Lynette Diaz

Community Outreach Specialist

United Healthcare

Nov 2017 - Current (8 years 8 months)

Investigate, identify, initiate and respond to opportunities to create or participate in marketing activities that lead to membership growth. Assist with planning, implementing and coordinating both sales and non sales events for all assigned products. Tracks and measures various sales event effectiveness. Assists with designing and measuring overall sales event strategy. Provide input, support and feedback on promotional opportunities, benefits, and other issues. Prepare preliminary budget recommendations for each approved event. Ensure all events are properly filed with appropriate regulatory agencies through the established UHC process. Identify, develop and maintain strong relationships with key community partners. Serve as an ambassado

Population Health Pre-Engagement Specialist

Lehigh Valley Health Network

Mar 2017 - Dec 2017 (10 months)

Responsible to support provider solutions. Interact with clinical team members, patients, providers and manage internal and external vendor and stakeholder relationships. Engage beneficiaries to enroll in care management services/programs. Review client data and refer to appropriate clinical resources based on patient need. Integrate clinical care coordination with disease management efforts to achieve low cost interventions that achieve the greatest benefit and increase the accountability of patients for management of their disease. Continually evaluate payor data providing feedback to staff to improve clinical gap closure related to evidence based care. Complete Transition of Care calls in accordance with department guidelines and payer e

IMS HRIS Service Center Coordinator

IMS Health

Oct 2014 - Jul 2016 (1 year 10 months)

First direct and indirect contact (i.e. email and phone) of employees, retirees, managers, HR and agents. Assist with inquiries about health and welfare benefits, payroll, company policies, HR Processes and Human Resources Information System (HRIS). Responsible for providing superior customer service while trouble shooting and resolving queries in a timely and effective manner. Document query records and assist HRIS with developing a knowledge base of standard answers to frequently asked questions enabling self service capabilities for employees and managers. Performed data entry, audit on FSA claims, Payroll changes and payroll report audits. Assisted with entering updates on the system, acquisitions and gave support to other team members

Project Coordinator/ Community Services Specialist

Altegra Health

Jul 2012 - Jun 2013 (1 year)

Coordinate home and office visits with different health plans and providers over the phone in PR and the US. Scheduled and Coordination of Clinics. Assist and provide beneficiaries from PR and the US, with available public and private benefits or services available in each state. Verify insurance coverage. Assist with inquiries regarding benefits and programs available. Contribute to team effort by accomplishing monthly goals.

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Appeals and Denials Coordinator

Compcare of PR

Sep 2010 - Jul 2012 (1 year 11 months)

Authorize psychological treatments and coordinate services with facilities. Process appeals and denials for inpatient care and pharmacy services requested. Answer inbound telephone inquiries regarding appeals and denials. Create and send the denials letters to providers and members. Assist other departments with Customer Service inquiries.

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Provider Relations Specialist

Medicare y Mucho Mas

May 2008 - Sep 2010 (2 years 5 months)

Provide exceptional customer service by supporting the Claims team and responding to inquiries from providers. Answer provider inquiries regarding verification of benefits and Claims status for office services and hospital claims Verify payment status, review claims spreadsheets and plan documents. Display strong clinical skills, and comply with HIPPA standards. Update and maintain provider data. Assist providers and billing representatives with the installment or any issues with the IMCLAIM system. Provide customer service to insurance members when needed.

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