Objective:

Results oriented professional with a strong medical background and education seeking a position within the Healthcare Industry that will allow me identify issues, conducts analyses, synthesize conclusions into recommendations and implement change.

Education:

University of Phoenix

Bachelor’s of Science in Business Management

Master of Business Administration

Skills:

Microsoft Access, Excel, Word, Power Point

MS Dynamics

Financial planning and variance analysis

MHC

QNXT

EZ CAP

Communication Skills

Crystal Reports

Fluent: Spanish and English

Written and Oral Presentation

Team Worker

Creative and resourceful

Relevant Work History:

HealthSmart Management Services Organization, Inc 1/2016- Current

Senior Financial Analyst

L.A. Care Health Plan 2/2012-10/2016

Senior Financial Analyst

Performed Shared Risk financial analysis to highlight areas of inconsistencies, identify trends, derive implications and benchmark results using key operations metrics and performance measurements.

Analyzed and reviewed DOFR

Worked closely with PPG on Shared Risk

Participate in team efforts aimed at providing end-of-month financial close activities and the development and monitoring shared risk progress and impact.

Formulate financial spreadsheets and models/pivot tables to demonstrate financial calculations and results and facilitate analysis and interpretation.

Processed Journal Entries and monthly accruals. Tracked Auxiliary Invoices and calculated estimated accruals for each vendor.

Analyze and Reconciliation of monthly Cost of Care Report.

Oband Medical Group 2/2011-2/2012

Accounts Receivable Representative

Diligently focus on revenue recovery

Completed special projects as requested by management

Input professional based charges, post payments, and monitor write off amounts

Follows up on aging report accounts ranging from 90-120 days old

La Vida Medical Group and IPA 11/2008-3/2010

Claims Supervisor

Supervise Data Entry, EDI, Scanning and Mailroom Departments.

Generate weekly production reports from each department for Manager.

Conduct new hire interviews, training as well as assist with new hire orientation.

Generate disciplinary action forms and counsel employees.

Created and maintain departments Policy and Procedures manuals.

Conduct department audits to make sure Protocol is being adhered to.

Coast Healthcare Management 10/2007-10/2008

Financial Analyst

Assist in the formulation of contract financial analysis and cost impact

Audit all Share and Full Risk pools and provide monthly and quarterly reports on pool status

Perform quarterly report on all ICORE drugs and submit claims for rebate reimbursement

Generate regular reports on ASC utilization by group and health plan

Report and monitor all ER utilization by group and physicians, determine outliners and educate providers on possible alternatives

Foster positive interaction and relationships with all internal departments

Family Practice of Glendale 11/2003-9/2007

Senior Medical Biller

Communicate and enforce patient financial policies; answers and resolves billing inquiries, performs any combination of routine calculating, posting, verifying and follow-up involving patient accounts with well rounded knowledge in all types of bill codes including government payers

Charge entry and electronic submission for the following bill codes as assigned: Medicare, Medi-Cal, CHDP and Managed Care programs.

Master coding techniques; analyze data and draw sound conclusions; communicate effectively orally and in writing; work in an organized manner.

Keep abreast of changing billing requirements and contractual obligations; negotiate settlement of outstanding accounts; work within established deadlines; maintain strict records of all transactions involving either patient/responsible party or insurance carrier; identify and correct errors.

CPT, ICD-9, and HCPCS coding rules with a working knowledge of their application; application of payer fee schedules in relation to coding and payment verification.

AIDS Healthcare Foundation 2/2000-11/2003

A/R Senior Medical Analyst.

Data analysis of reports, medical records and Accounts Receivable Aging reporting.

Analysis of Capitation, Fee for Service charges, Deductibles, Coinsurances and Write off’s.

Responsible for effectively administering, policies, and activity with accountability for all aspects of performance.

Daily Balancing of cash receipts posted.

Determine current policies are followed and adhered to, and that standards for internal control are maintained.

Appeal unresolved claims with all payers according to appeal guidelines.

Assisting clients with questions regarding medical plans, such Medicare, Medi-Cal, Third party payers and Managed Care plans.

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