Medicare Advantage Credentialing Coordinator
Resume:
Calvin Lam
*** * ***** *** *** Cell: 626-***-****
Glendora, CA 91740 Email: **********@*****.***
Summary Skilled Healthcare worker looking for challenging position where my experience and professional skills in electronic data interchange and experience with healthcare/Medicare will contribute to self-growth/success of AltaMed.
Experience Altura MSO: Credentialing Coordinator - Montebello, CA
June 2023 – Current
●Validate information for providers being re-credentialed.
●Generate primary source verifications for provider’s assigned for upcoming Credentialing committee.
●Update any information that may be missing in SProvider database.
●Update re-credentialing dates in SProvider database to reflect the current credentialing cycle.
●Assist in verifying new provider’s are in La Salle Medical Associates QUE on Riskonnect.
●Audit prior credentialing files, gather missing elements before submission to health plans.
●Send out Re-Cred applications 4 months in advance to provider’s ensuring documents have been received on time for processing.
●Prepare Re-Credentialing applications received for designation to coordinator.
●Update Master Re-Cred list with demographic and status of application.
Brand New Day/Bright Health: Member Experience Coordinator – Westminster, CA
September 2021 – June 2023
●Outreach to new members providing information and education regarding program features, benefits, requirements of Medicare plan.
●Communicate between providers and health groups to ensure members needs are met in a timely manner.
●Well versed in Medicare Advantage plans and guidelines.
●Create vendor and health plan knowledge training for successful onboarding of new hires.
●Trained new hires to ensure proper workflow, benefits offered with Medicare Advantage plan, vendor training, and how to properly document interactions.
●Support internal departments to resolve issues with Health Plans
●Attend provider network operations meetings and present resolutions for productive streamlining between network providers to members.
●Reach out and validate provider’s Medi-Cal enrollment status with Department of Health Care Services.
●Verify Member’s primary and secondary eligibility status.
●Provide eligibility and enrollment information to network providers.
●Proficient in MHC, Clickmedix Portal for provider/member information.
Optum: Patient Outreach Coordinator – Arcadia, CA
March 2021 – September 2021
●Supports execution of regional and site-based outreach programs targeted to Medicare Advantage patients.
●Plan, coordinate, and participate in telephone and mail campaigns, health fairs, site-based events, and other activities/events.
●Maintain excellent collaborative working relationships with Contracted Providers and staff, community centers, and vendors.
●Scheduled appointments in the company’s practice management application and updates relevant demographic and contact information to ensure accuracy.
●Confirmed eligibility with medical group to ensure no laps in coverage.
Covered California: Health Insurance Broker – Alhambra, CA
December 2015 – Current
●Assess the needs of clients through face-to-face or phone meeting interviews and discuss health insurance options.
●Phish information (background, general health, income, and family situations) to best tailor the client.
●Check eligibility, process quotes, and educate potential clients on insurance options available.
●Ensure clients have the proper coverage for himself/herself and/or his/her family.
●Calculate premiums and establish payment methods for sales.
●Build relationships with carriers and receive information for product training to be well-versed in product lines offered.
●Provide exceptional customer service skills and sales techniques to ensure customer retention.
●Communicate with healthcare providers, medical groups, and doctors to ensure clients are accepted and that their requested native languages are available.
●Update required information through healthcare marketplace and upload confidential information for verification purposes.
●Pursue leads obtained through direct referrals, lead databases, and cold calls.
Assistance Insurance Agency: Insurance Broker – Alhambra, CA
July 2015 – Current
●Provide insurance services such as: quoting Automobile and Homeowner’s Insurance, explaining appropriate coverage, and providing service to other client needs.
●Bundle Homeowner’s and Automobile Insurances as applicable to client needs.
●Build customer relationships by: ensuring customer satisfaction with services provided, checking that client needs are met, explaining the coverage amount purchased, and ensuring policies stay up-to-date.
●Consistently improve customer satisfaction through expert resolution of conflicts, issues, and concerns.
●Process applications, file claims, process endorsements, provide required documents for policies to remain in good standing, and renew policies.
●File claims for clients and communicate with insurance companies for prompt turnaround time for repairs.
●Perform administrative tasks including: maintaining client records, payment receipts, and evidence of insurance.
●Promptly respond to general inquiries from agency members, staff, and clients via telephone, mail, email, and fax communications.
Education Mount San Antonio College: 2009 – 2013
General Education Development Diploma: 2009
Mount San Antonio College
Licensure Property & Casualty License (#0k47720) valid till 9/30/2023
Health & Life License (#0k47720) valid till 9/30/2023
Skills Health: HIPPA regulation knowledge, Medicare and Medi-Cal knowledge, Excellent Team oriented, Excellent time management and organization skills, Ability to adapt and learn new programs/implementations.
Computer: Proficient in PC and Mac computers, Microsoft Office, Adobe Acrobat, troubleshooting general computer problems.
Other: wonderful team player, eager to learn, quick to adapt to change, excellent communication (verbal and written) and time management skills.
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