Margaret Cerna

Senior Consultant at HealthCare Information Management, Inc. (HCIM)
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Contact Information
us****@****om
(386) 825-5501
Location
US
Languages
  • Spanish Professional working proficiency
  • English Full professional proficiency
Skills

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Bio

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Credentials

  • Certified Agile Professional
    Six Sigma Global Institute
    Oct, 2021
    - Nov, 2024
  • Word Essential Training (Office 365/Microsoft 365)
    LinkedIn
    Sep, 2021
    - Nov, 2024
  • Excel Quick Tips (2018)
    LinkedIn
    Mar, 2021
    - Nov, 2024
  • Lean Six Sigma Green Belt in Healthcare Certification SSGI
    Six Sigma Global Institute
    Mar, 2021
    - Nov, 2024
  • Agile Requirements Foundations
    LinkedIn
    Feb, 2021
    - Nov, 2024
  • Enhancing Your Productivity
    LinkedIn
    Feb, 2021
    - Nov, 2024
  • Note-Taking for Business Professionals
    LinkedIn
    Feb, 2021
    - Nov, 2024
  • Programming Foundations: Databases
    LinkedIn
    Feb, 2021
    - Nov, 2024
  • Project Management Foundations
    LinkedIn
    Feb, 2021
    - Nov, 2024
  • Project Management Foundations: Requirements
    LinkedIn
    Feb, 2021
    - Nov, 2024
  • Project Management: Solving Common Project Problems
    LinkedIn
    Feb, 2021
    - Nov, 2024
  • SQL Essential Training
    LinkedIn
    Feb, 2021
    - Nov, 2024
  • SQL for Non-Programmers
    LinkedIn
    Feb, 2021
    - Nov, 2024
  • Scrum: The Basics
    LinkedIn
    Feb, 2021
    - Nov, 2024
  • The Top 10 Project Management Mistakes—and How to Avoid Them
    LinkedIn
    Feb, 2021
    - Nov, 2024
  • Time Management: Working from Home
    LinkedIn
    Feb, 2021
    - Nov, 2024
  • Transitioning from Waterfall to Agile Project Management
    LinkedIn
    Feb, 2021
    - Nov, 2024
  • Business Analysis Foundations: Business Process Modeling
    LinkedIn
    Dec, 2020
    - Nov, 2024
  • Business Analysis Foundations: Competencies
    LinkedIn
    Dec, 2020
    - Nov, 2024
  • Communicating to Drive People to Take Action
    LinkedIn
    Dec, 2020
    - Nov, 2024
  • Data Analytics for Business Professionals
    LinkedIn
    Dec, 2020
    - Nov, 2024
  • Effective Listening
    LinkedIn
    Dec, 2020
    - Nov, 2024
  • Managing Project Stakeholders
    LinkedIn
    Dec, 2020
    - Nov, 2024
  • Requirements Elicitation and Analysis
    LinkedIn
    Dec, 2020
    - Nov, 2024
  • Business Analysis Foundations
    LinkedIn
    Nov, 2020
    - Nov, 2024
  • Communication Foundations
    LinkedIn
    Nov, 2020
    - Nov, 2024
  • Excel Weekly Challenge
    LinkedIn
    Nov, 2020
    - Nov, 2024
  • Leading Productive Meetings
    LinkedIn
    Nov, 2020
    - Nov, 2024
  • Project Management Simplified
    LinkedIn
    Nov, 2020
    - Nov, 2024
  • Teamwork Foundations
    LinkedIn
    Nov, 2020
    - Nov, 2024
  • Communicating about Culturally Sensitive Issues
    LinkedIn
    Oct, 2020
    - Nov, 2024
  • Diversity, Inclusion, and Belonging
    LinkedIn
    Oct, 2020
    - Nov, 2024
  • Unconscious Bias
    LinkedIn
    Oct, 2020
    - Nov, 2024
  • Lean Six Sigma: Analyze, Improve, and Control Tools
    LinkedIn
    Aug, 2020
    - Nov, 2024
  • Consulting Professional Weekly Tips
    LinkedIn
    Jun, 2020
    - Nov, 2024
  • Leading Projects
    LinkedIn
    May, 2020
    - Nov, 2024
  • Six Sigma Foundations
    LinkedIn
    May, 2020
    - Nov, 2024
  • ABO Certified
    Certification of Board of Optician
    Aug, 2001
    - Nov, 2024
  • Texas Licensed Life, Health, and HMO Agent
    Texas Department of Insurance
    Aug, 2018
    - Nov, 2024
  • Tax Pro
    H&R Block
    Oct, 2017
    - Nov, 2024
  • HIPAA Certified
    -

