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Medical Health

Location:
Culver City, CA
Salary:
60000
Posted:
January 31, 2014

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Resume:

Stephanie Ashford

***** ****** **

Palmdale, CA *3550

310-***-****

Summary: A detailed-oriented professional with experience in the health

care and social services industry. Major strengths include: Windows 2010,

PowerPoint, Microsoft Word, Excel, AS400, Virtual Chart, Sandis, Medical

Terminology, Law Enforcement Terminology, Knowledge of EPO/POS/PPO

policies, Knowledge of HIPAA/JCAHO/NCQA/URAC standards, Type 65-75 wpm,

excellent communication, writing and interpersonal skills.

Education:

California State University Long Beach, California

Masters of Science in Healthcare Administration (12/2007)

California State University Long Beach, California

Bachelors of Science in Healthcare Administration (05/2004)

University of Southern California, Los Angeles, California

Nursing Program Candidate, Health Science Campus (08/1998-01/2000)

Life, Accident, & Health License (01/2014)

Experience:

AC Hospice, Inc. 12/13 to

present

Director of Operations/Assistant Administrator

. Supervise Personnel/Disciplinary Action of employees

. Oversee Operations of all Hospice Services

. Employee Orientation/In-Service Trainings

. Ensuring JCAHO compliance/ Internal audit compliance/ Chart Review

. Grievance and Incident Reporting

. Organizational Billing/Health Plan coordination/Check Benefits and

Eligibility

. DME Contract Negotiations and other supplies

. IDT Meetings/ Collaboration with all disciplines regarding patient

care

. Field Visits/ Track Certifications of Terminal Illness reports

Molina Healthcare of Long Beach 08/12 to

12/12

Utilization Management Coordinator (Contract)

. Obtains appropriate information for authorization request entry/claims

processing/DRG

. Requests clinical records per procedure.

. Accurately applies appropriate policies, procedures, and stop loss,

eligibility, and benefit policies/PDR

. Refers requests and notifications to appropriately licensed health

professional for review.

. Accurately documents all activities as per policy including entry into

automated systems.

. Interacts with the providers or members as appropriate to communicate

approval outcomes in compliance with state, federal and accreditation

requirements.

. Performs hospital notification functions.

. Reports suspected fraud and abuse as per company policy.

. Performs required clerical support duties.

. Maintains confidentiality of all PHI in compliance with state and

federal law and Health Net Policy.

Anaheim Adult Day Care, Anaheim, California 05/10

to 05/11

Program Director (Non-Profit/Behavioral Management Program)

. Knowledge of Title 17 and 22 requirements/Regional Center policies

. Recruit, employ, evaluate, supervise, and train staff/Reconcile

Payroll

. Coordinate job development and Consumer Employment/Interviews

. Maintain communication with care providers and families/Maintain

Client Census

. Maintain employee files/Attend Semi-annual and Annual meetings

. Process referral packets and Conduct In-service Trainings/Community

Resources

. Audit Personnel and Client Charts/Generate Data Collection Materials

and Life Skills Training Materials

. Review and document all Special Incidents

. Develop and write behavior intervention plans/Intake Assessments

Fresenius Medical Care, Van Nuys, California 10/09 to

05/10

Financial Coordinator

. Explores, recommends, and coordinates the varied financial assistance

options available to FMS kidney dialysis patients/Counseling Patients

. Provided Financial Waivers and Grants through the American Kidney

Foundation

. Ensure the provision of the best financial resources possible for each

patient in the assigned clinics while maximizing revenue for the

company

. Collaboration with Social Security Office, Medi-Cal, Medicare, COBRA

Administrators, and Commercial/Private Insurances

. Applies policies and procedures of stop loss, benefits and eligibility

appropriately

. Occasional Travel as needed

Los Angeles County Sheriff's Department, Monterey Park, California

05/08 to 09/08

Deputy Sheriff Trainee

. Academy instruction in department policies and procedures

. Defense Tactics

. Criminal and civil law concepts

. Physical fitness techniques

. Use of firearms, arrest procedures

. Operation of emergency vehicles

South Central Los Angeles Regional Center, Los Angeles, California

5/06 to 05/08

Case Worker/Service Coordinator (Non-Profit/Social Services)

. Good client interview skills/Case Management-Special Needs/ Report

Writing-IPPs

. Request Funding-POS Authorizations/ Caseload of 91 families

. Clinical/Social Agency Knowledge/ Attending IEPs and ISP meetings

. Knowledgeable of Conservatorship, Disability laws and Lanterman Act

. Community Relations/ Initiating Interdisciplinary Teams/Client

Advocacy

. Extensive interaction with Program Managers, Vendors, Behaviorist, and

Specialists

. Initiate Special Incident Reporting, Coordinate Services/Community

Resources

. Occasional Travel as needed

Prospect Medical Group, Santa Ana, California

3/06 to 5/06

Data Analyst

. Responsible for collecting, analyzing, and reporting data related to

operational metrics.

. Creates databases to track operational performance

. Develops and analyzes operational performance reports (e.g., for

claims data, provider data, utilization data)

. Collects and analyzes data to create summary statistics of performance

. Creates and publishes periodic reports as well as any necessary ad hoc

reports

. Performs other duties as assigned.

United Healthcare, Long Beach, California

10/02 to 5/04

Intake Notification Coordinator

. Pre-approved outpatient and inpatient medical services, discharge

planning, quoted benefits/eligibility, adjusted claims, resolved claim

issues, complaints/ICD-9/HCPC Coding and liaison between utilization

review and providers.

. Administrative support, benefit/policy/stop loss education, claims

processing, DRG, PDR, securing patient confidentiality.

Managed Health Network, Los Angeles, California

10/00 to 12/01

Intake Specialist

. Authorized behavioral health services, resolved client and provider

complaints.

Pre-certified outpatient and inpatient services, assisted in quality

improvement and generated explanation of benefits, claims

adjustments/processing, DRG, provider negotiations of single case

agreements, quoted benefits/stop loss/eligibility coverage, PDR, and

training and acted as assistant supervisor.

References:

Available upon request



Contact this candidate