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Health Insurance Eligibility Navigator/Enrollment Counselor Resume Example

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HEALTH INSURANCE ELIGIBILITY NAVIGATOR/ENROLLMENT COUNSELOR
Professional Summary

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.

Skills
  • Strong interviewing skills
  • Superior customer service
  • Verbal and written communication
  • Highly organized with attention to detail
  • Program development
  • Medicaid/SNAP/TA experience
  • HIPPA compliant
  • Staff training/Orientation
  • Public speaking
  • Data entry/Report generation
  • Medical terminology
  • Disability criteria knowledge
Work History
Health Insurance Eligibility Navigator/Enrollment CounselorRush Enterprises - Biloxi , MS08/2014 - 07/2016

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
Medicaid Managed Care/Disability CoordinatorNathan Littauer Hospital/Fulton Co Dept Social Svc - City , STATE07/2001 - 08/2014

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
Care Coordination Administrative AsstNathan Littauer Hospital - City , STATE03/1999 - 07/2001

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
Office ManagerWilliam Gleaves Woodworking - City , STATE09/2001 - 07/2016

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
Education
High School DiplomaBroadalbin Perth Central School - City

Salutatorian

Associate of Applied Science: Resource ConservationFulton-Montgomery Community College - City, State
  • 3.95 GPA
Volunteer Experience

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.

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How this resume score could be improved?

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87Good
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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

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