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.
• Communicates and works effectively with colleagues from other departments.
• Follows written and verbal communications

• 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.

• 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.
• 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.

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.

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.

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.