*** * **** **., *** PERDO CA ***** 310-***-**** ad3j1u@r.postjobfree.com

JESSE VASQUEZ

Objective

To acquire a promotional opportunity within the Health Care Community, where I can utilize my experience and knowledge to advance in a positive way.

Experience

04/01/23 to Current Harbor UCLA Medical Center Torrance CA Supervising Patient Financial Services Worker 1

Supervise/Manage Patient Access Emergency Registration Department night shift, which consist of 12 Patient Resource Workers, 3 Patient Relation Representatives, and 1 Intermediate Clerk. I also cover other shifts, which may have up to 20 staff at any given time. This Department is a Level 1 Trauma Center with Trauma unit, Pediatrics unit, Adult Critical Care unit, Obstetrics unit, Urgent Care unit, Psychiatric Emergency, Rapid Medical Evaluation/Triage, Properties and Valuables.

I provide technical and administrative supervision to ensure that all units are covered and are running efficiently. Staff interviews patient, update demographics, check patient eligibility, schedule follow up appointments and assist our Financial Verification Unit. I will assist with these duties, when short staff or department gets extremely busy. Example, schedule ward discharge, emergency department, urgent care and specialty appointments. I am willing to work any shift, weekends and holidays. Assist in any way possible for the benefit of the department. I pride myself in being Patient Centered, which is one of our principles, by this I lead by example to encourage my staff and department to perform at the highest level.

As a Subject Matter Expert, I assisted in the implementation of our new system, Transaction Services in training my staff, other units and supervisors. This is an ongoing process to learn and navigate different ways to manipulate the system to make it efficient for the staff or user.

We use a variety of different system to determine patient eligibility, Transaction Services, Health Net Portal, LA Care Portal, Medical Wed site, 270/271, Revenue 360, Availity, Noridian Portal, Tri-Care West, Kaiser Permanente and a variety of other entities to ensure patients and covered. Staff will screen self-pay Patients for Hospital Presumptive Eligibility (Temporary) Medical. If patients are not eligible, they will refer to our Patient Financial Services to Department for further screening and assistance with other county programs. Example Ability to pay, Full Scope Medical, out of county discount program are just some of the programs they provide.

Train and instruct employees on work assignments, policies, procedures, and workflows related to Patient Access/Emergency Registration functions. Plan, assignments supervise, and evaluate the work of the unit. Conducts unit meetings to promote staff development and to interpret federal, State, and County regulations, policies, and procedures.

Assists in the evaluation, orientation, and promotion of personnel; initiates appropriate corrective and disciplinary actions; handles grievances at first level.

Implementation of new ideas, strategies and recommendations to make workflow most efficient for staff. Conduct investigations on complaints and complex cases to minimize error, which may result in write offs or loss of revenue.

Coordinate or assist other county departments/agencies with work and support. Example assist Bed Control in ensuring patients are fully register, insurance is verified, and all demographics are correct and ready for transfer. Verify insurance for Utilization Review, to make sure patient’s primary insurance is eligible, so they can coordinate authorization for admission. Refer patients to Patient Financial Services department to obtain a verity of county programs to ensure their ability to pay and have proper medical services.

Assist Consolidated Business Office (CBO). Work the Bump List of accounts that can’t be billed in a timely manner. I must locate the problem by investigating why the account is being rejected. Accounts can be coded Medical, HPE, Medicare, Private Insurance, California Children services, Ability to Pay, Workman’s Comp, IHSS and a variety of other county programs. Investigating consist of Checking MEDS, LRS, 270/271, Revenue 360, Medical Website, California Children Service website, Medicare website (DDE) and Private insurance websites (Example: Health Net). Checking ORCHID (Cerner) images for Documentation that may assist in correcting account information. Calling Patient to obtain correct information such as Proof of insurance, birth certificate, identification, authorizations and any other documents that may assist in the billing process. If Patient has Medi-cal issues, I may have to inform Patent Financial Services to email Medical Worker or control worker to request assistance in correcting problems and obtaining status. Once proof of coverage is providing and/or documents request are obtained, I inform CBO to ensure timely billing. Any issues that may require my assistance (Example running Meds, updating accounts, and contacting patients). If no eligibility is obtained and all efforts are exhausted, then notes are placed on account and changed to self –pay in RCO and Cerner.

