Cindy Hoffmann Email & Phone Number

Kerrville, Tx, Us

• Experience with Medicare Advantage (MA) plan members and MA insurance and/or Medicaid case management. • Engage individuals over the phone, data entry, and related computer skills. • Excellent verbal and written communication skills; ability to communicate with elderly individuals. • Ability to analyze and interpret benefit program criteria; ability to interact and decipher information via telephone or correspondence inquires • Effective communication skills, orally articulate, have good written communication skills, and also be good listeners; Judgement; Analytical skills; Research skills; People skills; Perseverance; Creativity.

• Meet production/departmental goals by answering inbound calls and conducting telephonic outreach activities to screen MA plan members to determine pre-eligibility status for additional benefits. • Meet daily, weekly, and monthly performance goals related to schedule adherence, telephone availability. Working rate and completion of follow-up assignments. • Meet quality standards by ensuring proper phone etiquette and adherence to scripts, have accurate and descriptive case documentation, and proper disposition of cases. • Conduct follow-up activities for processed correspondence and/ or inquiries from BeneLynk Outreach initiatives. • Participate as required in BeneLynk staff and operational development programs. Be a team player and communicate openly and honestly

• Documents all patient interactions in a concise manner that is compliant with documentation requirements for Model of Care, NCQA and Center for Medicare and Medicaid Services (CMS) regulations. • Receives and responds to incoming Care Coordination inquiries from all communication venues: e.g. phone queue, TrueCare, portal, claim queue, department e-mail box or RightFax • Document eligibility, benefit, and authorization information in accordance with established guidelines, while meeting or exceeding daily, weekly and monthly production goals. • Research patient accounts due to invalid and/or missing authorization information and correspond with clients, insurance companies, patients, sales representatives to obtain the necessary information to ensure accurate, timely and complete claims submissions. • Communicates and works effectively with colleagues from other departments. • Follows written and verbal communications • Maintains knowledge of all health plan benefits, network, CMS, regulations, health plan policies

• Review patient’s chart under Orders Management and Eligibility Status. • Process referral if less than 6 months. • Contact patients by phone that have referrals over 6months old with further clarification • Request records from patient. • Contact Clinical and Hospital facilities to obtain Clinical notes for Dates of Services that have occurred in order to close an open referral that can now be completed. • Task PCP, NP requesting to close Old Open Referrals that meet criteria. • Document communications, actions, and other data in an information system. • Mail out Certified letters to patients. • Send out Alerts for patient’s coming in for MHM appointments to have them follow up with SRS after their appointment. • Schedule appointments through NextGen book appointments for Registration so patient may come in and provide needed documents for possible Methodist Health Care Services. • Keep an update of progress daily on Excel Spread Sheet. • Send out Total numbers of Open Orders Closed.

• Focuses on the improved documentation of acuity for the capitated GMG patient population through the Review Medical History process, intake visits and other outreach efforts. Also helps with other Manage Care Plan projects • Maintain accurate database of GMG Capitated patients, update database monthly form enrollment and disenrollment reports. • Accurately update the database to track each stage of the Review Medical History process. This is vital to an effective process and accurate reports. • Confirm all information in Centricity is accurate with database and insurance by verifying current active insurance through Availity, UHC and or WellMed. • Prepare audit documents as defined; create logical batches reviewers. • Process completed audits for timely data entry into EMR. • Run appointment reports; notify providers and staff of patients on the daily schedule that needed Review Medical History completed. • Document appropriately in GMG computer system, Review Medical History database and other associated systems. • Successfully meet production goals. • Exercise tact and courtesy when dealing patients, visitors, physicians, and co-workers. • Able to work efficiently under pressure. • Maintain strict Confidentiality

Responsible for satisfactory completion of training program for Case Specialist Trainee Answer phones from automated call distribution system Triage daily download of referrals and ensure appropriate worksheets are assigned to corresponding conditions as identified by Veteran’s Administration Vaerify appropriate CPT and CLIN codes are assigned to each case Utilize eClinical Works and eProcess Communicate directly with claimants and providers Obtain medical history for specific conditions Determine appropriate examinations, tests and specialists required for each case Schedule appointments for examinees including follow-up appointments and rescheduled appointments Ensure all examinees and providers receive necessary documentation Confirm consultative reports and diagnostic test results are received in a timely manner Meet or exceed contract timeliness guidelines in both the scheduling and case management systems Other projects and duties as assigned.

Greeting patients and visitors, in person or on the telephone; answering or referring inquiriesVerify patient’s insurance information and coverage for day of procedure.Verify referral is on file. If no referral on file obtain referral on web.Maintains patient accounts by obtaining, recording, and updating personal and financial informationCollect ID and insurance card to scan for outpatient surgery.To provide assistance in understanding and resolving patient financial responsibilities. Provide a personal contact for patient/guarantor in understanding the intricacies of patient payment, payment methods, and alternatives.Determine copays, deductibles, out of pocket, billing, cash collection.Have strong communication skills and be able to handle stressful, uncomfortable situations.Protects patients' rights by maintaining confidentiality of personal and financial information.Comforts patients by anticipating patients' anxieties; answering patients' questions; maintaining the reception areaEnsure complete and accurate registration, including patient demographic, Data entry, and current insurance information.Monitors electronic referral boxes in EMR throughout the day to capture referral requests in real time.Prepares and processes all referral and pre authorization paperwork.Gathers pertinent information as needed via EMR or from clinical team.Contacts various clinics, facilities, companies to obtain information to accurately complete referral/pre authorization requests.Calls patient within 48 hours of initial referral to provide update.Flags Provider and or MA within 48 hours of initial referral to provide update.Utilizes EMR functions to document all pertinent informationMaintains confidentiality by following all applicable HIPAA regulations.A team player who demonstrates an enthusiastic, caring and compassionate commitment to the patient and their unique circumstances.

Assist and Review inpatients and out patients to determine the requirements of what is needed for CareLink illegibility.Work with Case Managers, Social Workers, Cardon, CTRC, Admissions office, and CareLink phone center on getting in-patients and out-patients screened and seen for enrollment.Utilize time management skills to effectively execute all assignedAssist members in resolving any CareLink issues, and complaintsResolve all urgent or complicated cases involving members.Screen accounts for proper possible CareLink Enrollment.Work Patient Online Requests to productively schedule CareLink appointments