Medical Management & Managed Care Supervisor

Michelle Garza-Velasquez

***** ****** ******

Riverside, CA 92507

Cellular 562-***-****

Email: **********************@*****.***

OBJECTIVE

To obtain a position with the potential for advancement with increased decision-making responsibilities.

MANAGEMENT SKILLS

Over 25 years of Medical Management experience. Experience with Managed Care system and products such as: Demonstrated ability to manage both clerical and medical staff. Working knowledge of Admitting Procedures, Guidelines and policies. Ensured staff obtained and maintained required skills and certifications to perform necessary duties. Provided support, training and supervision to staff to ensure that we are providing the highest quality of patient satisfaction. Coordinated personnel and payroll activities with Human Resources as required in a timely and efficient manner. Have represented a medical group at employer-sponsored health fairs, conducted Patient Satisfaction Surveys and report gathered data, computed and reported monthly encounter data, computed and reported member enrollment by product and health plan, and worked closely with the Marketing and Sales Department on their Member Retention Programs. Empowered and mentored staff to increase their knowledge of Healthcare System as well as Managed Care Systems.

RELEVANT SKILLS & QUALIFICATIONS

Working knowledge of Microsoft Word, Excel, Access, EPIC, EZ-CAP, Asterion.com, PBAR, Cerner, Meditech, Invision, CUBS, Affinity and EPIC. Bilingual in Spanish. 10 Key and typing skills. Excellent customer service and problem solving skills. Reputation as a dependable and professional employee. Motivated self-starter with an aptitude for learning new skills quickly, such as new computer skills or tasks specific to an office. Effectively manage different responsibilities simultaneously. Ability to work well under pressure. Able to coordinate multiple projects. Comfortable with stepping in and undertaking tasks outside of my scope of responsibility to ensure continuity and provide great customer service. Always willing and available to work additional shifts if requested. Knowledge of HIPAA, EMTALA and JCAHO guidelines.

EMPLOYMENT

Client Services Manager

December 2014 to Present

Loma Linda University Health Care

Responsibilities: Resolve patient and Group administrations concerns relevant to billing and registration and patient care. Work closely with hospital staff and administration to resolve such concerns. Delivery of great customer service. Respond to complaints and grievances filed with Health Plans or government agencies. Work with Administration and Risk Managers to obtain necessary documentation to audit accounts and resolve such concerns. Work with Collection companies contracted by the hospital to collect and resolve concerns. Provide AR analysis and trends. Develop and maintain an ongoing relationship with my respective group practices. Knowledge of payer issues and the effect on the billing and collection practices. Work diligently with department Chiefs, Administrators and staff at the different practice groups to resolve concerns and lower AR. Perform other duties as needed. Trend AR to develop better practices and collections. Meet with group Administrators and report monthly with my specialty practices to report financials.

Responsible for overseeing, managing, analyzing and reporting financials for the following specialty groups: Ophthalmology, Anesthesia, OB/GYN General, OB/GYN Oncology, OB/GYN Maternal Fetal Medicine, OB/GYN Urology, Emergency Medicine and Critical Care Services.

Onsite Liaison/Business Office

January 2012 to December 2014

Marina Del Rey Hospital Marina Del Rey, CA

Responsibilities: Resolve patient and administrations concerns relevant to billing and registration and patient care. Work closely with hospital staff and administration to resolve such concerns. Delivery of great customer service. Respond to complaints and grievances filed with Health Plans or government agencies. Work with Administration and Risk Managers to obtain necessary documentation to audit accounts and resolve such concerns. Work with Collection companies contracted by the hospital to collect and resolve concerns.

Manager, Admissions & Emergency Room and Ancillary Registration

August 2010 to January 2012

UCLA Healthcare Systems Santa Monica, CA

Responsibilities: Quality Review of Admitting Registration staff accounts. Scheduling of staff. Delegation of staff assignments. Cash Deposits for all areas of responsibility. Registration of patients. Counseled staff on disciplinary concerns. Audit phone system for abuse and timeliness of call handling. Resolved patient concerns. Worked closely with Nursing Supervisor relevant to bed delays and physician concerns.

Supervisor, Admitting Services & Bed Management August 2006 to August 2010

Children's Hospital of Orange County Orange, CA

Responsibilities: Provide training and support to Lobby Receptionist as well as Admitting and Bed Control Representatives. On call twenty four hours. Provide customer service to patients, families and visitors. Work collaboratively with Supervisor, of Financial Services to ensure collection of co pays and deductibles are collected. Scheduling of staff to provide twenty four hour coverage for a staff of thirty two. Screen potential candidates and complete the necessary documents for the hiring process. Provide counseling to staff, not limited to disciplinary measures. Complete employee competencies and evaluations. Manage and complete the submission of KRONOS (payroll) for Receptionists, Admitting, Bed Control and Financial staff. Work diligently with staff to adhere to the changing of Visitor Policies. Implementation of Bed Board to ensure correct physician assignment and bed assignment following certain criteria and guidelines. Maintain positive relationships with staff and coworkers, and exercise the "Open Door Policy". Provide Staff with Accuracy Reports monthly and counseling if necessary. Mentor and empower staff. Assist Director of Admitting Services with any delegated tasks. Work collaboratively with physician's, Business Development and nursing supervisors to ensure correct physician assignment and implement any changes as well as maintaining positive working relationships.

