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Healthcare and well-educated leader with a consistent, proven track record of exceeding performance goals.
Comprehensive knowledge of HMOs, PPOs, Medicaid, Medicare Part A/B and Medi-Cal, as well as payer billing requirements, online billing system and CPT-4, ICD-10-CM and HCPCS codes for rehab.
Proficient with Epic software system.
University of California Los Angeles (UCLA) Rehab Services June 2011-Present
Administrative Specialist (Nov. 2015-Present)
Demonstrate stellar knowledge of healthcare to establish new administrative processes for Cardio-Pulmonary Rehab that optimizes clinical workflow.
Build and maintain relationships with colleagues and patients.
Verify patient insurance information, including eligibility, benefits, authorization requirements, treatment limits, co-payments, deductibles and co-insurance expenses.
Interview patients to determine the party that will be responsible for paying for medical services.
Process Authorization Treatment Authorization requests for Medicaid/Medi-Cal patients.
Estimate costs of procedure/s using Price Index guidelines and explain costs to patients.
Play a key role with securing authorization for durable medical equipment (DME).
Volunteer Administrative Assistant (June 2011-Nov. 2015)
Communicated effectively with patients and clinical staff in person and over the telephone.
Scheduled appointments for physical, occupational, prosthetics and orthotics after determining prescriptions, authorizations and referrals were valid.
Achieved telephone call center performance metrics.
Kleinman & Wallace Dental May 2003-Dec. 2009
Scheduled dental appointments for patients.
Verified the insurance of patients and explained benefits.
Performed bookkeeping-related tasks, including monitoring the daily ledger.
Master of Business Administration (MBA), Ashford University; earned Nov. 2015
Bachelor of Arts (BA), English, University of California, Los Angeles (UCLA); earned June 2008
Acquired knowledge while participating on a number of groups:
On the Process Improvement Committee, examined patient/office workflow processes; assessed productivity for clinical and administrative staff; and created better communicative tactics between clinical and administrative staff to streamline patient care.
On the Access Workgroup, structured a mentoring program that including creating a problem statement; current method/conditions; suggestions for new methods; and expectations/indicators.
On New Patient Workgroup, led a workshop to promote a paperless environment and leverage Epic software.
On the Interviewing Panel, screened prospective employees for a clinical position.
Successfully designed and implemented a blueprint of the administrative process for a partner department s (Cardio-Pulmonary) following the abrupt retirement of an Administrative Specialist.
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