JULIEROSE PANGELINAN, BIS, CRCR

707-***-**** adridj@r.postjobfree.com 154 Christine Dr. Vacaville, CA 95687 WORK EXPERIENCE

Best Western Plus, LLC – Dixon, CA

Front Desk Agent...March 2022–Present

Processes room registrations, reservations and revenue transactions;

Prepares housekeeping reports & maintenance workorders;

Verifies billing, rooming lists & updates for group & corporate accounts. AMN Healthcare, LLC – San Diego, CA (Remote)

Revenue Cycle Consultant...July 2021–June 2022

Assisted with the development of content for use in the RFP/proposal process;

Attended and participated in Client C-Suite workgroups;

Recommended program performance objectives with performance levels;

Assisted with defining processes, policies, procedures, business rules according to local, state and federal regulations.

UCSF Health – San Francisco, CA

Senior Compliance Program Consultant...Dec 2015–March 2021

Assisted & collaborated with Director of Compliance Operations in management, initiating, leading, planning, risk assessment, gap analysis, process improvement of multiple complex projects & deliverables enterprise wide to reduce risk, non-compliance, fraud, waste & abuse;

Reviewed hospital inpatient, hospital outpatient & FQHC processes to determine alignment and adherence with standards set forth in Medicare & Medi-Cal regulations, Title 22 CCR, Conditions of Participation (CoPs), CA Health & Safety Code, The Joint Commission standards, 340B Drug Program, CDC, NPSG, OIG, FDA, DEA & DOJ governance;

Developed audit tools to measure compliance with regulatory governance; issues advisory guidance based on health policy review in conjunction with audit results; monitors corrective action plans;

Effectively performed process improvement & change management through data gathering and analysis, best practice research, process mappin;

Organized & facilitated workgroups to carry out business process improvement initiatives to strengthen mitigation plans, internal controls & framework for areas of non-compliance;

Reviewed medical record documentation and patient encounters for adherence to LCD, NCD, ICD-10 CM/PCS, CPT, HCPCS, CLIA, MUE, NCCI edits, IPPS, OPPS and APC rates. Guam Regional Medical City - Dededo, Guam

Executive Consultant (Remote)...Dec 2015–Sept 2016

Provided complex analytical support and guidance to finance team for accurate CDM build, capture of clinical billing data, reimbursement & revenue cycle reporting;

Ensured patient account information contained accurate and comprehensive data to provide timely billing and optimal reimbursement for services;

Applied ICD-10 CM/PCS, HCPCS, NCCI, MUE, CLIA, CPT, Medicare, and Medicaid guidelines to reduce reimbursement deficiencies;

Assisted in planning, development & implementation of compliant hospital outpatient clinic workflows that affect the front, middle and back-end revenue cycle. Guam Regional Medical City – Dededo, Guam

Medical Coding Manager...July 2015–Dec 2015

Under the direction of the HIM Director, coordinated, and implemented projects and/or programs to improve the quality & cost-effectiveness of coding operations;

Supervised & managed the performance of 13 coders, Co-managed administration of 3M, Allscripts & MedAssets health information systems;

Established, implemented and maintained a formalized review process for coding compliance, formal audit reviews to monitor the accuracy of clinical coding based on ICD-9 CM and ICD-10 CM coding guidelines;

Provided guidance to coders on performance, productivity issues & adherence to coding changes, guidelines and regulatory requirements;

Assisted & educated physicians and other healthcare providers by advocating proper ICD-10 CM documentation practices;

Worked collaboratively with IT to manage & oversee software interface, security issues, upgrades, and implementations.

Sutter Health - Mather, CA

Lead Applications Analyst...Feb 2015 - July 2015

Provided project management control and oversight of Optum Computer Assisted Coding (CAC) software application, environment, and platform changes;

Monitored application performance and system jobs; provided detailed specifications and applicable data mapping related to HL7 messages, interface analysis, product configuration/enhancement, upgrades, hotfixes, error logs, testing, go-live;

Developed and led integration solutions for application related technical and business issues; communicated End-to-End, led and facilitated the Executive Steering Committee. Stanford Hospitals and Clinics - Palo Alto, CA

Revenue Integrity Program Manager...May 2014 - Feb 2015

Managed CDM & charge capture practices in Audiology, Sleep Clinic, Dermatology, Inpatient Nursing Units, Orthopedics, Device Management, Pharmacy, POCT, Cochlear Implant, Plastic Tech, Ophthalmology, Primary Care & Medical Specialties clinical departments;

Provided education to clinical staff regarding CPT, HCPCS, Revenue Codes & modifiers, billing & compliance risk impact;

Facilitated & led work-group & process improvement meetings;

Collaborated & consulted with clinic managers, physicians, nurses & charge capture leads to improve revenue capture & reduce compliance risk, identify inefficiencies in charge capture process, and CDM structures;

Performed basic financial analyses to report the impact of revenue usage, payment changes resulting from payer practices and CMS regulation changes. Communicates findings to clinical managers;

