Data Entry Administrative Assistant
Resume:
FRANCISCA A. URIBE
SANTEE, CA ***71 adw49m@r.postjobfree.com
OBJECTIVE
Motivated individual seeking a customer service position. Seeking to improve customer experience using a positive attitude, patience and problem-solving skills and experience working in the healthcare industry.
SKILLS
Experience with computer systems and software while keeping up with recent technologies. Knowledge of analytic programming tools and methods (SAS, SQL, Business Objects, SAP/Crystal). Understand relational databases, data systems and data warehouses. Committed to continuous learning. Strong reporting skills using, Microsoft Suite – Excel (spreadsheets, pivot tables, graphing, tables, calculations, and automation efficiently to process large quantities of data relevant to business tasks reporting, Access (create and maintain Access databases), Word and Power Point. Fluent in Spanish.
EXPERIENCE
Centene / Mindlance – 10/31/2022 – 03/07/2023
Program Coordinator
Perform tasks necessary to promote member compliance.
Screen members by priority for case management (CM) assessment.
Perform transition of care duties to include but not limited to, contact the member’s attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information.
Outbound calls and enrolling members into care management.
95% of shift making outbound calls to members that may have health needs to make a referral to team of Registered Nurses.
Time Management/Organized
Working Multiple Systems/Programs/Computer Savvy
Magellan Health
Customer Service Associate, 12/6/2021 – 07/15/2022
Responsible for meeting call handling requirements and daily telephone standards as set forth by management.
Proficient typist
Able to maneuver through various computer platforms while verifying information on all calls.
Performs necessary follow-up tasks to ensure member or provider needs are completely met.
Provides information regarding client in-network and out-of-network reimbursement rates and states multiple networks to providers.
Refers callers requesting provider information to Provider Services regarding client professional provider selection criteria and application process.
Proficient in Microsoft Suite, Excel, Word, etc.
TDB Communications
Customer Service Rep III, 03/2021 – 07/2021
Assist callers with incoming calls to the Vaccine Information Hotline
Data entry in CRM
Research and verify information for accuracy
Manpower/Telebusiness
Customer Service Rep, 01/2021 – 03/2021
EDD State of California Remote CSR
Answer incoming calls for a high-volume call center for the State of California/EDD
Assist callers with filing claims or questions regarding their existing claims
Data entry
Research and verify claims for accuracy
AETNA INC., San Diego, CA
Project Lead, 2016 - 2019
Project Lead in the HMO/Healthcare environment. Develop and provide information and analysis to support business operations for internal and external customers.
Responsible for providing Regulatory Reporting of Compliance State scheduled annual, quarterly and Ad Hoc Reports. These reports include Utilization Review, State Market Conduct Exams (MCE) and follow up items from previous findings or corrective action plan (CAP).
Responsible for CA Department of Managed Health Care (DMHC) reports of enrollment, Exam UR logs and Provider Pull lists.
Support Quality Management (QM) department providing reports to attain accreditation of HMO and PPO commercial and Medicare plans.
Responsible for Case Management reports for standard NCQA Case Management Files for specific states.
Assisted in Centers for Medicare & Medicaid Services (CMS) – Internal Oversight Medicare Compliance & Operational Integrity and pulled universe reports for audits.
Provided Plan Sponsor Specific Utilization Review data for Department of Labor (DOL) audits.
Provided support to Network staff on transition of Timely Accessibility Reports Project to support NCQA Standard.
Compiled data and reports on requests for out-of-network provider services.
Responsible for maintaining database and providing Ad Hoc reports for Texas Plan Sponsors for Case Management Reports. This is to remain in compliance with Texas state reporting requirements.
Provide support and train new employees in department.
Senior Informatics Analyst, 2014 – 2016
Responsible for the successful delivery of reports to support QM to meet business needs, interacting directly with internal and external clients and colleagues.
Responsible for creating and implementing and maintaining Texas Plan Sponsors for Case Management Reports and database.
Responsible for the transitioned of Microsoft Access Report queries to SAS queries.
Provided National Health Exchange out of network reports to Support NCQA standard.
Provided annual, quarterly and in some instances monthly State Regulatory Reporting for specific states via scheduled or Ad Hoc reports.
Provided Plan Sponsor Specific Utilization Review data for DOL audits reports.
Responsible for DMHC provider appointment Availability Survey and Timely Access Reports and Provider Satisfaction Survey required by the CA DMHC. Supported staff in Transitioning Timely Access reports to Network staff.
Provide support as backup for projects in department and train new employees in department.
Quality Analyst, 2012 - 2013
Analyst, 2003 – 2012
Responsible for the successful delivery of reports to support QM to meet business needs, interacting directly with internal and external clients and colleagues.
Worked with Project Manager and Senior Consultant and provided reporting for Utilization Review State Regulatory reporting.
Provided data analysis and/or reporting as needed throughout and post HEDIS project.
During HEDIS project would translate for members and or provider offices for QM staff.
Supported Regional QM with systems and data requirements.
Provided Ad Hoc Reports for DOL for Sponsor Specific audits.
In 2009, supported HEDIS by managing and maintaining databases.
In 2009, was nominated and received the 2009 West Region Health Care Management (HCM) President Award. The award was based on exemplary performance in the areas of collaboration and innovation, as well as commitment and demonstration of the Aetna Values.
In 2005, was instrumental in the implementation of the Healthcare Effectiveness Data and Information Set (HEDIS) Fax process for AZ/NV. Created and implemented database for tracking incoming and outgoing faxes/medical records for HEDIS 2006.
Received Network & Provider Services Silver Award, Q2-2004 for the Aetna Way Excellence Awards Program recognized for contribution and performance associated for Operational Excellence/Profitability.
Worked with QM staff to streamline/enhance QM department functions, e.g. implemented
electronic committee packets vs. copying/mailing committee packets for Quality of Care (QOC) in 2003.
Developed and implemented Health Delivery Organization (HDO) database for all CA according
to the credentialing specialists’ specifications in 2002
Created Provider Medical Groups (PMG) database to assist in Recredentialling/Credentialing to support NCQA.
Created Washington Provider Satisfaction database to analyze and report on the Seattle Provider Satisfaction Survey.
RELATED EXPERIENCE
AETNA HEALTH PLANS OF CALIFORNIA, INC., San Diego, CA
Quality Management Analyst / Specialist
Administrative Assistant/Credentialing Specialist – Quality Management Department
PARTNERS HEALTH PLANS, San Diego, CA
Customer Service Administrator Administrative Assistant
EDUCATION AND TECHNICAL SKILLS
Computer Science Studies, Grossmont college, San Diego, CA
SAS Programming 1 Essentials, 2016
SAS Programming 2 Data Manipulation Techniques
White Belt ABX (Achieving Business Excellence), 2017
REFERENCES
Reyna Lopez (family member)
Monique Santos (Supervisor at Aetna)
Deanna McKinney (friend/coworker at Aetna)
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