YESENIA LOSOYA
Long Beach
Summary
Detail-oriented Care Coordinator with expertise in comprehensive assessments and care coordination for C-SNP members. Experienced in conducting Health Risk Assessments, verifying diagnoses, and educating members on plan benefits. Knowledgeable in CMS and HIPAA guidelines, fostering interdisciplinary collaboration, and delivering quality case management to enhance health outcomes for high-risk Medicare populations.
Overview
4
4
years of professional experience
Work History
Care Coordinator
SCAN Health Plan
2025.09 - Current
- Perform initial and annual Health Risk Assessments (HRAs) for C-SNP members to determine appropriate interventions and referrals.
- Verify qualifying chronic condition diagnoses to ensure C-SNP eligibility compliance, collaborating with providers to obtain required documentation.
- Apply motivational interviewing techniques while proactively managing assigned caseloads through report review, timely outreach, through follow-up, and collaboration to meet team performance goals.
- Educate members on plan benefits and connect them to community resources using the SCAN Findhelp platform.
- Act as a triage point of contact for members, providers, and medical groups to resolve access to care and benefit-related issues.
- Utilize MedHOK, ika Claims System, and Genesys to document member interactions, manage cases, and conduct outreach in accordance with CMS and HIPAA standards.
Care Connections Representative
Molina Healthcare
2022.07 - 2022.12
- Made outbound calls to Molina members across 14 states and set up approximately 30 preventive care appointments daily.
- Facilitated communication between patients, nurse practitioners, and administrative staff using Epic system to update member contact information and document detailed interactions.
- Used Transunion database to obtain desired information on members and complied with Health Insurance and Portability and Accountability Act (HIPAA).
Healthcare Administration Intern
Cambrian Home Care
2021.10 - 2021.12
- Conducted project and designed pivot tables to identify key company locations for targeted caregiver recruitment based on client and payer needs.
- Installed and configured equipment for employee use, ensuring operating systems and software compatibility.
- Diagnosed and resolved faults based on technical knowledge and use of pre-scripted repair trees.
- Performed system updates and troubleshot issues on over 50 administrative computers to maintain optimal performance.
Education
B.S. - HEALTHCARE ADMINISTRATION
CALIFORNIA STATE UNIVERSITY LONG BEACH
CA, USA05.2022
A.S. - BIOLOGICAL SCIENCES
LONG BEACH CITY COLLEGE
CA, USA06.2020
Skills
- Care Coordination & Case Management
- Health Risk Assessments (Initial & Annual)
- CMS & HIPAA Compliance
- Patient Advocacy
- Motivational Interviewing
- Data Entry & EMR Systems
- Microsoft Office (Word, Excel, Outlook, PowerPoint)
- Team Collaboration & Goal-Oriented Performance
- Bilingual: Spanish/English
Certificates And Awards
- First Aid, CPR, and AED Certificate, American Heart Association, 05/22
- How to Build Credibility as a Leader Certificate, LinkedIn Learning, 05/22
- President's Honor List Award, Jane Conoley, Fall 21 & Spring 22
Timeline
Care Coordinator
SCAN Health Plan
2025.09 - Current
Care Connections Representative
Molina Healthcare
2022.07 - 2022.12
Healthcare Administration Intern
Cambrian Home Care
2021.10 - 2021.12
B.S. - HEALTHCARE ADMINISTRATION
CALIFORNIA STATE UNIVERSITY LONG BEACH
A.S. - BIOLOGICAL SCIENCES
LONG BEACH CITY COLLEGE