Angelo Ramos Email & Phone Number

Middleburg, Fl, Us

Receiving calls from prospected and current members to review their medical needs and get them covered with the best suitable plan for their healthcare needs. Licensed agent and appointed with all top insurance carriers, selling products such as Medicare Options, PDP, and Medicare Supplemental products.

Bilingual Medicare Sales Agent for Kaiser Permanente Medicare Sales LOB. Receiving calls from prospected members and current ones to review their medical needs and get them covered with the best suitable plan option with KP.

Jacksonville, Florida, United States

Provide sales coverage for and develop the best possible market penetration for all Wellcare products to present and prospective accounts in the assigned territory in accordance with the company's policies and programs. Provide greater access to health insurance by providing education and assistance to Medicare individuals. Distribute health education materials and arrange for health screenings. Provide Facilitated Enrollment, help facilitate the continuance of health insurance, and offer assistance with recertification. Identify prospective members and determine eligibility for participation in the Advantage Medicare product. Understand and apply all policies and procedures pertaining to: Disclosures and provisions of the Advantage Medicare product Enrollment and disenrollment. Develop a presence in the local community to help generate enrollments. Conduct home visits and personalized appointments as needed to complete the enrollment process. Market Advantage on-site at hospitals, senior centers, assisted living facilities, community events, and other sites as designated. Understand the covered benefits, non-covered benefits, exclusions, and exemptions; assist members in accessing health care, transportation needs, and other services or issues as they occur and pertain to members. Conduct and participate in telemarketing/outreach efforts as required. Attend and participate in sales meetings, training programs, conventions, and special events—complete applications promptly and accurately.

Orange Park, Florida, United States

Regional patient assistance coordinator for HCA Healthcare in the South Atlantic Division. Reviewed potential indigent patients' accounts and verified eligibility for patient assistance programs for pharmaceutical drugs administered during hospital stays or visits. Coordinated drug recovery and replacement with hospital personnel, physicians, and pharmacy directors for indigent patients. Filled out patient assistance drug recovery/replacement applications and submitted them for physician and hospital representative signatures. Helped escalate and coordinate drug credits to patients' accounts. Assisted with outreach to patients for missing information needed for patient assistant program recoveries and verified Medicaid reports for insurance verification. Retrieved HIPPA release of health information and limited power of attorney (LPOA) for patient assistance programs as needed and coordinated application fulfillment for durable medical equipment (DME) recovery for medical devices with chief financial officers (CFOs) and hospital controllers from the South Atlantic Division.

Miami, Florida, United States

Reviewed and investigated provider claim appeals for Florida Statewide Medicaid Managed Care (SMMC), Medicaid Long-Term Care (LTC) plans, or the Florida Market Place. Investigated the root cause of denial of claims in consideration for review. Processed claim appeals and disputes against Molina's plan and vendors. Processed IHT referrals. Drafted acknowledgment, adjustments, and resolution letters for appeal cases. Ensured timely resolution per Medicare and Medicaid standards as mandated by the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Administration (AHCA). Reviewed CPT/HCPC and ICD9 coding, procedures, and guidelines; reviewed UBC04 claims and HICFA1500 for errors per guidelines and procedures for claim submittal. Reviewed claims for duplicate lines needing correction and balance billing errors. Reviewed provider write-offs due to claim denials for no Medicare reimbursable rates. Reviewed claims for proper coordination of benefits billing.

Miami, Florida, United States

Served as a patient advocate to try to overturn initial plan level denials. Coordinated and investigated all incoming grievances and appeals for both Medicare and Medicaid members against the health plan and benefits covered as notated in the plan's evidence of coverage and member handbook. Prepared acknowledgment and resolution letters for grievance and appeals cases in accordance with the Centers for Medicare and Medicaid Services (CMS). Triaged and directed all matters for grievance resolution to appropriate personnel, such as Utilization Management, Case Management, Quality Improvement, Risk Management, Compliance, and Health Education per established policies and procedures. Prepared Part C, D, and LEP cases to submit to the Independent Review Entity Maximus Federal Services. Followed policies and procedures to ensure compliance was maintained in accordance with CMS guidelines and the Agency for Healthcare Administration (AHCA) for Medicaid cases. Assisted with scheduling Administrative Law Judge Hearings or ALJ's to ensure the Health Plan's presence, Medical Directors, PharmD, and appropriate personnel. Prepared statement of matters packets for Medicaid Fair Hearings and Grievance files for the Subscriber Assistance Program (SAP) cases. Received and resolved provider inquiries related to claims and acted as a liaison between the providers and the health plan. Worked with Customer Service to resolve balance bill issues and other member complaints regarding providers. Fluent knowledge of various Healthcare Systems such as Trizetto, EAM, QNXT, PA-HUB, DentaQuest portal, Beacon/VAM, FLMMIS, and MARX.

