Management System Medical

Tiffany M Del Rosario

Phone: 808-***-****

************@*****.***

Ability Summary

CPI, CSR, CPR BSR

Medical terminology, ICD 9 and DX coding.

Knowledgeable with EPIC and IDX

Familiar with insurance websites example HMSA NAVINET etc.

Knowledge with HIPAA guidelines.

Clinical procedures, (vitals and history intake, Blood Draw etc)

Referral to HMO insurance companies.

Blue card Blue Shiedl billing procedures

Proficient in Microsoft Office; Word, Excel and Outlook.

Able to operate copy, printer and fax.

Efficient on WITS program

HMIS Program

Employment History

8/16/20 – to Current – IHS

846 Kaaa’HI St Honolulu, HI 96817

Guest Relation Service

Professionally interact t with, Support internal HIS polices and carry out daily site specific and organizational procedures that create a culture of hospitality, trust and respect.

Welcome visitors, accept donations, issue receipts to donors and store items in the proper Maner.

New and returning guest intakes.

Keep an accurate account and documentation of all events occurring during shifts..

Accurate documentation of Drug observation log.

9/16/2019 – to 8/15/20 – TriCare

3375 Koapaka St suite C310 Honolulu, HI 96819

Complex Authorization Specialist

Conducts research to ensure accurate documentation of the patient's clinical information.

Review and respond to complex referral requests from VA and civilian providers with appropriate coding and provider selection.

Responds to inquiries from Veterans and providers regarding specific aspects of the VA program. Information and assistance includes referrals, authorizations, and the location and use of network and certified providers.

Consistently display professional and courteous service skills to internal and external customers.

Takes appropriate measures to comply with HIPAA regulations to protect privacy of Veteran’s health information.

Documents the transmission of medical referrals to the facility or the network provider in line with procedures.

Documents all communications involving Veteran and provider contacts.

Develops knowledge of various software applications in use at TriWest, including procedures and processes of the VA program.

Assesses faxed or emailed documents, to ensure appropriate entry into the medical management system.

Works with standard coding systems including: standard medical taxonomy, International Classification for Diseases, Current Procedural Terminology, and Health Care Common Procedure Coding System.

Verifies and ensures that appropriate referral procedures are followed for the various types of VA eligible beneficiaries. Ensures procedures are followed for referrals based on Veteran category geographical location and the provider's request.

Enters data into the medical management system.

Identifies potential quality of care or safety issues

Requests medical records as directed, scans records into the medical management system, and prepares records for quality of care review.

Identifies potential discrepancies in the medical management system to assure quality compliance.

Consistently meet department productivity and performance metrics.

Performs other duties as assigned

Regular and reliable attendance is required.

07/2014 – 9/15/2019 Hawaii, INC.

875 Waimanu St #, Honolulu, HI

CBCM Program Assistant

09/2016 – 7/2018

Responsible for all communications and updates regarding referrals.

Facilitates and assist with clients admissions and discharges.

maintain and balance client activity budget.

Maintain receiving and outstanding records of supplies and equipment needed, maintains adequate par levels for supplies.

Assist in tracking and obtaining of authorizations from AMHD UM, Ohana CCS HMSA and other Medical insurance providers.

Assist as needed with insurance billing current old and when needed to be researched for non payment

Collect necessary data and prepare reports.

Orient new associates to office and current employees with new office procedures. .

Care Hawaii, INC.

875 Waimanu St #, Honolulu, HI

Office Assistant (Compliance & HR )

04/2015-9/2016

Provide Clerical support to the Compliance and HR departments.

Adheres to federal and state laws and regulations as well as company and agency policies and procedures regarding compliance, labor, health and safety issues.

Participated in agency training and supervision as required.

Assist the HR with department with management of employee personal files and there credentialing files.

Assist with taking minutes and distribution for administrative meetings.

Participates on the corporate compliance committee.

Assist the Office and Compliance Manager with internal monitoring and auditing.

Care Hawaii, INC.

875 Waimanu St #, Honolulu, HI

Direct Support Worker- ADH Level 1, 2 & 3

07/2014 – 04/2015

Provide support and supervision to individuals with developmental disabilities in classroom and community settings.

Implement Positive Behavior Support and Individual plans based on a client person centered need.

Collect data and complete participant progress notes daily.

Report any client incident or adverse reports according to standards.

Responsible for assisting participants with various aspects of independence, vocational, social skills as well as assist in activities of daily living.

Customer Care Advocate

07/2012 - 06/2014 HMSA Hawaii Medical Association

818 Keeaumoku St, Honolulu, HI

Interact with customers to provide information in response to inquiries about products and services for Blue Card dept.

Blue Card department is responsible for out of state and out of country services provided by out of state providers and out state bluecard members. Responsible to process claims and answer claim questions, form explanation to denial according to their policy or corrections need to be done to claim to get claim processed.

Education and Training

Issuing Institution Location Degree Received Course of Study

Medical Assistant School HI - Vocational School Certificate Medical Assistant

Occupational Licenses & Certificates

Certification Title Issuing Organization Completion Date

Certified Medical Assistant - Med Assist Schools of Hawaii 11/01/2002

References Available on Request

Contact this candidate