Annette M. Contreras

Long Beach, CA ***** Cell: 562-***-****

SUMMARY OF QUALIFICATIONS AND EXPERTISE:

• Twenty seven years of extensive and diverse experience in healthcare

• Strong education and training related skills

• Excellent presentation and oral communication skills

• Extensive knowledge of software application systems / various programs for specific companies

• Knowledgeable, reliable, self-directed and team player

• Strong management and coordination business related skills

PROFESSIONAL EXPERIENCE:

UTILIZATION MANAGEMENT TRAINING SPECIALIST / EXECUTIVE ADMIN SUPPORT (Dual Role)

Molina Healthcare, Ca. 05/2006 - Present

• Conduct new hire training for Utilization Management staff (Medicare and Medi-cal)

• Transfer knowledge to the UM staff for continuing system upgrades and processes.

• Implement and facilitate presentations for new hire training materials and training workshops

• Liaison for Provider Relations, Member Services and Claims with the goal of building a better relationship for our providers.

• Coordinate/ organize in-services with outside vendors and CEU programs

• Create and maintain Molina intranet access (SharePoint) for Medical and Medicare LOB within the UM department

• Testing new and upgrades of systems with IT Network

• Perform quality improvement audits for clinical and non clinical

• Executive support to the VP, Healthcare Services

• Coordinate and present meeting minutes.

• Arrange for travel, check request, reimbursements

• Revise Policy and Procedures guidelines as need to maintain federal and state laws for Medi-cal and Medicare

PERINATAL CASE MANAGEMENT COORDINATOR (UM COORDINATOR): 2006 - 2007

• A new position creating responsibilities to run the department efficiently and accurately to ensure high quality service to our patients

• Call for concurrent inpatient reviews and discharges

• Monitor / maintain logs of active/inactive cases

• Assess/screen and educate patients for PCM enrollment

• Authorization/coordination of referrals for open cases

• Coordinate transition of care for members with non contracted providers

• Run productivity reports

TEAM LEADER - INTAKE REFERRAL COORDINATOR:

Foremost Pharmacy Services 10/2005 - 05/2006

• Coordinate employees schedules

• Staff nurses for IV therapy home services

• Verify and complete IV infusion process physician order from referral source

• Verify insurance eligibility/benefits and obtain authorization/pre-certification and follow up

• Arrange set ups for new and continue patients

• Knowledge of Medicare Part D, Medi-cal billing

PHYSICAL THERAPY ASSISTANT/INSURANCE COORDINATOR: (PART TIME)

New West Rehabilitation Physical Therapy 06/2005 – 10/2005

• Assist Patient’s rehabilitation workout (aquatic and land).

• Educate patients strengthening and set up home exercise programs

• Insurance verification and billing

A Contreras (2 of 2)

TEMPORARY / CONTRACT ASSIGNMENTS 4/2003 – 05/2005

• CLIENT LIAISON REPRESENTATIVE – Canfield & Associates

• CERTIFIED MASSAGE THERAPIST / FRONT DESK SCHEDULER – Southern California Rehabilitation Injury Treatment Centers

• FRONT OFFICE MANAGER – California Wellness Centers

• FREE LANCE MASSAGE THERAPIST

UTILIZATION MANAGEMENT COORDINATOR:

Affiliated Doctors of Orange County 09/2001 -04/2003

• Authorize referrals for Prior Authorization with strong medical coding

• Verify insurance and benefits.

• Run daily data and monthly reports.

• Work with all levels of management and liaison to all departments.

REFERRAL INTAKE COORDINATOR:

Life Care Solutions 07/1999 – 09/2001

• Verify and complete process physician order from referral source.

• Insurance verification: eligibility and benefits.

• Obtain authorization /pre-certification and follow up

• Set up deliveries for all new and continuing patients.

• Staff respiratory therapist for home services.

• Knowledge of Medicare Part B and Medi-cal billing

EDUCATION:

Public Communications – Present

Associates Degree: Human Service Generalist: 2002

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