Michelle Menicable

• Implement and manage enrollment & eligibility functions for singular clients via both existing and future technologies (EDI, API, self-service, one-time load, etc.)
• Managing 100 small business groups.
• Support client management with research and develop customer specific resolutions.
• Support client management with both EDI and general Enrollment expertise
• Understand and develop comprehensive knowledge of core enrollment capabilities, channels, guidelines, and requirements.
• Consult with customers/vendors to analyze and understand enrollment needs
• Provide guidance on most effective and efficient enrollment solutions
• Analytical- Identify cause and effect relationships between known variables
• Builds and maintains partnerships & relationships with customers, vendors, teammates, and other business partners

• Serving as the Project Leader for Client Implementation
• Managing 150 key account groups mostly corporations.
• Single point of contact to manage implementation of all products and services for new customers, as well as renewals and plan changes for existing customers
• Document and communicate detailed implementation plans
• Direct, coordinate and drive implementation, ensuring the customer a successful, timely and seamless experience
• Track and monitor the progress and review timelines daily of all functional areas throughout the implementation process
• Manage account implementations, including, but not limited to:
• Structure and billing setup
• Eligibility/enrollment collection
• Plan building
• History conversion/coordination with prior health insurance carrier
• Certificate(s) of coverage
• Health plan ID Cards
• Build and sustain strong customer relationships throughout the implementation process as the primary point of contact, as well as give ongoing support throughout the plan year

Maintain electronic eligibility information submitted by the client/vendor

• Managing 130 groups with combination of key, national accounts and public sectors.
• Work with the group contact to interpret electronic eligibility requirements
• Helping contacts in resolving errors and issues with their EDI file.
• Ensure timely submission and updates to the eligibility system
• Managing enrollment data both electronic, spreadsheet and manual on three platforms.
• Main point of contact during testing for clients who are moving from paper to EDI file feed
• Setting up a call with the third-party vendors to discuss electronic eligibility specs and spreadsheet templates.

• Responsible for retrieving medical records both paper and electronic from different healthcare facilities
• Making outbound call for approximately 60-80 calls per day
• Entering data of successful medical record retrieval
• Updating CRM tool with existing and new leads
• Conducted thorough research to identify trends and inform decision-making for business growth initiatives.
• Led successful sales presentations to prospective clients, resulting in increased partnerships and collaboration opportunities.

• Projects that impact the team including providing updates on project statuses
• Day to day support with regards to process, workflow, and end to end implementation knowledge
• Engaging in projects impacting operational/systematic changes, new product strategies, etc
• Supporting process documentation review/maintenance and training creation
• Bringing identified process gaps to the attention of the leadership/partner team
• Coordination of issue analysis necessary to identify customer specific issues and determine root cause effectively.
• Influencing the business to solve issues using innovative ideas and/or approaches
• Providing consultative insight on operational business impacts
• Supporting new hires during nesting period approximately 15-20 per batch
• Acting as a team lead during the absence of supervisors
• Taking escalated calls
• Advance troubleshooting with the clients

• Assisting clients with their account-related queries
• Payment assistance via credit/debit card and advise of other payment options
• Directory assistance
• Basic troubleshooting
• Responsible for sending technician for problem that cannot be resolved over the phone
• Receiving approximately 70-80 calls per day