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Medical Assistant Manager

West Palm Beach, Florida, United States
August 22, 2018

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Bachelor’s Degree Interdisciplinary Studies

Keiser University, West Palm Beach, FL

Medical Assistant (MA) Program and Associates, Medical Administration

Pima Medical Institute, Albuquerque, NM

Associates Degree, Integrated Studies/Business Admin, HR, Law and Ethics,

Central New Mexico Community College, Albuquerque, NM


Lean Six Sigma Training, September 2015

Centennial Care Training w/ Certification, November 2013-2015

Marketplace/ ACA Training w/Certification, September 2013-2015

Medicare/Medicaid Training Certification, May 2013-2015

Compliance Training Certification, April 2013-2015

HIPAA Security & Privacy Certification, April 2013-2015


Accounts Receivable Specialist/Medicare- Infusion Services

CVS Health, Phoenix, AZ. (November 2017-July 2018) Relocated back to Florida

Assist in the resolution of denials, partial payments, and payment variances for Patient Financial Services (PFS)

Maintain and release all-ship-verified claims for all third party claim accounts within established time frame as assigned, Resolve errors and make claim edits assigned in work queues, Credit/Recharge

Follow work list prioritization of accounts for resolving accounts and/or submitting claims, Contact payers and patients when necessary for PFS processes, written reopening’s and appeals

Request relevant information from appropriate Revenue Cycle and clinical departments as required through the course of the PFS processes - Make necessary adjustments to patient demographic, insurance, and account balance information, conduct QA audits, prioritize age buckets and specialty projects.

Complete A/R adjustments, request other adjustments, build templates and instructional/informative PowerPoint presentations Adhere to all regulatory compliance areas, policies and procedures

Proficient in performing and assisting others with Excel spreadsheets, Cintix, ERN, MediAR, ePremis, HC360, Med-Metrix, Revenue Recover, Emdeon, CGS and Noridean Websites

Reviews Processor II/ Claims Analyst, HR Assistant

Molina Healthcare, Albuquerque, NM. (April 2013-Feb. 2016)

Process all requests/approvals/denials regarding member PHI (Protected Health Information).

Format, review, and create Centennial Care Program P & P’s (Policy and Procedure forms).

Provide ongoing monitoring and serve as an advisory on compliance and potential fraud matters.

Participated with the Anti-Fraud, Waste and Abuse Program (FWA) & Government Contract team.

Train CRP’s, RN’s & LPN’s in CCR & PA (prior-authorization) processes, prepared for & preside at NCQA audits.

Process CCR Medicaid & Medicare admissions, reviews, discharges and denials, Care Coordination

Assist in the claims flow processes, review and update claims. Prepare for appeals and CIR’s

Created step-by-step instruction materials, interview, train and support; implement Lean Processes

Recruitment, onboarding, job placement, back ground research & continued ed. verification


Merchandiser, HR Assistant, WIS International, Colorado Springs, CO. (February 2007-November 2008)

Performed hands-on/onsite inspections, daily, weekly and monthly audits. Perform interviews.

Designed, created, built and dismantled displays. Recruited and serviced new accounts.

Customer service and maintained relationships between store owners and our company.

Office/Operations/HR Manager, Timberline Spraying & Services, Woodland Park, CO. (January 2004-April 2006)

Responsible for corporate financial accounts, A/R & A/P. All human resources duties.

Handled all the day to day clerical and office duties including high phone volume, customer relations, mail correspondences, scheduling of appointments, and supply maintenance.

Formed the operations structuring of pesticides, inspections, and qualifications logs.

Office Manager, HR Mgr., Claims Specialist, Trainer, Physiotherapist/CA, Straight Chiropractic, Chandler, AZ, & The Gym Doctor, Gilbert, AZ. (January 2000-December 2003)

Worked hand in hand with patients to create beneficial and effective rehabilitative exercise programs.

Excelled at all general front and back office duties including educating and training of those skills to new hires.

Composed and edited written communications, dictations, and Dictaphone transcriptions.

Developed & maintained a system for storage, ordering, receiving, displaying, & distributing.

Efficiently handled high phone volume, set schedules, & made payment arrangements.

Performed re-exams, prepared & developed patients x-rays, instructed rehabilitative exercises, performed massages, EMS, inter-segmental traction, heat &/or ice therapies.

Handled ins. verifications, processing, billings, and coding. Physician/Attorney liaison, prepared legal narrative.

References available upon request

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