Angelie Martinez Cruz

Researched and resolved pharmacy benefit claim denials for a Capgemini/CVS client by contacting prescribers, insurers, and copay programs; initiated and submitted prior authorizations and enrolled patients in copay assistance, achieving required task closure targets.

Facilitated inbound/outbound enrollment calls for Louisiana Medicaid managed care, guiding members through plan selection and eligibility while ensuring compliance with MMC/Maximus policies.

Coached UnitedHealthcare members on blood pressure self-management, assessed eligibility for complimentary health equipment, and coordinated referrals to nurses and pharmacists for escalated care.

Explained Medicaid/Medi‑Cal benefits and plans, processed enrollment changes and ID distribution, and resolved billing and claims inquiries to improve member experience.

Managed patient calls for medication scheduling and delivery, triaged clinical calls to nurses/clinicians/pharmacists, and completed new patient enrollment assessments to support care continuity.

Provided PBM customer support by explaining plans and prescription claims status, updating member accounts, handling appeals, and meeting call center performance metrics.

Handled high-volume inbound calls, screened and routed patient inquiries, and coordinated appointment scheduling to optimize clinic access and workflow.

Processed pathology accessioning by creating MRNs, entering case/specimen data, tracking slides/blocks, and coordinating FedEx dispatch to originating facilities to ensure report availability for physicians.

Managed radiology patient intake, coordinated distribution of imaging results to patients and providers, and maintained follow-up lists and radiological records to support department workflow.

Managed 80–100 daily incoming calls to schedule appointments, coordinated provider schedules, and maintained scheduling reports using Excel while supporting administrative tasks.

Completed a high school program focused on early childhood education administration, earning a high school diploma.