04/01/19 to 04/01/23 Harbor UCLA Medical Center Torrance CA

Supervise/Manage Billing Inquiry Unit and Medi-cal Clerical Unit, which consist of 9 Patient Resource Workers, 5 Intermediate Typist Clerks and 2 Senior Clerks, they are a highly specialized unit taking care of any and all complaints regarding Patient Accounts and billing. Clerical unit assist in updating all Medi-cal closed cases in the MTS, CalSAWS and MEDS. Clerical also assist in all incoming calls to our Patient Financial Services.

Interviews and complete Fast Track Application for Patients and LA Bio Medical (Research patients. Monitor and ensure payments are completed, then provide Statement of Accounts. Send Log of completion to CFO and Chief Revenue Manager. Assist Chief Revenue Manager in any special projects that may arise regarding Patients, county departments or our vendors.

Oversees the Cashier Unit and oversee the ICCP. It is a tool the A-C distributes to departments annually (some semi-annually or on a bifurcated basis annually) that departments use to self-assess internal controls over areas such as cash, purchasing, information technology, and payroll. In charge of reviewing and approving 1st level Deposits. Ensuring staff coverage and cross training the cashiers unit.

Interviews patients or their relatives and/or representatives to obtain financial and other eligibility data and assists patients in and processing Medi-Cal and other healthcare program applications. Collects data and review patient information in LEADER Replacement System (LRS), Medical Eligibility Data System, Cerner (ORHCID) Power Chart as well as other information systems. Interprets provisions and requirements of the various governmental healthcare programs to provide a plan that is beneficial to the patient and the department. Analyzes financial Data, Interview Patients, and reviews medical records to establish patient eligibility for a variety of federal, State, Private and County healthcare programs, such as My Health LA, Medical, Short Doyle, Medicare, General Relieve, California Children Services, Ability to Pay, Family Pact, and assist in completing the necessary documents within time limits specified by the appropriate governmental agency. Determines patients' financial ability to reimburse the County for healthcare services; interviews and corresponds with patients, responsible relatives and/or representatives, attorneys, employers, agencies, and insurance companies to obtain, verify, or clarify information, and explains County policies; may secure payments and arrange payment plans. Determines whether patients have healthcare coverage and identifies the billable resource(s) for Consolidated Business Office, contractors’ venders and collection agencies. Investigate problem situations and complaints to assist other hospital departments, agencies, or community resources when appropriate. Example: Patient Advocate, Board of Supervisors. May review patients' files to pursue the collection of delinquent accounts receivable; may recommend, when appropriate, temporary, permanent suspension or write off accounts or transfer delinquent accounts to collection services for further follow-up. Assist Patient Finance Director on special projects and deadlines. Provides technical assistance and review on difficult Cases to other county Departments, Patient Financial Services Supervisors, Patient Financial Control Workers, Patient Financial Services Workers, Patient Resource Workers and Patient Relations Representatives, to resolve cases and ensure approval or Denied.

Liaison to Consolidated Business Office working with Directors and staff on investigating all error on Bump Back Accounts that can't be billed due to errors on accounts that need to be corrected to ensure timely billing. Running and confirming eligibility on Medical Eligibility Data System (MEDS), LEADER Replacement System (LRS), 270/271, Medical State website, private insurance, revenue 360, updating carrier codes, calling Patients for verification of coverage and correcting dates of birth on Medical. Update all account inpatient and outpatient once eligibility is confirmed. Work with Utilization Review on Month end Inpatient Account and daily Admission to confirm eligibility of all forms of coverage. Update, run and confirm eligibility for variety of federal, State, Private and County healthcare programs, such as Health Way LA, Medical, Short Doyle, Medicare, General Relieve, California Children Services, Ability to Pay, Family Pact and Private Insurance. Follow up on pending Medical with Medical workers supervisors and control workers. To ensure payment and cases will be approved in a timely manner. Deliver and transport priority Medical cases and time sensitive documents as to ensure case will be approved to other county facilities and Patient Financial Services departments.