Reviewed IP, OP, HAS documentation within EPIC, MedAssets & other internal systems to resolve charge capture, billing, coding, compliance issues. Kaiser Permanente National Compliance - Oakland, CA Regulatory Auditor...June 2012 –May 2014

Researched & applied federal/state laws and regulations and health policies for evaluation of internal controls, management of compliance risks & identification of potential areas of performance improvement;

Developed audit tools to measure compliance performance & developed CAPs;

Managed observation and MSP audits; Co-led SB 853 and Timely Access Behavioral Health audits;

Served as compliance consultant for government regulations, medical coding & billing in developing business requirements & implementation of process;

Prepared presentations to key stakeholders and management, participated in workgroups;

Collaborated with care delivery, California Department of Managed Care, regional revenue cycles, local medical center compliance to resolve compliance risks. Kaiser Permanente Revenue Cycle - Oakland, CA

Hospital Charge Capture Consultant...Feb 2008 – June 2012

Partnered with HIM, NCO, RBO, RCO, Front Office Operations Improvement (FOOI), EPIC, CMT, Resolute, Technology Solutions, Facility DRCs, Physicians, Nurses to identify root causes & provide solutions for middle & back-end Revenue Cycle thereby optimizing operational performance;

Provided analytic support in the development of workflows & internal processes in conjunction with feedback & input from technical, clinical and business owners;

Supported clinical lead in risk management & process improvement;

Managed, coordinated & implemented reconciliation of existing BCB Table & Medi-Cal revenue rates according to LOC;

Applied Medicare, Medicaid, CLIA, NCCI Edits, ICD-9 CM, CPT regulations and guidance to gap analysis and contributions to workgroups, claims edits/work ques, system builds/updates and fixes of strategic importance;

Managed Clinical Inventory System for HCPCS C code supplies/devices (stents, delivery systems, embolization protection systems, intracardiac septal defect implant system, vascular grafts, implantable mesh);

Assisted KPHC resolute, CMT, Bio Innovation teams with EAP (Orderables, Billing records, Charge codes & Split Bills) as it relates to charge triggers, CMT workbook, Radiology, Lab

(RILIS, Cerner Millennium), ePremis, RAD interface, Spacetrax;

Health Information Data Integrity: Analysis, Reconciliation & Consultation in the areas of Billing, Surgery (OpTime), Ancillary Services (Laboratory), Anesthesia, Nursing Services & Bed Charge Billing Table.

Kaiser Permanente Division of Research - Oakland, CA Medical Record Analyst...Feb 2001 – Feb 2008

Conducted studies for manufacturers developing new vaccines that are not yet licensed;

Monitored the medical records of vaccine recipients for post licensure surveillance;

Collaborated with Department of Health and Human Services (DHHS), Centers for Disease Control (CDC) Immunization Safety Office (ISO) and FDA;

Reviewed & analyzed provider & nurse documentation, disease process, diagnosis and procedures pertaining to Acute Flaccid Paralysis, Alopecia, Influenza, Rheumatoid Arthritis, Bell’s Palsy, Guillain-Barre Syndrome, Prostate Cancer & Parkinson’s Disease. Kaiser Permanente Appointment & Advice Call Center – Vallejo, CA Teleservice Representative...Dec 1999 – Feb 2001

Answered incoming calls according to protocols, triaged calls based on protocol outcomes, verified patient demographics;

Booked appointments based on physicians’ calendar via PARRS;

Documented patient messages to physician offices, disclosed specific patient test results. PacifiCare Obstetrics & Gynecology Clinic – Tamuning, Guam Front Desk Supervisor...Jan 1998 – Dec 1999

Supervised day-to-day activities of registration clerks in accordance to HIPAA & internal policies and procedures;

Assisted department manager with hiring, promotional interviews and evaluations;

Developed operating desktop procedures; Monitored opening and closing procedures;

Mentored, coached, and trained staff on effective customer service, referral process and billing issues.

Marriott Hotel Front Office Operations – Berkeley, CA Night Auditor...Feb 1996 – Dec 1997

Processed room registrations, reservations and revenue transactions;

Prepared housekeeping reports & maintenance workorders;

Performed transaction audits & verifications;

Reconciled room, F&B & retail charges.

Onward Agana Beach Hotel Food & Beverage – Tamuning, Guam F&B Secretary...May 1994 – Jan 1996

Prepared event contract & event orders;

Coordinated room set up with banquet staff;

Finalized menu items & cost with kitchen secretary & Chef;

Received, reviewed & triaged incoming & outgoing correspondences;

Maintained calendar for F&B Director & Manager.

EDUCATION / TRAINING / VOLUNTEER WORK

Graduate Certificate, Bioethics & Health Policy

Neiswanger Institute for Bioethics, Loyola University Chicago...Aug 2018 Bachelor of Integrated Studies, Health Services Administration, Health Science & Health Information Management Weber State University...Dec 2015 Certified Revenue Cycle Representative CRCR

Healthcare Financial Management Association HFMA...Expires June 2022 Shop Steward, Local Union 29 Kaiser Permanente, Northern California...Jan 2003 – Feb 2008

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