StephanieMartinez

507EAST161STSTREET#11B
Bronx,NewYork,10451
6465446922
SMARTINEZ0284@YAHOO.COM

Objective
Toobtainaresponsibleandchallengingpositionwheremyeducationandexperienceinthehealthinsuranceindustrycanbefully
utilizedandwillhavevaluableinputaswellasroomforgrowth.

Experience
ARCHCARE,NEWYORK,NY
LeadEnrollmentCoordinator,May2012Present

Auditsenrollmentanddisenrollmentapplicationsanddatatocertifyitscompletenessaccuracy.
Ensureproperorganizationanduseoftheenrollmentworkingfilestoverifyenrollmenteligibilitypromptly
andcorrectanydiscrepanciesviainvestigationandcommunicationwithmarketingRepresentativeorpotential
membersneeds.
ProcessmembershipapplicationforeligibleapplicantsinaccordancewithCMSregulationsandinorder
receivedbytheenrollmentdepartmentensuringaccuracyofdataentryandsubmission.
Respondstomemberinquiresviatelephoneandorbymail
.Answeringmultilinedmemberservice/eligibilitycallqueue
PrepareReconciliationadjustmentsandcorrecterrorsasneeded
Prepareattestationreportsasrequired.
LiaisonbetweenArchcareAdvantageandVendorsaswellasCardinalIPAs
AssignmentofaMarketingreferralstoNurses,OutsideVendorsandIPAsforNewYorkStatesUniform
AssessmentSystemandHomevisitscheduling.
TakingdownConflictFreeEvaluationreferralsforprospectiveMLTCEnrollment
CreatingandattestingtocasesinNewYorkStatesDepartmentOfHealthCommerceSystem
TrainingfellowEnrollmentstaffmembersonvariousenrollmentsystems
Handlingofgrievancesandappealsbyresolvingmembercomplaintsinatimelymanner.Functioningasan
informationsourcethroughtelephonicassistancetomembers,Providers,billingagencies,anddepartmentstaff.
AssistanttoMarketingDepartmentinvariousdaytodaytask(CollectionofTimesheets,Expensereports,
SubmissionofMarketingrepresentativesmonthlyMarketingSchedule/EventstoHPMS,aswellascoordination
ofevents,OrderingMarketingadvertisingsupplies,answeringMarketinginquiries)
CentersforMedicareServicesErrorReports
VendorErrorReports
ProcessingandSubmittingmonthlyCentersforMedicareServicesAudit

AFFINITYHEALTHPLAN,BRONX,NY
EnrollmentRepresentative,Mar2011May2012
Responsibleformeetingorexceedingadailygoalof30applications
ResponsiblefordeterminingeligibilityofpotentialmembersoncesubmittedbytheMarketingdept.
Meetingamonthlyqualityrateofaminimum92%orhigher
CreatingandupdatingfilesusingtheFacetssystem
Accuratelydetectedanddocumentedcasesofpotentialfraudandreportedthemtotheinvestigationdepartment.

Education
MONROECOLLEGE,BRONX,NY
HumanServicesCandidate,Expectedgraduation,Jan2018

AdditionalSkills
ProficientinMicrosoftWord,Excel,PowerPoint,AccessandOutlookFamiliarwithMedicaid/CHP/FHP
enrollmentdatabase,EPACESandFacetsSystem.Strongorganizationalandinterpersonalcommunication
skillsCustomerserviceorientedskills.AbilitytomultitaskProveninterpersonalandteamskillsBilingual
Spanish/English

ReferencesAvailableUponRequest