Edlyn Viloria Email & Phone Number

Brooklyn, New York, United States

Brooklyn, Ny

Manage the Entitlement (Medicaid) & Enrollment department for Alphacare's Managed Long Term Care Plan.

United States

o Conducts orientation and training with new staff on policies and procedures, criteria for the Revival Choice MLTC program, home and facility visit(s) for comprehensive health reassessment including, behavioral and home safety requirements on potential members, educate applicant, family and/or caregiver(s) on program benefits. o Ensure training materials are updated as changes occur. o Answer questions related to enrollment by clinical and non-clinical staff. o Track assessment schedule on a timely basis within the clinical system to ensure staff is on task with priorities and deadlines. . o Ensures staff enters visit and assessment information in TRUCHART System and state assigned data entry program accurately and timely.o Conducts weekly/monthly meetings as needed with staff. o Ensures compliance within the department’s activities where Federal and State laws are applicable. o Receive, assess, research, resolve, and respond to potential member issues. o Identify trends based on issues brought by the Enrollment staff. o Generate reports as needed for staff, supervision, and management. o Develop, monitor, and evaluate staff performance standards. o Maintain effective relationships with external vendors in the community and internal management staff.

Brooklyn, New York

Ensure completion and accuracy of new member enrollment information for timely submission of cases to enrollment broker.Coordinate, and track new referrals.Establish working relationships with referral sources.Maintain contact with referral sources to provide feedback on enrollment status, concerns, need for additional information, and assistance in contacting potential members.Coordinate home visits for assessments, reassessments when needed due to expiration of initial assessment prior to enrollment, and follow up visits as needed.Assist Intake Nurse and Entitlement Coordinators in planning, contacting, obtaining, and coordinating visits as requested or needed.Develop and oversee training program of all staff participating intake and enrollment process.Monitor trends in referrals to determine reasons for enrollment, reasons for selecting other care options, reason for denials. Monitor market trends relating to health care policy and member demographics.Participate in Quality and Member satisfaction initiatives for continuous improvement of marketing and marketing and enrollment staff, member retention and satisfaction.Manage enrollment team including inquiry, eligibility determination and application process.Ensure compliance with all applicable regulations.

New York Ny

o Screen and explain the program to potential clients.o Receive, input, and verify insurance for new incoming referrals. o Assign all referrals to RNs and outsourced agencies for home assessments or to Medicaid Specialist if client has not Medicaid or RVI 3 Conversion.o Track all pending enrollments and follow up with New York Medicaid Choice –Maximus.o Follow up with Lombardi and Nursing Homes to remove exception code on client’s Medicaid.o Provider Liaison for the Central Intake Unit at New York Medicaid Choice – Maximus, HRA, DSS Westchester, Nassau, and Suffolk County.o Review, approve and process Consulting Services for payment.

o Screen and explain the MLTC program to potential enrollees.o Receive, input, and verify Medicaid coverage for new referrals. o Submit Medical record to HRA for approval to MLTC program. o Track all enrollments and Disenrollment’s with New York Medicaid Choice/Maximus, HRA, DSS Westchester, Nassau and Suffolk County.o Provider Liaison for the Central Intake Unit at New York Medicaid Choice/Maximus, HRA, DSS Westchester, Nassau, and Suffolk County.o Submit all Deferrals, Recind, and Withdrawal letters to New York Medicaid Choice/Maximus, HRA, DSS Westchester, Nassau, and Suffolk County.o Enter SAAM’s into DELTA State Program.o Create Financial Billing Roster on a monthly basis for the Finance Department.

-Process referrals and assign them to the Membership Development RN.-Submit enrollments, disenrollments, and conversions to HRA. -Verify patient's Medicaid eligibility and Medicare Part D Information.-Assist Membership Development Manager, Supervisors and RN's with medical record completeness. -Track referrals and update the vendor agencies, CHHA's and State agencies.

Registered new patients, scheduled appointments and recurring therapy sessions.Verified patients insurance, processed claims and medical codes into MediSoft.Maintained company info in MS Excel spreadsheets for owners.

Serviced three separate departments.Arranged meetings, travel arrangements, car services for employees.Maintained and updated phone list, attendance records, schedules, supplies.Met with prospective clients and vendors. Assisted management preparing and reviewing financial statements.

o Serviced three separate departments.o Arranged meetings, travel arrangements, car services for employees.o Maintained and updated phone list, attendance records, schedules, supplies.o Met with prospective clients and vendors. o Assisted management preparing and reviewing financial statements.

Answered all calls, assisted tenants, and maintained all clerical work.Assisted HR manager on daily tasks.Processed accounts payable, accounts receivables, and leases.