EC Elva Cardona

Elk Grove, CA ***** 279-***-**** adxnjg@r.postjobfree.com

PROFESSIONAL

SUMMARY

Health Care Administration professional and Medical Assistant with 20+ years of experience providing administrative health care support in a myriad of positions. Experienced in utilization management referrals, inpatient coordination, Ambulatory surgery and Hospital scheduler for Memorial Hospital. Clinical appointment management, and financial coordination. Proficient in Word, Excel, Access database, IDX, EPIC, Power Point, and other office equipment. Detail- oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. SKILLS Experience with Access database,

IDX, EPIC, Microsoft Office, Power

Point, Dbase IV; Lotus 1-2-3;

Microsoft

Windows: Microsoft Excel for

Windows: Harvard Graphics:

Multi-Mate: Microsoft Word. Word

Pertect >.: working knowledge of IBM

and Andle computers: Entrex CRISAS

maintrame: OMEGA system (Strong

Memorial Hospital: Blue Cross CRT:

Preferred Care

PCEASY: Omnipro ( Medicare CRT):

Medicaid EMEVES; various office

equipment, including Xerox Memory

Writers

WORK HISTORY HOMEMAKER AIDE 05/2022 to CURRENT

Cardona Elk Grove, CA

Participated in fun group activities with patients to boost mood, improve overall memory, and provide light entertainment.

Promoted good oral and personal hygiene by aiding patients with shaving, bathing, and teeth brushing.

Completed dusting, washing dishes, laundry, and vacuuming for patients. Maintained and organized patient rooms and communal spaces to minimize environmental and safety hazards.

Provided companionship and emotional support to enhance mood and quality of life.

Followed infection control procedures and adhered to safety and security protocols.

MEDICAL ASSISTANT 06/2019 to 05/2022

Sutter Health Elk Grove, CA

All back office duties including rooming patients, assisting in procedures such as vasectomies, sigmoidoscopies, minor surgeries, treadmills and circumcisions. Training of new hires and filling in for the lead while she was on maternity leave. I was also instrumental in setting up a new satellite office including furnishing it with all necessary equipment, ordering supplies and implementing follow up ordering as needed. Coordinating staff hours, working with the providers to insure they had what they needed in their new surroundings, setting up OSHA and HIPAA compliant regulations. I volunteered for numerous committees and was instrumental for setting up the account with Quest labs. Sanitized, restocked, and organized exam rooms and medical equipment. Assisted with routine checks and diagnostic testing by collecting and processing specimens.

Completed EKGs and other tests based on patient presentation in office. Updated inventory, expiration and vaccine logs to maintain current tracking documentation.

CERTIFIED MEDICAL ASSISTANT 01/2016 to 06/2019

Sutter Gould Medical Gastrointestinal Specialist Modesto, CA SGMF Gastroenterology Modesto, CA

Certified Medical Assistant

• Obtain medical history, vitals and document in patient chart

• Strictly adhere to healthcare facility policies and procedures

• Schedule patient appointments and procedures

• Perform in office tests: Fibro scan, SIBO breath test, capsule endoscopy • Maintain provider call pool

• Referral processing and submission

• Prior Authorizations for procedures and medications

• File appeals and set-up peer to peer for providers

• Lead huddles

• Create procedure letters, smart phrases and smart lists

• Work on special projects as assigned

• Mentor new hires

• Rapid Response Team Member

• Call Center experience

• Lead for Process Improvement Team

Enhanced patient outcomes by providing knowledgeable education on procedures, medications, and other physician instructions. Collected and documented patient medical information such as blood pressure and weight.

Directed patients to exam rooms, fielded questions, and prepared for physician examinations.

UTILIZATION MANAGEMENT REFERRAL SPECIALIST 06/2014 to 01/2016 Sutter Gould Medical Foundation Modesto, CA

Perform medical reviews of managed care referral requests that have written criteria for review and identify health care delivery inefficiencies. Send referral notifications to medical providers and patients regarding referral requests, including writing and sending denial letters. Complete the work-up and the review of claims received from Sutter Physician Services for pending claims.

Review and work-up provider/plan appeals by screening appeal for adequate information, providing Medical Directors with all pertinent information regarding the appeal and communicating with health plan on decisions.

Manage Acute Enrollee submissions to health plans which included reviewing member medical record information from outside records or EPIC in order to submit Acute Enrollee paperwork to health plans. Involved with the EPIC Migration Team for referrals, case management, and UM Reporting. Working closely with SPS IT teams and EPIC teams during this process.

Create a UM referral matrix database using Access which has now been updated to an Excel spreadsheet which includes Division of Responsibility Information in order for referrals to be processed in a timely and efficient manner.

Create referral processing rules to be put in place in EPIC for automation of referral processing.

Report compliance for several weekly, monthly, and bi-annual reports to several health plans.

Skilled in all preparation of records for health plan audits. Collaborate in creating department standard work and have helped in auditing reports to ensure that department standards are followed by staff. Knowledgeable in compliance standards set by HMO's, NCQA, CMS, and DMHC.

Versed in an array of continuous improvement tools centered on lean manufacturing and six sigma methodologies including standard work, continuous flow, 5S, and kanban systems.

Evaluated medical guidelines and benefit coverage to determine appropriateness of services.

Obtained authorizations from multiple insurance carriers for various levels of care.

Devise or identify solutions for irregular requests and issues. Supervised and maintained all utilization review documentation through Software.

REFERRAL COORDINATOR 10/2012 to 06/2014

Sutter Gould Medical Foundation Turlock Site Modesto, Ca Scheduled appointments with specialists on behalf of clients. Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.

Called insurance companies to get precertification and other benefits information on behalf of patients.

Weighed patient need, provider availability, and insurance coverage to determine optimal scheduling.

Accessed and reviewed patient records to verify receipt completed referral paperwork.

Facilitated referrals to other healthcare providers and resources to bridge service gaps.

Responded to patient inquiries to offer timely updates regarding referral status.

Developed and implemented effective strategies to increase referral sources.

Assisted with completion of referral forms and verified data accuracy and completion

Developed and maintained strong working relationship with referral sources to streamline processing.

Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.

Attended continuing education courses to stay current on referral processes and best practices.

INPATIENT COORDINATOR 05/2003 to 10/2012

Doctors Hospital Manteca, CA

With minimal supervision and considerable latitude for independent judgment this position managed all inpatient admissions to the Strong Epilepsy Center at Memorial Hospital.• Ensured that admissions took place as scheduled, dealing extensively with third party payers, utilization review, financial counseling,doctors, and nurse practitioners.• Served as the spokesperson in negotiations with insurers regarding patient coverage and approvals, with an emphasis on pricingexplanation, including global package pricing system.• Made decisions on behalf of the program in dealing with complex issues and questions raised by insurance company utilization reviewrepresentatives.• Assured that all pre-approvals are in place and all billing is done correctly post-admission. Schedule patient review conferencesmaking sure all records are available for faculty.• Prepared monthly statistical worksheets for Unit Administrator and Finance Department, verifying accuracy and completeness o EDUCATION Diploma Medical Assisting 05/2002

Merick College, Modesto, CA

GED High School Administration 2001

Patterson High School, Patterson, CA

LANGUAGES Spanish

Native or Bilingual

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