Lead Financial Assistance Coordinator Nov. 2005 to Aug. 2006

Tenet Healthcare Systems Anaheim CA

Responsibilities: Provide assistance to patient’s who are unable to pay off the total charges owed to the facility. Thorough research of patient’s demographics, real estate and assets must be completed prior to recommendation of Charity Care. Certain guidelines and criteria must be met for a patient to qualify for Charity Care. The patient must meet a certain Federal Poverty Guideline percentage in order for the patient to qualify for Charity Care or qualify under the Medically Indigent Program . Request the necessary documentation to support the recommendation being submitted to the hospital Chief Financial Officer. Document account thoroughly with all work efforts.

Lead, Admitting Feb. 2004 to Sept. 2005

Chapman Medical Center Orange, CA

Responsibilities: Balancing of hospital census on a daily basis, making sure room charges and accommodations and order correspond. Report data monthly on Activity Report. Supervision of staff of thirty. Scheduling of Admitting, E.R. Registrar’s, and PBX staff to ensure proper coverage. Take call on weekends to ensure coverage of shifts in case of sick call ins. Collect data to produce Registrar Activity Report. Assist Registration staff with admission’s in E.R., Outpatient and Inpatient Admitting. Cover PBX. Provide translation to all medical floors upon request. Participate on Patient Satisfaction and Medical Record’s Committees. Display great customer service. Provide Financial Counseling when necessary. Resolve complaints and grievances. Report to Admitting Manager and Patient Accounts Director.

Manager, Admissions & Specialty Clinic’s Sept. 2001 to Dec. 2003

Casa Colina Hospital, Centers for Rehabilitation • Pomona, CA

Responsibilities: Provided training to Outpatient Admission Coordinators and Specialty Clinic Staff. Trained and updated new and existing employees regarding hospital contracted health plans and IPA’s or Medical Groups and admitting software. Delegated all tasks. Processed Medi Cal Treatment Authorization Requests (TAR’s) and worked closely with all government agencies, i.e., California Children’s Services (CCS), Medicare and Medi cal. Coordinated and organized departments responsibilities. Implemented new Specialty Clinic’s. Scheduled staff. Provided assistance to Director, of Outpatient Services. Coordinated meetings and in services for forty therapists and admission coordinators. Held weekly meetings with admission coordinators. Responsible for hiring and termination of all admission coordinators.

Lead Financial Counselor & Admitting Clerk /Medi-Cal Coordinator Dec. 1999 to Sept. 2001

Huntington East Valley Hospital • Glendora, CA

Responsibilities: Verification of Insurance and benefits for Inpatient, Outpatient (Observation), Same Day Care (Outpatient Surgery), and Geriatric Psychiatric admissions. Obtained authorization and or tracking numbers for all Inpatient and Observation status admits and assist Same Day Care Financial Counselor when necessary. Resumed responsibilities of the Admitting Director when necessary. Provided supervision, support and assistance to all Admitting Department Employees. Trained and updated new and existing employees regarding hospital contracted health plans and IPA’s or Medical Groups. Assisted with Meditech System questions. Collected patient co payments and or deductibles for services rendered. Collection of patient valuables when necessary. Worked closely with Utilization Review Nurses and staff. Reviewed and follow up of accounts listed on Bill Hold report. Conducted Patient Satisfaction Surveys and reported gathered data.

Manager, Member Services June 1997 to Nov. 1999

Latino Health Care Network Medical Group • Long Beach, CA

Responsibilities: Triaged all incoming calls to determine course of action. Verified provider contracts, responded to our member's concerns and issues, verified health plan eligibility and enter each member's eligibility status into our database, processed member transfers, handle member's emergencies, processed regular disenrollments, maintained positive working relationships with my counterparts at each of our health plan partners, gathered pertinent information for the purpose of filing member grievances, resolved member issues such as urgent care access by interacting with our Provider Services and Utilization Review Department. Coordinated patient care, and interacted with various DME providers to assure patients received correct equipment. Attending weekly Utilization Review Committee. Process Denial of Service Letters and disburse to health plan, providers, and member. Working closely with QI/UM Director. Assist in researching and resolving capitation issues.

Sr. Member Services Representative/Grievance Coordinator Jan. 1989 to May 1997

Tower Health • Long Beach, CA

Responsibilities: Answering and screening a high volume of incoming calls. Provided excellent customer service and knowledge of Managed Care system. Training of new and current staff. Intake and resolution of Grievances.

EDUCATION

Montebello High School • Montebello, CA • 1988

Tri City- ICD 9/CPT Coding Summary, 2001, Rio Hondo Community College

References Available Upon Request

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