Miami, Florida, United States

Provided basic information regarding plan benefits and educated the members in standard procedures. Assisted members in filing organization determinations, coverage determinations, and following the grievance or appeal process. Handled incoming calls from our VIP providers/members LOB, assisted with Health Risk Assessments or HRA's, and completed and documented welcome calls for new members. Helped with returning voice messages left by members when needed.

Miami, Florida, United States

Worked as travel insurance operator and arranged immediate medical assistance such as medical appointments to clinics, emergency room hospitals, specialist or house call services, dental emergencies, repatriations, and burial arrangements for customers traveling to the United States that had Mapfre travel insurance with our affiliates worldwide. Answered incoming calls from affiliates companies, patients, or providers and provided information on ongoing medical assistance. Verified coverage with affiliate companies, requested medical records, and forwarded the information to our affiliates for processing of claims and coordinating medical aid to people traveling outside the United States, the Caribbean islands, and Canada. Conducted audits and reviewed/analyzed data and documentation.

Miami, Florida, United States

Answered incoming calls of members in need of roadside assistance. Assisted in sending out the correct service, such as an accident or regular tows, jump start, lock-out, winch, or fuel delivery service. Answered general inquiries of plan benefits and explanation of coverage and dispatching calls to contracted and non-contracted providers. Advised customers of provider's name and estimated time of arrival time.

Tallahassee, Florida, United States

Enrolled Medicaid recipients in health-managed care plans that participated with Florida Medicaid, such as Health Maintenance Organizations or (HMO), Medipass or (Fee for Service), Provider Service Networks (PSN), and Community Care Networks. Conducted referrals for enrollment into the Children Medical Services Network (CMS). Answered and logged general inquiries/calls. Helped with changing and dis-enrolling Medicaid recipients from health plans. Verified eligibility for good cause changes outside of Medicaid open enrollment. Provided basic information regarding managed care plans, Medicaid options, and enrollment. Assisted with changing doctors for Medipass or fee for service. Assisted with the coaching of new employees.

Tallahassee, Florida, United States

Assisted with training and coaching of new coordinators in reviewing children's applications for Florida Healthy Kids. Assisted in translating Spanish to English documents and making outbound calls to parents to verify missing information. Processed Medicaid Closure files sent by the Department of Children and Families. Verified Medicaid eligibility and citizenship via Florida Systems. Reviewed supporting income documentation to determine program eligibility for Medicaid/Medikids or the CMS network in accordance with the Florida Poverty Level. Completed workflow inventory reports and task tracker correction sheets for application teams 1 and 2.

Tallahassee, Florida, United States

Enrolled Medicaid recipients in health-managed care plans that participated with Florida Medicaid, such as Health Maintenance Organizations or (HMO), Medipass or (Fee for Service), Provider Service Networks (PSN), and Community Care Networks. Conducted referrals for enrollment into the Children Medical Services Network (CMS). Answered and logged general inquiries/calls. Helped with changing and dis-enrolling Medicaid recipients from health plans. Verified eligibility for good cause changes outside of Medicaid open enrollment. Provided basic information regarding managed care plans, Medicaid options, and enrollment. Assisted with changing doctors for Medipass or fee for service. Assisted Recipient Service Manager with the composition and English-to-Spanish script translation for the EDS phone tree menu.

Tallahassee, Florida, United States

Enrolled Medicaid recipients in health-managed care plans that participated with Florida Medicaid, such as Health Maintenance Organizations or (HMO), Medipass or (Fee for Service), Provider Service Networks (PSN), and Community Care Networks. Conducted referrals for enrollment into the Children Medical Services Network (CMS). Answered and logged general inquiries/calls. Helped with changing and dis-enrolling Medicaid recipients from health plans. Verified eligibility for good cause changes outside of Medicaid open enrollment. Provided basic information regarding managed care plans, Medicaid options, and enrollment. Assisted with changing doctors for Medipass or fee for service.

Associate Of Arts - Aa

High School Diploma, General Studies

Activities and Societies: Marching Band

Bachelor'S Degree, Health Administration With Aging Services Concentration And Minor In Business Management