Ivonne Bogen

Ivonne.***** Tustin, (***) Williams Bogen@331-CA, 0118 92780 gmail.St Unit com S

CAREER OBJECTIVE

Proactive professional with 25+ years of experience and a proven knowledge of customer service, data collection and analysis in managed care.

Regal Medical Group, Orange, CA

Network Management Coordinator, Jul 2022 – May 2023

• Working as an internal liaison in maintaining and processing databases.

• Coordinate receipt and processing of all provider contracts, terminations and credential.

• Ensure contract compliance and adherence to DMHC, DHS, CMS and all regulatory government agencies.

OPTUMCARE, Costa Mesa, CA

Business Analyst, Aug 2012 – Sep 2022

• Maintain Data integrity that directly impacts claims, authorizations and provider data base.

• Regulatory analysis and compliance.

• Create or review technical design documentation to ensure the accurate development of reporting solutions.

WESTERN MEDICAL MANAGEMENT LLC ARTA HEALTH NETWORK, Irvine, CA Data Base Analyst, Jun 2010 - Aug 2012

• Work as part of a project team to coordinate database development and determine project scope and limitations.

• Train users and answer questions regarding automated service.

• Specify users and user access levels for each segment of database.

• Review procedures in database management system manuals for making changes to database.

• Identify and evaluate industry trends in database systems to serve as a source of information and advice for upper management.

Network Services Contracting Coordinator, Feb 2009 - Jun 2010

• Assist in Network growth and development to include preparation of contract packets for recruitment. Responsible to work with Network Service Managers and providers to obtain proper signatures and documentation to effectively process newly recruited or existing providers.

• Ensure contract compliance with adherence to DMHC, DHS, CMS and other regulatory agencies as required by contracting HMO's.

Customer Service Supervisor, Apr 2004 - Feb 2009

• Providing leadership to the Customer Service staff. Developed a competent and motivated team which provides outstanding customer service to both members and providers.

• Generating and running reports to identify call trends and plan strategies to assure call wait times to meet health plan guidelines.

• Communicates with other departments and management to resolve problems and expedite work. Utilizations Management Coordinator, Oct 2001 - Apr 2004

• Manage and process daily electronic and hard copies of referral authorizations through web portal, to include appropriate coding.

• Verifying member eligibility and health plan coverage.

• Responsible for maintaining monthly QM and QA reports for denials, transplants for all health plans.

• Experience working with Medicare, MediCal, OP, IP, Transplant and Discharge nurse, running bed day reports.

• Responsible for collecting all appropriate documentation for referral process, including contacting directly Physician office.

MEMORIAL HEALTHCARE, Signal Hill, CA

Appeals Coordinator, Jan 1998 - Sep 2001

• Evaluate analytical methods and procedures to determine how they might be improved.

• Participate in internal assessments and audits as required.

• Coordination and processing of appeals, grievances and denials for commercial and Medicare members for all services.

EDUCATION

Academy of Arts Institute

Santa Ana, CA

Diploma Art of Cooking (June 2011)

Golden West College

Huntington Beach, CA

Completed coursework towards General Education American Sign Language.

• Relevant Coursework: Deaf Culture

Los Angeles Valley College

Van Nuys, CA

Certificate of Completion Medical Insurance Billing and Medical Coding. ADDITIONAL SKILLS

• Spanish - Fluent 100% speaking and writing.

• American Sign Language - Fluent 80%

15504 Williams St Unit S Tustin, CA, 92780 714-***-**** adyb3u@r.postjobfree.com

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