Health Insurance Eligibility Navigator/Enrollment Counselor Resume Example
Diversely qualified, energetic administrative professional with over 17 years experience in the healthcare and social services fields looking to return to professional employment. Bringing a dedicated work ethic and strong office acumen focused on customer service, efficiency, with a positive attitude to meet and exceed department objectives with minimal supervision.
|
|
As a representative of the NYS of Health Insurance Enrollment Center, under the Affordable Care Act, I worked to educate, enroll, and maintain eligibility for health insurance benefits to residents in a tri-county area and patients and visitors in the hospital in which our office was based.
- Scheduled appointments and interviewed 4-8 applicants/day to determine eligibility and explain health insurance options, scope of benefits, costs, state subsidies, and penalties
- Helped applicants gather documentation needed for eligibility and uploaded information to their accounts
- Communicated with people from various cultures, backgrounds, and socio-economic statuses using active listening and interpersonal talents to ensure consistency and representation
- Acted as a liaison between client, health insurance provider and NY State Enrollment Center
- Managed quality assurance program including on-site evaluations, internal audits and customer surveys
- Developed field enrollment office sites to reach rural and under-served populations and fostered community relationships that would enhance outreach efforts
- Attended community health fairs, outreach events, school/college events for marketing and enrollment
- Kept detailed accounting records for state grant funding requirements
- Maintained State certification by consistently meeting online training deadlines
Responsible for oversight and management of the county's Medicaid Managed Care Department under the direction of the Medicaid Principal and also acted as the Disability Coordinator for Medicaid and Public Assistance applicants in need of specialized services.
- Helped to design, implement, and maintain protocol to transition 14,000 Medicaid enrollees into a mandatory managed care environment; including managed long-term care
- Actively attended and spoke at stakeholder's meetings with other staff, state representatives, health plans, contractors, and recipients to ensure protocol was equitable, transparent, and smooth
- Worked cohesively with Public Assistance, SNAP, and Child Support Units on client eligibility for benefits and enrollment by devising internal eligibility notification system
- Compiled monthly and quarterly enrollment spreadsheets for Director, health plans and State departments
- Performed new hire department orientation and developed department-specific training manual
- Regularly assisted Medicaid enrollees with health plan benefit questions, provider issues, billing problems, network concerns, complaints and fair hearings
- Routinely negotiated with health plans on members' behalf regarding enrollment, billing, complaints, etc
- As Disability Coordinator, pursued referrals, interviewed applicants and completed forms for those meeting criteria. Obtained medical records, submitted cases for review, and connected client to additional community services
Acted as support staff for utilization review nurses, discharge planners, social workers and charge nurses to fulfill all necessary and related clerical duties for the hospital and patients.
- Provided stat medical record copying for patient transfers by rapidly accessing only necessary documents for patient transfer
- Complied daily patient census data for change-of-shift meetings
- Prepared IPRO/Medicare letters for patients meeting alternate-level-of care criteria and dispensed letters according to regulations
- Data-entered patient medical diagnoses, symptomatology, and status for Utilization Review nurses and submitted to insurance payors for continued stay approval
- Typed patient claim denial rebuttals and resubmitted with medical evidence to insurance payors for reconsideration
- Canvased and tabulated bed availability for nursing and adult homes on weekly basis for Discharge Planners
- Faxed PRI data to nursing homes for patients in need of placement
Assisted in the design, support and growth of spouse's successful high-end rustic furniture business.
- Implemented organized systems for payment collections, AP/AR, deposits, petty cash and recordkeeping
- Made quarterly payments for self-employment tax to IRS
- Accepted customer payments, made receipts, completed show contracts, ordered office & shop supplies
- Answered phones, took messages, sent and returned emails
- Helped design marketing materials, postcards, flyers, and negotiated with printers
- Maintained business calendar for furniture fairs, craft shows, client in-home installations
- Attended shows and marketed product
Salutatorian
- 3.95 GPA
Triad Golden Retriever Rescue
Jan 2020- Present
Assist in the rescue, rehabilitation, and re-homing of Golden Retrievers surrendered by owners, shelters, breeders and in neglect cases by transporting dogs, writing adoption biographies, conducting adoption phone interviews & veterinary checks, attending adoption events and promoting fundraising activities.
DISCLAIMER
Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.
How this resume score could be improved?
Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:
- Completeness
- Formatting
- Word choice
- Measurable results
Resume Overview
School Attended
- Broadalbin Perth Central School
- Fulton-Montgomery Community College
Job Titles Held:
- Health Insurance Eligibility Navigator/Enrollment Counselor
- Medicaid Managed Care/Disability Coordinator
- Care Coordination Administrative Asst
- Office Manager
Degrees
- High School Diploma
Associate of Applied Science : Resource Conservation
Similar Resumes
