DHA Support

Maria H Baer (Mari)

Address: **** ***** ***, *** *******, TX 78224 Phone: 210-***-**** Email: ******@*******.***

Professional Summary:

Decisive Office Manager with extensive experience in healthcare administration, Medicaid operations, and front-office coordination. Proven ability to lead teams, manage complex scheduling, optimize workflow efficiency, and ensure compliance with Medicaid policies, HIPAA guidelines, and military healthcare systems. Skilled in Medicaid claims processing, eligibility verification, patient referrals, and financial reconciliation within high-paced healthcare settings. Bilingual in English and Spanish, ensuring effective communication with diverse clientele.

Key Skills:

Medicaid Program Management – Proficient in Medicaid COWA, MMIS, CIM3, HRSN, Flex Funding, ensuring smooth operations in claims processing and eligibility inquiries. Leadership & Team Management – Managed training initiatives, compliance procedures, and personnel oversight,

Administrative Coordination – Strong background in credentialing, scheduling, and front-desk operations.

Data Management & Reporting – Expertise in large-scale healthcare data analysis, financial reconciliation, and compliance reporting.

Customer Service & Front Desk Operations – Skilled in-patient interaction, appointment scheduling, and insurance verification

Bilingual Communication – Fluent in English and Spanish, ensuring accessibility and patient engagement.

Professional Experience:

Customer Referral and Claims Support Specialist (Remote-6 Month) November 2024 – May 2025

Health Share of Oregon – Vander-Howen Temp Agency

Customer Referral & Claims Support Specialist (Remote – Contract)

Managed Medicaid eligibility verification, claims processing, and patient referrals, ensuring accuracy and compliance.

Provided guidance on Medicaid benefits, navigating patients through coverage options.

Maintained electronic health records (EHR), financial reconciliations, and compliance reporting.

Coordinated with members' Physical, Dental, and Mental Health Plans for referrals, claims, and prior authorizations.

Administered credits, returns, claims correction, and invoicing for members' health insurance plans.

Monitored daily and weekly expedite reports and managed all quotation and order issues, including disputes, pricing issues, invoicing discrepancies, quality concerns, delivery disputes, and quantity discrepancies.

Drug Demand Reduction Program Observer (Military Contract-Part-time) October 2024 – Present

Koniag Government Drug Demand Reduction Program

Drug Demand Reduction Program Manager and Observer (Military Contract-Part-Time) August 2020 – August 2023

Loyal Service Government Service -Air Force National Guard Reserve Lackland Air Force Base, San Antonio, TX

Conducting specimen quality assurance.

Coordinating travel, events, and training procedures.

Supervising students in urinalysis chain of custody, observation, and packaging.

Managing urinalysis files.

Training observers and assistant.

Updating urinalysis directives and instructions.

Maintaining control of urinalysis specimens through the chain of custody.

Direct observation by same-gender members to ensure sample integrity.

Quality assurance on Specimen Custody and Document (DD 2624).

Military Medical Business Junior Data Analyst (Military Contract) November 2018 – September 2023

Planned Systems International (PSI) 4ESCorp - Lackland Air Force Base, San Antonio, TX

Oversaw data integration between MHS-GENESIS, CHCS, AHLTA, ensuring TRICARE, Medicaid and other Medical Insurance compliance. ensuring timely source file transmissions and notifying managers of any delays.

Optimized reporting processes to ensure policy and procedural compliance.

Managed a shared Outlook mailbox and triaged training requests via SharePoint Portal.

Developed metrics to measure data accuracy and variance, and trained personnel on workload and financial reconciliations.

Managed and maintained databases to support MEPRS, utilizing Business Objects, Microsoft Access, and SQL

Provided reports for audits, training personnel in financial reconciliations and workload analysis.

Secretary III-Administrator Support (Military Contractor) April 2015 – September 2018

Infused Solutions - CASE-HSC Army Virtual Tele-Behaviour Health Clinic-Warrior Resiliency Program (WRP)

BAMC-Fort Sam Houston Military Base, San Antonio, TX

Coordinated Medicaid-covered telehealth services, assisting with patient scheduling and referrals.

Managed provider credentialing and policy dissemination, ensuring administrative efficiency.

Developed pivot tables & reports on TRICARE program performance, optimizing workflow processes. Provided technical support via virtual training, managed patient scheduling and assessments, and reported program performance and patient outcomes.

Created pivot tables and VLOOKUPs in MS Excel and managed data sets.

Create all the provider templates, referral management, adhering to the guidelines Maintained training documents and credential schedules for all the WRP providers.

Assisted in policy dissemination and managed SharePoint sites.

Coordinated recruitment, performance assessment, and work assignments to ensure timely completion as per contractual obligations.

Patient Appointment and Military Medical Referral Specialist-Clerk III (Military Contract) January 2013 – April 2018

Glacier Technologies, San Antonio Military Medical Hospital Consult Referrals Appointment Management Office (CAMO) Lincoln Bldg., San Antonio, TX

Coordinated Medicaid-covered telehealth services, assisting with patient scheduling and referrals.

Managed provider credentialing and policy dissemination, ensuring administrative efficiency.

Developed pivot tables & reports on Medicaid program performance, optimizing workflow processes.

Coordinated patient scheduling and managed medical care referral

Delegated tasks to team members to improve productivity.

TRICARE Beneficiary Services Representative (BSR) (Military Contract) June 2008 – July 2011

SAIC / APPTIS, Commander Fleet Activities Sasebo, Japan (CFAS)

Provided educational support to TRICARE program beneficiaries.

Provided guidance on TRICARE and Medicaid eligibility, ensuring accurate enrolment and claims processing.

Conducted briefings to educate personnel on healthcare benefits and policy updates

Education:

Monte Miguel High School, Spring Valley, CA 1995 Cuyamaca College, CA Triad Aviation Academy Flight Attendant Preparation Program, Greensboro, NC

Reference upon request

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