Accomplished bilingual Social Service Case Manager accustomed to treating diverse patient needs while managing dynamic conditions. Offering excellent clinical knowledge and judgment combined with strong documentation, vitals monitoring, and problem-solving abilities. Well-versed in managing emergent cases with poise.
Skills
Bilingual (English/Spanish)
Advocacy and Counseling
Insurance Verification (Commercial, Government and Private)
ability to work independently, set boundaries,
prioritize duties, and multi-task;
Decision-making
Experience
05/2018 to Current
Eligibility SpecialistUbc – Lake Mary, FL,
Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
Performs admissions and eligibility processes (intake, reassessments, etc.) to ensure appropriate placement of clients within HACS' internal continuum of care including but not limited to medical, behavioral health, and housing-related services.
Conducted interviews with applicants, explaining benefits process and which programs were available.
Protected patient data in alignment with HIPAA privacy protocols.
Determined functional status, activity, acuity and self-management levels to make proper care referrals.
Assists HACS' clients in completing applications for mainstream services including making appropriate referrals for such services as well as referral follow up. Updates client demographic information and financial information/documentation at each visit or when the client's situation changes to ensure on-going service eligibility and compliance with all local, state, and federal regulations.
Performs insurance coverage and grant eligibility verifications by making field calls or using other verification tools
Coordinated support services and optimized communication between healthcare workers and patients.
Informed patients and families of treatment options and at-home care strategies to reduce unnecessary burden on hospital resources.
Collaborated with various healthcare providers to facilitate delivery of services.
08/2016 to 04/2018
Team Leader Certified CounselorHarris County – Hockley, TX,
Supervised, Monitor and led a team of (4) four individuals that worked on insuring over 43,000 uninsured patients for Harris County.
Assessed, motivated and empowered team members to work to build customer satisfaction and loyalty, to support retention and growth.
Inform the client in a timely manner of all approval and denials of coverage.
Developed and implemented policies, procedures and process improvement initiatives to improve retention rates and increase customer satisfaction.
Oversaw all financial and operational processes.
Interviewed, hired and trained new quality customer service representatives.
Conducted assessments to obtain information for participant-centered plan of care.
Managed multiple program budgets and approved purchases for staff.
Reviewed staff work and gave comprehensive and constructive feedback.
Handle payroll.
Helping clients in preparing application to establish eligibility and enrollment.
Assisting in qualification intake for insurance affordability program.
Provide outreach and education to consumers.
Delegated daily tasks to team members to optimize group productivity.
03/2003 to 07/2016
Bilingual Eligibility SpecialistDepartment Of Human Services, Virgin Islands – City, STATE,
Performs admissions and eligibility processes (intake, reassessments, etc.) to ensure appropriate placement of clients within HACS' internal continuum of care including but not limited to medical, behavioral health, and housing-related services.
Developed appropriate care plans for at-risk individuals and high-risk families.
Screens and assesses individual and family client needs, which forms the basis for the client's service or treatment plan.
Performs insurance coverage and grant eligibility verifications by making field calls or using other verification tools.
Assists HACS' clients in completing applications for mainstream services including making appropriate referrals for such services as well as referral follow up.
Updates client demographic information and financial information/documentation at each visit or when the client's situation changes to ensure on-going service eligibility and compliance with all local, state, and federal regulations.
Documents all services in the electronic health record and practice management systems., Division of Family Assistance.
Collaborated with various healthcare providers to facilitate delivery of services.
Interviewed applicants to determine eligibility for programs such as Food Stamps, welfare, and medical assistance as well as any other government sponsored program.
Managed logistics for abuse and neglect cases from start to finish.
Verified personal and financial data through correspondence with financial institutions and other government agencies.
Provide all clients with exceptional high-quality customer service and record keeping.
Assumed role of counselor or advocate.
Documentation, computerized record keeping, preparation and maintenance of client files.
Scheduling an average of 150 appointments per month.
Keeping abreast of federal policy changes.
Ensured that benefits were distributed in a timely manner.
Maintaining confidentiality.
Education and Training
Expected in 01/2015
: Legal Studies Keiser University - , GPA:
Expected in 01/2005
Associates Degree: Business Management Ashford University - , GPA:
Expected in 01/1995
: General Studies University of the Virgin Islands - , GPA:
Expected in 01/1997
Business Applications Certification: Speedy Secretarial Institute - , GPA:
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