Experience

Caduceus Medical Group

• Hospitals and Health Care
• 1 - 100 Employee

• Business Development /Marketing

  • Aug 2016 - Present

• Risk Management & Concierge

  • Aug 2016 - Present

  -Analyze patient utilization to determine legitimacy of patient compliance, treatment, and follow-up / post-treatment care. -Input patient healthcare facility to comply with government and insurance company to ensure patient received proper care and to follow reimbursement policies. -Analyze daily patients' follow-up care and assure accrediting agency standards to determine criteria concerning patient care and satisfaction, treatment, and continuity of care. -Work with MD's and practitioners to guarantee accurate charting and ensure quality patient outcomes. -Promote our services, highlight our impact, and build our relationships with the community. -Develop and actively manage referral base.



Independent Contractor

• Freelance Paralegal & Executive Administrator

  • Feb 2016 - May 2018

  -Assist with contractual issues by researching contractual history to assure compliance.-Conduct client interviews and maintain contact with clients.-Provide exceptional customer service by answering client inquiries and assisting clients with paperwork.-Maintain electronic and paper filing system, including scanning, saving, and organizing documents.-Assist with scheduling of clients and professional staff.-Hire, manage, train, review, and set goals for department and staff.



Scripps Health

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Patient Service Representative III

  • Sep 2013 - Dec 2016

  -Provided exceptional customer service to help clients feel calm and comfortable.-Managed and operated multiline phones. -Responded to customer inquiries in a timely and accurate manner.-Assisted with the scheduling, authorization, and follow-up for customers.-Maintained accurate records by advancing registration and updating customer demographics.-Coordinated departments and hospital to schedule surgeries.



It's All About You, LLC

• Owner, Operator

  • Dec 2010 - Dec 2013

  -Oversee end-to-end process including client acquisition to marketing sales. -Responsible for all facets of contract development, including analysis, negotiation, and closeout. -Identify and work with new business areas to assign closeout responsibilities and pinpoint process improvement areas. -Manage multiple, concurrent processes, and, where necessary, strategically prioritize to ensure all deadlines are met.



Keller Williams Realty

• United States
• Real Estate
• 700 & Above Employee

• Director of First Impressions and Transaction Coordinator

  • 2010 - Feb 2011

  -First point of contact for office -Managed calendars, databases, and data entry-Answered phones and directed calls to appropriate person -Managed, organized, and executed multiple projects and events including Project Green and Feed America-Assisted realtors with open houses, contracts, and sales



Coronado Eye Associates

• Administrator & Surgery Scheduler

  • Dec 2008 - Dec 2009

  -Hired and managed a staff of five, conducted daily officer operations, and gave regular performance reviews.-Communicated with patients to assure continuity of care with post-operative appointments.-Coordinated contractors and meetings between doctors and external entities.-Scheduled surgeries and follow-ups for pre and post care.-Assured patient compliance with physician recommendations.-Reviewed and assured compliance with HIPPA regulations.-Provided data, reporting, and specialized office assistance.-Fostered a seamless and efficient service network.



Coventry Healthcare

• IT Services and IT Consulting
• 1 - 100 Employee

• West Coast National Account Manager & Administrative Coordinator

  • Dec 2007 - Dec 2008

  -Responsible for managing and supporting all aspects of Provider Relations for all reimbursement products including Medicare, Medicaid and all managed care plans.-Evaluated the provider network to ensure membership access and develop recruitment plans.-Effectively maintained relationships with other department managers and served as main liaison between care management and care management coordinators.-Managed servicing Hospital, Ancillary, and long-term Care Providers for all products offered.-Actively participated in escalated claims issues by facilitating meetings with providers and coordinate research of claims issues internally.-Provided continuous training to team members to ensure that they possessed the required knowledge and information to effectively carry out their responsibilities.-Created and maintained provider relations newsletter, provider directory, and provider manual.-Managed the process of credentialing and re-credentialing.-Managed work plans for staff in order to accomplish objectives.-Developed provider network applications in order to efficiently run reports and manage network.-Effectively interpreted provider contracts to ensure accuracy of rates, policy and procedures.



Primary Provider Management Company, Inc.

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Vice President of Provider Relations and Client Services

  • 1984 - 2007

  -Selected to work with Medical Directors & Administration for knowledge of utilization review and ongoing credentialing/quality assurance for 470 medical providers in California.-Ensured all providers were knowledgeable of, and in compliance with PPMC contracts and the Department of Health Services (DHS). -Acted as a liaison between Providers, Medical Director, and upper management. -Regulated compliance with Medicare/Medicaid rules & regulations and audited medical documentation. -Provided exceptional customer service and built effective relationships between departments and providers within the organization.-Worked with our providers on coding and documentation. -Provided excellent customer service to Medicaid population to ensure access to care. -Developed policies, procedures and standards for all department activities and processes. -Developed and monitored departmental budget.-Ensured compliance with all CMS (Center for Medicare & Medicaid Services), and State Medicaid regulations.-Directed and implemented strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs.-Ensured that all grievances & appeals were processed in adherence to the Centers for Medicare and Medicaid (CMS) guidelines and plan policy.-Prepared case files for Medical Director Review and external (including IRE) review of grievances & appeals.-Prepared clear, objective, accurate and comprehensive case histories for consideration at committee meetings (including Board of Directors).