Benefits and Eligibility Specialist with 10+ Years Experience

TAMESHA EDMOND

Concord, CA ***** *************@*****.*** 510-***-**** LinkedIn

Certified Enrollment Counselor – Covered California Epic Super User Bilingual: English / Spanish (Conversational)

PROFESSIONAL SUMMARY

Results-driven Benefits and Eligibility professional with 10+ years of experience in community health settings, specializing in patient enrollment, insurance eligibility determination, and benefits administration. Proven track record managing high-volume caseloads, training large teams, and maintaining compliance with federal and state health programs including Medi-Cal, CalFresh, Covered CA, and Presumptive Eligibility. Certified Enrollment Counselor with deep knowledge of OneApp/CalHEERS portals and a demonstrated commitment to providing equitable care to diverse and underserved populations.

WORK EXPERIENCE

Eligibility Benefits Manager October 2015 – April 2026

West Oakland Health Council — Oakland, CA

•Trained and supervised a team of 40 specialists in enrolling patients into Medi-Cal, CalFresh, Fam Pact, Presumptive Eligibility, Health Pac, CHDP, and EWC using OneApp/CalHEERS/Covered CA portals

•Conducted patient financial screenings and determined eligibility for a full range of federal, state, and county health programs including Medicare, Medi-Cal, and Covered CA

•Provided Covered CA education to patients on available plans and metal tiers, ensuring informed enrollment decisions

•Registered 150+ patients daily into practice management systems, maintaining 90%+ data accuracy and updating records annually or as information changed

•Authorized and processed 50+ benefit payments and cash balances per day; managed sliding fee scale determinations based on individual income

•Proactively tracked insurance expiration dates, pending statuses, and primary care assignments to maintain coverage retention

•Conducted outreach to patients due for insurance renewal to prevent lapses in coverage

•Launched and led annual open enrollment workshop for 200+ employees; planned quarterly community outreach events for 300+ attendees

•Wrote grants resulting in $50,000 in quarterly awards to support member services programming

•Conducted new hire orientations, exit interviews, and performance reviews for 100+ staff; managed bi-weekly payroll for 100+ employees

•Collaborated with 5 inter-departmental networks and assisted billing department in resolving insurance and payment issues

•Maintained HIPAA-compliant patient files and records; ensured full compliance with federal and state privacy regulations

Driver Supervisor November 2004 – October 2015

United Parcel Service (UPS) — Concord, CA

•Led and supervised 60+ drivers using GPS mapping technology and consistent communication

•Served as liaison between customers and drivers, dispatching delivery instructions via computerized diad boards and communicating clear daily goals

•Ensured safety compliance to district standards; reviewed and approved driver timesheets

•Built strong working relationships with drivers and customers in a high-volume, fast-paced environment

SKILLS

Benefits Administration Eligibility Determination Patient Registration Medi-Cal / Covered CA / CalFresh / Presumptive Eligibility

OneApp / CalHEERS / Covered CA Portals Epic (Super User) Microsoft Office Suite Practice Management Systems

Grant Writing Staff Training & Development Payroll HIPAA Compliance Community Outreach Event Planning

Bilingual: English / Spanish (Conversational)

CERTIFICATIONS & LICENSES

Certified Enrollment Counselor (CEC) — Covered California

HIPAA Training Certificate

BLS/CPR Certification

EDUCATION

Trade School in Nursing — Pacific Coast Trade School, Santa Ana, CA

High School Diploma — Lynwood High School, Lynwood, CA

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