Finance, Case Management & Healthcare Admin Leader

ANNA LISA MACIAS: Perris, CA [951-***-**** [*********@******.***] Bilingual: English & Spanish

PROFESSIONAL SUMMARY

Performance-driven professional with a diverse background in Financial Recovery, Government Case Management, and Healthcare Administration. Proven track record of exceeding monthly quotas and managing high-volume workloads with precision. Expert in negotiation, investigative fact-finding, and bilingual communication. A "never-quit" problem solver dedicated to helping clients find solutions while driving organizational revenue and maintaining regulatory compliance.

CORE COMPETENCIES

●Financial & Collections: Debt Recovery, Account Reconciliation, Negotiation, Quota Achievement.

●Case Management: Fact-Finding, Due Process, Fraud Investigation, Claim Processing.

●Healthcare Admin: HIPAA Compliance, HMO/Medicare/Medi-Cal, Prior Authorizations, STAT Referrals.

●Operational Leadership: Team Mentoring, Quality Assurance, Conflict De-escalation, High-Volume Call Handling.

PROFESSIONAL EXPERIENCE

Private Nanny / Household Manager

Private Family March 2024- March 2026

●Dedicated Caregiving: Provided full-time care and supervision for two children, maintaining a safe, structured, and enriching environment.

●Professional Coordination: Managed daily schedules and educational activities while maintaining a productive environment for a parent working from home.

●Reliability: Demonstrated exceptional dependability and multi-tasking abilities over a four-year tenure.

●Case Worker (Contract): Maximus (via Manpower Agency) March 2022 – May 2023

●Investigative Fact-Finding: Lead comprehensive investigations into high-volume unemployment claims to resolve pending issues regarding wages, misconduct, and voluntary quits.

●Due Process Management: Conduct detailed interviews with both claimants and employers to gather evidence, ensuring all parties receive due process according to state guidelines.

●Fraud Mitigation: Identify and resolve discrepancies in reported earnings by analyzing wage data to ensure claim accuracy and integrity.

Collection Agent: Consumer Portfolio Services May 2017 – February 2020

●Revenue Recovery: Managed a monthly portfolio of high-risk auto finance accounts (30–120 days delinquent), consistently meeting and exceeding quotas to secure performance bonuses.

●Team Leadership: Promoted to Department Lead to mentor colleagues on negotiation tactics and customer service excellence.

●Operational Efficiency: Partnered with upper management to optimize phone queues and inbound call flow, significantly improving department efficiency.

Prior Authorization/Referral Specialist: Inland Empire Health Plan (IPA) September 2012 – May 2015

●Clinical Adjudication: Evaluated medical referrals against strict clinical guidelines to approve or deny authorizations.

●Urgent Care Coordination: Guaranteed 100% daily completion of all STAT authorizations, ensuring urgent patient care requirements were met without delay.

Referral Coordinator / Front Office: Tri-Valley Internal Medicine Group July 2007 – August 2012

●Promotion: Fast-tracked from Front Desk to Coordinator to lead the office’s transition into HMO insurance acceptance.

●Bilingual Advocacy: Provided expert English/Spanish translation for physicians and patients during medical consultations.

●Financial Support: Verified insurance benefits, collected co-payments, and managed accounts receivable and daily sheet balancing.

TECHNICAL SKILLS & EDUCATION

●Financial: Accounts Receivable, General Ledger, Day Sheet Balancing, Bank Deposits.

●Administrative: High-Volume Call Handling, Scheduling (Appointments/Surgeries), Data Entry.

●Insurance Knowledge: Private, Commercial, HMO, Medicare, and Medi-Cal.

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