10/01/16 to 04/01/19 Harbor UCLA Medical Center Torrance CA Patient Financial Services Worker

Liaison for Consolidated Business Office (CBO). Manage the Bump back List of accounts that can’t be billed in a timely manner. I must locate the problem by investigating why the account is being rejected. Accounts can be coded Medical, HPE, Medicare, Private Insurance, California Children services, Ability to Pay, Workman’s Comp, IHSS and a variety of other county programs. Investigating consist of Checking MEDS, LRS, 270/271, Revenue 360, Medical Website, California Children Service website, Medicare website (DDE) and Private insurance websites (Example: Health Net). Checking ORCHID (Cerner) images and LRS images for Documentation that may assist in correcting account information. Calling Patient to obtain correct information such as Proof of insurance, birth certificate, identification, authorizations and any other documents that may assist in the billing process. If Patient has Medical issues I may have to locate Medical worker in LRS and email Medical Worker or control worker to request assistance in correcting problems and obtaining status. Once proof of coverage is providing and/or documents request are obtained, I provide CBO with copies. Any issues that may require my assistance (Example running Meds, updating accounts, and contacting patients). If no eligibility is obtained and all efforts are exhausted, then notes are placed on account and changed to self –pay in RCO and Cerner.

Manage the monthly Inpatient Subsiquentcials Inpatient List for Utilization Review (UR). Every first of the month I must look up all Inpatient accounts for prior month in Cerner and format list for printing. Run a face sheet and Meds for every account. If account has other coverage such as, Medicare, Private Insurance, California Children services, Ability to Pay, Workman’s Comp, IHSS or other county programs, the proof of coverage needs to be obtained and provided to UR. The same procedure as above is needed obtain proof of eligibility. If other type of coverage is obtained or any changed may have occurred during the month, then account needs to be noted in Cerner Power Chart to inform UR.

Monthly Medical Pending from Consolidated Business Offices. My Supervisor gives me a list of Pending Medical account to run MEDS and LRS to confirm coverage. Depending on the status of the account I may need to contact patient and/or Medical worker to confirm status of Case. Some accounts may have other coverage, which I may have to obtain eligibility by following same procedures as above. Accounts are then updated and noted in RCO and Cerner.

Cover when short staff in other PFS units. I had to change my shift to grave yard and work daily Admission from Emergency room and schedule admissions for UR. Consist of same procedures as Monthly Sub-Sequential but on daily basis.

Opening Medical in LRS, MTS and Power Chart notation.

Covering Billing Inquiry if Short Staff. Answering phones, assisting staff on any difficult calls regarding patient billing.

Covering front desk answering phones, checking patients in and setting Medical Worker Appointments. Checking LRS to locate worker and providing Patient.

Delivering Medical Case to other DHS Facilities and picking up supplies at DPSS, when running low.

Working Overtime to complete time sensitive work or special projects for Director and Supervisors. Whatever it takes to assist the department including staying late, working weekends and holidays.

Overtime for Administering cover help desk as needed.

09/01/07 to 09/01/16 Harbor UCLA Medical Center Torrance CA

Intermediate Supervising Clerk Patient Finance

Supervise/Manage 4 Patient Resource Workers and 1 Intermediate Typist Clerks. (Up to 9 employees in the past). Billing Inquiry and Files unit.

Supervising duties includes Annual Performance Evaluations, Appraisal of Promotability Evaluations, Discipline and Write-ups when subordinates are not adhering to County Policies and Procedures. Delegate work assignments and handle difficult work situations.

Interview prospective employees and make recommendations concerning their employment.

Interview Patients to determine eligibility, so accounts can be update to Private Insurance, Healthy Way LA, Medical, Short Doyle, Medicare, General Relieve, California Children Services, Ability to Pay, Family Pact, and variety of other County and Private Programs.

