Office Administrator - E&A Medical DBA Bronx Health Center - 253 East 142nd street Bronx, NY
Part-time role seeking for full time.
- Spearheaded comprehensive compliance programs for Article 28 regulations, ensuring seamless operations and maintaining excellent standing with NYS health authorities.
- Ensuring the facility operates in compliance with NYS Article 28 rules and regulations.
- Staying current with changes in healthcare regulations and policies.
- Overseeing the day-to-day operations of the facility.
- Developing and implementing policies and procedures enhancing patient care and staff performance.
- Hiring, training, and supervising staff, including medical and administrative personnel.
- Evaluating staff performance and providing feedback.
- Resolving staff conflicts, fostering a collaborative and productive work environment.
- Communicating with staff, patients, families, and other stakeholders to enhance care delivery.
- Collaborating with other healthcare professionals and organizations.
Director of Business Development & Enrollment Operations - Centerlight Health System - 136-65 37th Ave Flushing, NY
(2023-04 - 2024-10)
Lead a PACE program for qualifying non-dual (Medicaid) and dual (Medicaid and Medicare) participants in receipt of long-term care services and benefits.
- Responsible for overseeing and leading the Data Entry, Intake, Eligibility, Enrollment, Clinical Assessments, Quality Reviewers, CDPAS, and Disenrollment operations functions.
- Overseeing the clinical assessment and reassessment operation processes, including managing nurses' schedules for maximum conversion from referral to enrollment and timely reassessments as per department and business goals while remaining in compliance with CMS, NYSDOH, and PACE regulations.
- Developed and implemented policies and procedures and standard operating procedures.
- Budget for adequate staffing and coverage plans given current and projected levels of enrollment.
- Identify referral trends that will lead to the conversion of appropriate PACE candidates into the program and improve the overall quality of enrollments.
- Developed and ensured training of clinical staff on assessment visits, UAS-NY, PCAT, assessment tools, and capturing quality measures.
- In conjunction with the Care Delivery Department, oversee the authorization of personal care hours to ensure appropriateness and consistency with the participant's identified needs and Medicaid regulations.
- Ensure high performance and productivity of pre-enrollment verifications of Medicare, Medicaid, and PACE eligibility.
- Developed and implemented audits tools for auditing purposes to ensure compliance of all state policies and regulations.
- Oversee and ensure that all grievances and appeals, complaints inquiries are resolved timely.
- Oversee retention initiatives to ensure high-quality customer service while staying in compliance.
- Oversee project management team and providing strategic support to senior leadership.
- Maintain and generate required reports, including NYSDOH, CMS, for Quality Improvement.
- Work collaboratively with the Marketing department in developing necessary related compliant materials.
- Function as a Liaison between Entitlement Unit, Maximus, Department of Health, and Local Department of Social Services as required.
- Maintain relationships with contracted agencies and ensure invoices are processed accurately and timely.
- Ensured that star quality measures are met through preventative assessment and personalized plan of care
Manager, Program Coordination/ Operations Manager - Fidelis Care New York/Centene Corporation - 2501 Jackson Ave Long Island City, NY
(2018-10 - 2023-04)
Successfully led seven teams Nursing home team, dual team, fax team mail team, care management, disenrollment, Nursing home reconciliation. These teams serviced members who are receiving long term care services.
- Effectively executed all facets of leadership, including, employee engagement, recognition, training, performance management and conflict resolution.
- Engaged in an initiative-taking approach in order to identify and correct quality measures including expedient follow to ensure compliance.
- Ensured nursing home authorization report and N code report for Managed Long-Term Care (MLTC) and Medicaid Managed Care (MMC) members are accurate for account receivable and payable.
- Ensured monthly calls, daily task report, authorization report, audit report, to ensure efficiency and production is up to par with departmental standards.
- Collaborated with internal teams and external units to coordinate services for members.
- Developed workflows, desk level procedures and implemented goals within the teams and ensured that goals are met.
- Developed and implemented policies and procedures for utilization management programs to facilitate the use of appropriate medical resources and decreased financial exposure, care management, disenrollment, and administrative functions.
- Developed and implemented audit tools to improve areas that are not meeting state guidelines.
- Developed, implemented, and maintained utilization management programs to facilitate the use of appropriate medical resources and decrease the business unit's financial exposure.
- Reviewed members' records for coverage determinations, organization determinations, appeals, claims, and other grievances to ensure that adequate services are rendered.
- Collaborated with vendor management system and temporary agencies to successfully onboard and train temporary workers for staffing purposes.
Off Exchange and MLTC Enrollment Supervisor - Fidelis Care New York/Centene Corporation - 2501 Jackson Ave Long Island City, NY
(2015-08 - 2018-10)
Supervised the MLTC team, off exchange team, QHP, CHP and Medicaid team.
- Managed the day-to-day operations of the Enrollment department. Maintained quantitative and qualitative performance, inventory reports, and continuously monitors data and operations to ensure compliance with the department's goals and objectives.
- Acted as a liaison to external partners including DOH, Maximus, local department of social services (LDSS), and providers. Maintained staff by recruiting, orienting, and training employees, developing personal growth opportunities.
- Participated in problem and issue resolution and the development of workflows, processes, policies, and procedures.
- Served as interdepartmental liaison to build and maintain cooperation between departments symbiotic to both enrollment process and member satisfaction.
- Developed workflows, desk level procedures and implemented goals within the teams and ensured that goals are met.
- Prepared annual budget; scheduled expenditures; analyzed variances; initiated corrective actions.
- Developed and implemented audit tools to improve areas that are not meeting state guidelines.
MLTC Outreach Specialist - Fidelis Care New York/Centene Corporation - 2501 Jackson Ave Long Island City, NY
(2014-08 - 2015-08)
- Performed necessary administrative functions of the program by developing informational handouts/packets, following up on referrals and appointments, and regular tracking and reporting of daily activities.
- Closely followed and tracked all long-term care generated referrals to consistently measure and evaluate individual performance and effectiveness, leading to continuous improvement in outreach efforts to maximize referral opportunities.
- Participated in intake activities as necessary, including general qualification screening, documentation collection, benefit education/applications, site tours, home visits, and other follow-up to aid in the enrollment or education of a prospect.
- Developed and planned a weekly schedule of outreach activities in alignment with outreach strategies and targets as advised by management.
MLTC Case Coordinator - Citi Health Home Care Services - 3018 Glenwood Rd Brooklyn, NY
(2013-02 - 2014-06)
