Karla Castro Email & Phone Number

Coolidge, Arizona, United States

In contract role for Humana, provide telephonic counseling and support to Spanish-speaking members to ensure ADA regulations are being met by Medicare. Direct members to proper channels by providing direction on next steps. Support providers with ADA-compliant materials and documentation. Communicate with providers and Humana attorneys regarding ADA and Centers for Medicare and Medical Services (CMS) guidelines. Prioritize cases based on urgency. Mitigated potential lawsuits, which could be $1+ million, as liaison with CMS to ensure Medicare services were ADA compliant. Avoided possible civil rights violation by helping HIV-positive member find provider who could meet medical needs after another provider was unable to offer accommodations. Reduced or eliminated Medicare fines through member education on how to provide appropriate paperwork to illustrate compliance.

Acted as member advocate for up to 50 members, educating them on guidelines and requirements. Visited homes twice monthly to provide resources on food and nutrition, medication, financial assistance, home health care, and medical devices. Goal was to avoid rehospitalization through follow-up care and education. Supported up to 800 members virtually as resource for healthcare resources. Conducted research on claims to determine reasons for approval or denial. Trained new employees. Enabled Humana to secure additional Medicare funds by ensuring members completed preventive screenings through incentives and support. Reduced rehospitalization through alignment with Arizona Long-term Care Association to provide in-home care and housekeeping for members. Improved members’ peace of mind by negotiating payments for healthcare services, which helped avoid collections and fines. Encouraged members to build and continue positive health habits by introducing them to community resources, including Meals on Wheels, home modifications, and free medicine.

Supported children and families through increasing levels of responsibility and promotions. Managed all aspects of multiple cases, including site visits, educating parents, and collaborating with various community agencies to provide services. Attended court hearings, and met with childcare providers and schools. Participated in IEP, 504, and child family treatment meetings. Conducted family visits and educated parents about CPS guidelines. Educated families on child development and childcare. Mentored new employees, providing training on policies, systems, and documentation. Participated in forensic interviews as Spanish translator. Supported SWAT teams and police during highly volatile situations involving children. Attended ongoing training about topics to provide optimal services. Recognized as #1 specialist at location for quality of reports and time management. Improved clients’ parenting skills by building supportive, empathetic relationships that transformed hostility and fear to understanding and planning next steps.

Masters, Education With Emphasis In Counseling Human Relations

Bachelor Of Science - Bs, Sociology