Sales: Proven track record in health insurance sales, achieving targets and building strong client relationships.
- Case Management: Proficient in managing complex cases, ensuring timely resolution and client satisfaction.
- Data Analytics: Skilled in analyzing data to drive informed decisions and improve processes.
- Registration Representation: Successfully represented clients in registration processes, ensuring accuracy and compliance.
Data Entry Clerk/Outbound Telemarketing Representative
Royal Health Care
2010.07 - 2013.04
- Enter data for all new enrollments pertaining to NHP, CHP, FHP, and Medicaid applicants
- Insert data for all transfers applicants and update all members demographics
- Submit members information into Human Resources Administration database
- Process all daily statements and weekly transmittals data to ensure and convey reports to corporate
- Answered and handled all incoming calls on a timely manner with questions and concerns on a regular basis
- Responsible for conducting successful outreach to the assigned listing of NHM-FHP members to recertify
- Correctly report BOC Codes using the provided measures in the database
- Complete and close 60% of assigned cases with positive feedback
- Update changes in demographic information, request emergency contacts and email addresses.
Education
Diploma - Medical Billing & Coding
Ashworth College
07.2021
College Degree - Associates Psychology and Sociology
UTESA
01.1998
Certificate - Language Education
Universidad Tecnologica de Santiago
01.1998
Skills
- Data Entry
- Medicaid, Medicare and Marketplace knowledge
- Analytical Skills
- Eligibility Determination
- Problem-Solving
- Analytical Thinking
- Time Management
- Knowledgeable in Word, Excel, Teams,Sales Force,Create portal.
- Understanding of eligibility files, transaction sets, HIPAA, COBRA, FMLA, LOAs, QLE, and PTO regulations.
- Attention to Detail
Certification
- 2-15 Florida life/Health and Variable contracts Insurance, 04/01/22, 04/01/24
- Life Insurance
- Health Insurance
- Annuity
Timeline
Enrollment and Eligibility Specialist
Brighton Health Plan Solutions
2023.02 - Current
Health Care Advisor
U.S. Health Advisors
2022.04 - 2023.01
Registration Representative
Children Specialized Hospital
2016.08 - 2021.09
Field Member Service Representative
Health First
2013.08 - 2016.07
Data Entry Clerk/Outbound Telemarketing Representative
Royal Health Care
2010.07 - 2013.04
Diploma - Medical Billing & Coding
Ashworth College
College Degree - Associates Psychology and Sociology
UTESA
Certificate - Language Education
Universidad Tecnologica de Santiago
- 2-15 Florida life/Health and Variable contracts Insurance, 04/01/22, 04/01/24
- Life Insurance
- Health Insurance
- Annuity
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