Administrative Assistant Medical,medical staff coordinator
Resume:
JESSIE ALVAREZ
Los Angeles, 90065, CA
*******@*****.***// ******.*******@****************.***
OBJECTIVE
To obtain a challenging position as a Credentialing Specialist/Medical Staff Coordinator that will
advance both my educational background and professional experience by contributing my
knowledge/leadership in the management setting that will abide to the policies that will help our
production run efficient in a quick pace environment
QUALIFICATIONS
+2 years’ experience at L.A. Care Health Plan
Contact providers, participating provider groups (IPA’s) regarding outstanding cases/claims.
Received calls from providers regarding outstanding high dollar cases (claims), grievance cases.
Knowledge of contract rates for in network/out of network providers, vendors, facilities.
Billing knowledge of HCFA 1500, UB-04 and how providers need to bill PPO, HMO, and
CCS.
Knowledge software: QNXT, NPPS, Trizetto, Certified Profile (CPF), MHC, Essette, MEIS II
Assist as a Lead in Claims UM dept., by advising co-workers on how to resolve disputes with
providers/ issues in a professional manner and staying compliant with state regulatory laws
Creating providers and linking to groups in QNXT by inputting their information such as N.P.I
#,F.T.I.N., specialty, mailing address, and verifying they have no sanctions within that state for
network. Verify credentialing of rendering/biller providers if attested/certified for services within TX,
WI, and CA offered to our members. Uploading hcpc codes, specific cpt codes providers can provide
for members, Molina’s share of cost contracts for specific projects assigned in queue.
Prioritize projects assigned, as deadlines are implemented by the actual state health plan or state
(government). Providing recommendations in workflow/task so we will not have repetitive errors that
we come across and possibly test out process during pilot programs with IT dept.
Experience in Microsoft Office (Word, Excel, Power-point, Access, Outlook) courses, type
40-50 wpm
EDUCATION East LA Community College June 2011-present Los Angeles, CA
Liberal Arts (Associates Degree) & Criminal Justice Certificate: College units completed: 98 units
Theodore Roosevelt June 2007 Los Angeles, CA
H.S. Diploma
EXPERIENCE
Provider Configuration- Provider Info Mgmt. June 2014-present Long Beach, CA
Molina Health Care Health Plan
Load and maintain provider information into computer system(s) with attention to detail and
accuracy in a timely manner to meet department standards of turnaround time and quality.
Analyze by applying knowledge and experience to ensure appropriate information has been
provided. Analyzing troubleshoots with provider payments as to why the states WI TX CA sends
back issue. Reviewing any claim encounters (CEMS) or information that links providers to
Molina’s members. Audit loaded provider records for quality and financial accuracy and provide
documented feedback. Verifying providers do not have sanctions within that state, adding
specialty, attaching contract rate, affiliation to the Plan, etc.
Authorization Technician/Claims-Medical Mgmt. March 2012-Janurary 2014 Los Angeles, CA
L.A. Care Heath Plan
Creating tracking #/auths for our members with the clinical submitted and
inputting data information and possibly authorizing services or forwarding to RN’s, or
medical director. In addition supporting Claims by handling administrative and technical
functions of the authorization process, work on provider dispute claim special projects,
verifying authorization with delegated PPG’s, cap deducting PPG’s, filtering cases either to
the UM or Grievance & Appeal, assist in meeting regulatory timelines by maintaining
inventory of claim referrals, collecting information from billing providers in order for UM
Clinical staff to render decisions, working in conjunction with other departments,
Irrigation specialist October 2011-February 2012 Los Angeles, CA
Generation Water
Irrigation auditing of water usage on facilities such as L.A.U.S.D., Covina Unified School District,
surveying clients/school districts with forms and inputting through Microsoft excel, emailing
residents/schools who qualified for rain gardens and school audits, creating fliers for our non-profit
organizations volunteer work days.
Internship Administrative Assistant October 2011- Present Los Angeles, CA
Boyle Heights Technology Center (L.A.Y.O.M.)
Greeting visitors and having them sign-in with identification, answering phones calls
consisting of 50-60 calls daily regarding services, filing paperwork, writing letters to parents
regarding the upcoming events for the middle school kids, faxing documents, inputting data into
Microsoft excel, and maintaining the lobby clean.
Program Worker (tutor, coach) May 2008 - March 2011 Los Angeles, CA LA'S Best
Being responsible for 20-25 students, creating/organizing theme events such as Halloween, talent
show, sporting events, enriching kids academically with tutoring [Math, English, History]/ activities
[math games, sport games], filing and scanning documents to headquarters, resolving student/parent
problems, building students’ self-esteem with ice-breakers, serving snacks, weekly activity planning.
Administrative Assistant August 2005 - October 2006 Los Angeles, CA
East Los Angeles Skills Center Adult School
Assist the main office answering phone calls consisting of 40-50 calls daily regarding courses
offered for certified certificates, inputting data using excel, typing up letters to adult students of their
standings within the course they are taking,,filing paperwork, scanning paperwork, being courteous
and respectful to customers, receiving messages from adult students to aware teachers, and printing
paperwork.
VOLUNTEER WORK
Fresh Start 8/2013 Los Angeles, CA
Health Services dept., organizing/informing providers their assigned locations for the event; 411
information booth directing participants to specific areas they inquired on
Care Harbor 11/2014 Los Angeles, CA
Acute dept., guiding patients by completing physical check, & escorting for addtl’ treatment
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