Referring Patients our Finance Department to apply and set up appointments for a variety of County Programs. Review application for any errors as to ensure accounts are properly updated.

Work closely with Administration and Risk Management to resolve complex Patient Complaints.

Review Medical Records in Cerner Power Chart to determine if Patient had treatment and credit or charge accounts in Affinity RCO.

Investigate Patient Fraud by obtaining Patient Identification, Police Reports and review Medical Records to prove if account is fraudulent.

Assist other Supervisors from Hospital and clinics on resolving patient complaint and any other issues that may have occurred.

Scan billing and patient documents into our Quantum System (Electric Document Management) and Cerner.

Negotiate Compromises of patient’s bills and co-payments from Insurances. Provide any documentation to our Consolidated Business office and outside vendors to ensure compromise or negotiations are obtain for Patients.

Work with attorney on issues they may have regarding patient billing, compliance to Health Insurance portability and Accountability Act and obtaining Billing Statements.

Work with Collection Agencies or outside vendors to resolve billing issues and patient complaints.

Any and all functions regarding Patient Billing and Complaints, examples: running eligibility on 270/271, Meds and Leader systems, Medical State website, checking eligibility on private insurance, updating carrier codes, correspondence to patients, balance letters, referral letters, return data-mailers, billing accounts, and bankruptcies.

Work overtime in cashiers when needed as back-up.

Work on any special projects with regards to Patient Accounts or Patient Financial Services.

Billing Workers Compensation (County Industrial Accidents and Private), obtaining DR’s First Reports, provide all and any reports and application to appropriate departments to ensure timely filing.

Assist Chief Financial Officer in obtaining, reviewing and processing Fast Tract Research Grant Applications. To ensure all Accounts are coded, payments are posted, signatures are obtained to complete Contract, so Accounts can be adjusted properly.

Assist Patient Financial Services Manager in obtaining, reviewing and processing Fast Tract Applications, Prepaid Delivery Programs and Out of County Discount Program. To ensure all Accounts are coded, payments are posted, signatures are obtained to complete Contract, so Accounts can be adjusted properly.

03/2003 to 08/01/2007

Harbor UCLA Medical Center

Torrance CA

Supervising Clerk Patient Account

Interview Patients to determine eligibility, update and check account status.

Work with outside agencies and other county departments regarding patient accounts.

Work with collection agencies and social services.

Assist supervisor on special assignments.

Supervise Patient Resource Workers and take care of any problems or complaints, when supervisor is out.

Cover cashier when staff is out.

Work on special assignments in files unit.

Work overtime in Emergency Room for Patient Finance.

08/2000 to 03/2003

Harbor UCLA Medical Center

Torrance CA

Patient Resource Worker Emergency Registration Patient Finance

Interview patient to update accounts and checking eligibility.

Interview for registration in Labor and Delivery, Pediatric Emergency, Psychiatric Emergency and Urgent Care.

Perform patient Advance Directives, Traumas, Lost and Found, Pre-Register from other facilities and Direct Admits.

Meds and Leaders operator.

Heavy phones and patient volume.

11/1991 to 08/2000

Harbor UCLA Medical Center

Torrance CA

Intermediate Clerk Obstetrics and Gynecology/Appointment Center

Heavy volume of appointment, scheduling and phones.

Order charts and conveying messages.

Daily count of charge tickets.

Maintaining patient charts and ordering supplies.

Working front office in Medical Surgical Clinic.

10/1989 to 10/1991 Harbor UCLA Medical Center Torrance CA

Student Worker Appointment Center

Heavy volume of appointments, scheduling and phones.

Work referrals from other clinics.

Work in various clinics scheduling appointments, Eye, Urology, Head and Heck.

Education

1995 to Present

LA Harbor College and Training Programs

Completed many Business Administration and Management Courses.

Trained in various computer software and hospital systems.

Attended workshops in patient and employee relations.

Interests

Spending time with family, exercising, gardening, carpentry, computers and cooking.

References

Rita Romero 424-***-****

Frank Villegas 424-***-****

Alicia Valdivia 323-***-****

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