Medical Service
Resume:
DORIS G. ZAMORA
Miami, FL *3196
adf7tn@r.postjobfree.com
PROFESSIONAL OBJECTIVE: To obtain a position where I can apply my professional experience and education to
contribute to the success of the organization
EMPLOYMENT:
Total Diagnostics Solutions / Interamerican Medical Center LLC July 2016 – April 2018
Planned, administered and directed all services rendered at the medical center in conjunction with the center's Medical Director and Physicians.
Monitored patient flow at the Center and ensured the availability of services and efficient utilization of resources.
Assisted in the development of the Center's annual budget.
Ensured compliance with Regulatory Agencies' guidelines.
Interviewed, hired, trained and managed Center staff as needed
Reviewed all daily logs and time sheet summaries to ensure documentation and communication notes have been submitted and are accurate.
Handled necessary employee disciplinary issues fairly and objectively, in consultation with the Human Resources Department.
Provided thorough, objective and timely 90-day and annual staff performance appraisals for all staff
Organized Tech and Clients workflow
Developed relationship with Vendor for Radiology Platform
Ensured government compliance
Created procedure and protocols for Radiologist and tech
Checked doctor bills and cost effective protocols
Maintained all expenditures and Employee payroll
Maintained all equipment licenses and credentialing Licenses for Tech
Medical Park & Affiliated Centers, Miami, Florida Jul 2001-Aug 2016
Director of Network Management & Contracts
Developed networks and relationships with physician and third party administrators (MSO’S) (IPA’S).
Managed physician contracts, network development and provider service functions for developing and executing a provider network strategy.
Led and developed team of Network Development Representatives and Specialists.
Work in conjunction with medical management, sales and finance, developing action plans to meet market growth and medical cost targets.
Built a comprehensive network strategy to support market growth and medical cost target to include service area expansion and new product launch.
Negotiated managed care contracts with physicians, hospitals and ancillary services on both a fee for service and risk basis.
Analyzed cost and utilization data to develop specific actions to manage medical cost trend.
Developed practices to educate and assist risk partners in managing financial risk.
HIP of Florida, Hollywood, FL Jan 1996-Jun 2001
Ancillary Contract Specialist
Built a comprehensive network strategy to support market growth and medical cost target to include service area expansion and new product launch.
Negotiated managed care contracts for ancillary specialties in Broward, Dade and Monroe counties on both a fee for service and risk basis.
Worked with medical management, sales and finance, developing actions to meet market growth and medical cost targets.
Managed physicians contracting, network development and provider service functions for developing and executing a provider network strategy.
Kaiser Permanente Medical Care Program, Los Angeles, CA May 1990-Dec 1994
Outside Referral Coordinator
Coordinated for all cardiac surgery, transplant referrals and invoices.
Saved company $300,000 from examination of invoices and implementation of cardiac payment procedures.
Determined payment for all cardiac invoices. Examined all supporting documents prior to payment.
Resolved disputes with outside providers and other departments.
Worked with Regional contracting.
Prepared data for statistical reports.
Cardiac Catheterization Lab Coordinator 1989-1990
Coordinated transportation for patients through Outside utilization.
Reviewed Utilization notes to determine appropriateness of patient transfer.
Assisted with catheterization procedures and PTCA procedures.
Psychiatric Department Clerk 1985-1990
Screened and registered patients for office visits.
Assisted physicians with Psychiatry groups.
Called in prescriptions.
Managed confidential reports according to HIPAA guidelines.
Handled phones including a hotline for suicidal patients.
Prepared data for statistical reports and computer reports and computer projects.
Medical Walk-In/Urgent Care Receptionist 1983-1985
Screened and registered patients for office visits.
Scheduled appointments.
PROFESSIONAL SKILLS
Highly motivated.
Bilingual: Fluent in English and Spanish
Ability to communicate effectively; oral and written
Excellent analytical skills
Proficient in Microsoft Word, Excel, PowerPoint, Outlook Express.
Ability to prioritize, detail-oriented, organized and highly responsible.
Superior negotiation and customer service skills.
EDUCATION: ICD-9/CPT Coding Course 1993
Provider Relations/Member Services Courses
Claims Processing and Payment Courses
Kaiser Permanente, Los Angeles, CA
Business Management Courses 1983-1985
UCLA, Los Angeles, CA
REFERENCES:
Available upon request.
Contact this candidate