Experience

  • HealthCare Information Management, Inc. (HCIM)
    • United States
    • IT Services and IT Consulting
    • 1 - 100 Employee
    • Senior Consultant
      • Jul 2018 - Present

      Work as a Senior Consultant providing client support and guidance in Claim Operations as well as Business Operations flow. Analyze business data and assist in short term or long- term projects in effort to address variety of issues and needs, Work on internal and external assignments as it relates to implementation, enhancement, and integration with supported claim platforms. Provide assistances to clients with claim processing, provider enrollment, contracting, member eligibility, plan benefits; and health plan data reporting.

  • HealthTexas Primary Care Doctors
    • United States
    • Medical Practices
    • 1 - 100 Employee
    • Claims Manager
      • Aug 2011 - Jun 2018

      Oversee Claim Examiners and Customer Service department to ensure processes, deliverables; and accuracy are met. Oversee Data Entry Specialist responsibilities. Manage Eligibility data and encounter data submissions. Develop and retain relationships with current and new clients. Work with internal and external parties. Direct and manage claims staff on appropriate process and procedures. Establish Medicare guidelines and regulations. Manage Electronic Claim Submission processes. Review and Implement Provider Specialty Contracts. Review and Respond to Grievance and Appeals. Review and respond to CMS Non Contracted Payment Dispute Resolution Appeals. Experience in working with 837,835,EPF and text files. Prepare and submit CMS Universe reports. Prepare and respond to Health Plan Annual audits.

  • UnitedHealth Group
    • Hospitals and Health Care
    • 700 & Above Employee
    • Claims/Customer Service Manager
      • Apr 1996 - Jun 2010

      Oversee claims examiners processes, deliverables; and accuracy. Develop and retain relationships with current and new clients. Work with internal and external parties as well as directly with the client during claims process. Oversee Claim and Customer Service staff on appropriate reporting and procedures and phone etiquettes. Oversee Medicare Retiree Group. Managed and implemented Claim workflow processes, Oversee Refund and Overpayment department. Oversee Data Entry Specialist and Provider Adds Specialist. Worked directly with Subrogration, Adhoc, and Pre-existing accounts to ensure resolution was reached in a timely fashion.

  • Sam's Club
    • United States
    • Retail
    • 700 & Above Employee
    • Regional Manager
      • Jun 1989 - Apr 1996

      Managed Optical stores located in the South Texas Region. Provided support and training to Store Managers and employees. Conducted monthly store audit to ensure adequate merchandise is supplied. Monitored and measured store revenue and monthly store budgets to ensure profitable standards are met. Conducted monthly staff meetings. Recruited and hired new employees. Provided training and coaching for new and established associates. Managed Optical stores located in the South Texas Region. Provided support and training to Store Managers and employees. Conducted monthly store audit to ensure adequate merchandise is supplied. Monitored and measured store revenue and monthly store budgets to ensure profitable standards are met. Conducted monthly staff meetings. Recruited and hired new employees. Provided training and coaching for new and established associates.

Education

  • San Antonio College
    1989 - 1991
  • Lanier High School
    High School Diploma
    1983 - 1986

Community

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