Care Coordination & Enrollment Specialist

Celina Betancourt

Bronx, NY ***** Tel. 914-***-****

Email: ******.*****@*****.***

Work Experience

Integrated Care Coordinator, March 2019- Current

MVP Healthcare

Responsible for reaching all members on a monthly basis

Consult with patients and family members to discuss their health problems.

Schedule and coordinate face to face meetings with members, providers.

Coordinating patient-care services, educating them about their condition, and working with the care team to evaluate interventions.

Assists in completion of documentation required by the program.

Comply with organizational guidelines and health care laws and regulations

Enrollment Specialist, June 2016 – March 2019

Age Well New York

Responsible for Determining Prospective members eligibility.

Responsible for all data entry of enrollee information.

Assist in answering multiple phone calls for all lines of business (MLTC, Medicare and FIDA).

Responsible for managing all Voluntary Nursing Home and FIDA Enrollments.

Maintain a positive relationship with all referral sources and Elder law attorneys.

Responsible for contacting HRA, DSS, Nassau and Suffolk County for surplus amounts and Medicaid eligibility, Pooled Income Trust Documents.

Coordinate multiple Nurses’ schedules and appointments.

Maintain patient confidentiality as defined by state, federal and company regulations.

Responsible for running daily reports and following up on all active cases.

Prior Authorization Representative, March 2015 – June 2016

TFC Service Bureau

Responsible for obtaining Prior Authorization's from start to finish.

Answered calls from Physician offices, hospitals, and patients.

Contacted Insurance Companies for Start & End Dates.

Accurately inputted required information into computer database.

Followed up with hospitals for discharge dates as needed.

Reviewed structured clinical data matching it against specified medical terms and diagnoses or procedure codes.

Accurately submitted Prior Authorization request online.

Checked Patient Eligibility online.

Education

Sanford Brown Institute

Medical Billing & Coding (GPA 3.8), February 2015

General Equivalency Diploma, September 2013

Professional Skills

Proficiency with ICD-10 Codes, NY HCS/UAS, Medicare/Medicaid/FIDA, HIPAA, Claims processing, CPT, HCPCS, Insurance & Billing, MS Word, Excel, Power Point

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