Healthcare Administrative Professional Resume Title: Bilingual

Javier Alejandro Macias

***************@*****.***

*** ******** ******, ********, ** 11237 Cell: 929-***-****

Objective

Experienced Administrative Health Professional with a demonstrated history of working in the health care industry. Skilled in Medical Terminology, Physician Relations and Healthcare Services, Time Management, and Microsoft Word and Excel. Bilingual in English and Spanish.

Experience

Centers Plan For Healthy Living- Farmingdale, NY

CDPAS Coordinator, August 1, 2018- March 2020

Responsible for monitoring CDPAS events to ensure accurate and timely completion

Telephonic outreach to prospects and members interested in or receiving CDPAS.

Receives, reviews, and uploads CDPAS documents into member files.

Communicates with CPHL CDPAS vendors regularly and as needed.

Monitors, reviews, and completes CDPAS events within membership database, handling a

high volume of requests accurately and efficiently.

EmblemHealth – New York, NY

Patient Advocate, May 12, 2016-May 1, 2018

Implement Welcome Calls at AdvantageCare Physicians Center to new patients, welcoming them to the center, reminding them of future appointments and assisting them in completing their Health Risk Assessments.

Work on the Medicaid and Medicare Advantage CAHPS initiatives to impact CAHPS scores and Medicare STARS through interactions with members and receiving feedback on the plan.

Implement the Vision Board for Elmhurst AdvantageCare Physicians Center for staff members to see the percentages in the Press Ganey scores, HEDIS, and MyACP sign ups.

Serve as liaison between management, clinical staff and the community.

Help patients resolve insurance and billing issues through collaboration with health plan customer service.

Report to management on a weekly basis concerns and resolutions in order to improve customer satisfaction and Press Ganey scores.

Interact with and assist patients in signing up for the online patient portal and how to navigate the portal to have their office visit experience user friendly. Increase in sign-ups resulted in 16% to 27% in four months.

Amida Care – New York, NY

Member Service, May 12, 2014-September 29, 2015

Generated disenrollment reports and documents for investigative reasons.

Collaborated with audits of member charts in preparation for the corporate wide scanning of member charts and documents.

Scanned all Member Services member records (i.e. MDR, welcome letters, disenrollment letter, enrollment packet material, incentives forms and letters, term PCP letters, HIV verification).

Ensured members of their confidentiality and adhered to the Confidentiality and HIPAA policies and regulations.

Conducted outbound member calls to process returned mail to acquire corrected addresses and member education on reporting to HRA and/or the LDSS.

Performed other duties as assigned by the Member Services Supervisor, Director/Associate Director of Member Services.

Education

Queens Borough Community College – Bayside, NY

Associate of Science in Health Service Administration, May 2021

Major: Health Science/Health Care Administration (In Progress)

Certifications

Certified in Mental Health First Aid USA – Long Island City, NY

Completed the 8-hour course and certified in Mental Health First Aid, May 2017-May 2020

Honors

2011, Employee of the Month-Montefiore Hospital Orthopedic Department

2010, Nominated Face of Respect-Montefiore Medical Center

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