Stella Marie Adorable
Los Angeles,CA
Summary
Obtain a position as Operations Specialist to utilize and maximize management and leadership skills, customer service skills, organizational skills, analytical and problem-solving skills and at the same time have the opportunity for growth. Detail-oriented with 20 years of experience in home infusion industry.
13 years of experience in leadership roles. Detailed-oriented individual and highly collaborative known for creating and implementing policies and procedures to promote workflow improvement. Excellent leadership and organizational skills. Well-known for creating positive workplace culture and high-performing teams.
Overview
14
14
years of professional experience
Work History
Reimbursement Specialist
Option Care
Remote
03.2018 - 11.2019
- Created, organized and lead projects to resolve A/R, payor and process issues - improved KPI Score for NCPDP claims from 75% to 95% after implementation.
- Collaborated with cross functional teams to create improvement processes that positively impact employees, patient's and organization
- Acted as business process subject matter expert and supports field as appropriate ( NCPDP/PBM Support )
- Supported transformation and accounts receivable processes to achieve operational excellence
Intake Manager
Walgreens/Option Care
Sun Valley, Ca , CA
09.2009 - 03.2018
- Managed 16 team members
- Ensured appropriateness of patient referral process ( verify insurance coverage and obtain pre-authorization
- Ensured Customer Service satisfaction
- Performed chart audits to ensure compliance
- Monitored and evaluate team member productivity and performance
- Collaborated with other departments to meet goals
- Partnered with Sales Team to help educate Case Managers on payor requirements and clinical documentation requirements
- Participated in Quarterly Process Improvement Meetings, write Action Plans, implement and follow up completion
- Assessed authorization and denial metrics and adjusted operational plans to uphold quality standards
- Developed policies and procedures for effective referral management
- Handled employee onboarding processes, monthly & yearly one-on-one meetings
Reimbursement Manager
Walgreens Infusion Services
Burbank, CA
12.2007 - 09.2009
- Managed 24 team members
- Managed productivity and financial results for two branches
- Developed Reimbursement Department strategies and implementation of plans to ensure goals for intake and customer service levels, accounts receivable, bad debt, and cash are within stated objectives
- Partnered with Director of Reimbursement, Operations, Sales and other Corporate Departments to implement company initiatives
- Performed month-end process and reports
- Maintained strong knowledge of medical terminology and procedures
- Held monthly staff meetings and implemented team building exercises , which promoted positive working environment.
- Observed strict data confidentiality procedures to protect patients' information
- Reviewed billing and collections process and determined improvements to streamline workflows
Reimbursement Supervisor
Walgreens Infusion Services
Burbank, CA
12.2005 - 12.2007
- Supervised productivity and provided on going training for staff
- Involved with interview and onboarding process
- Reviewed and submitted timesheets for payroll
- Handled payor projects assigned by Reimbursement Manager such as claim audits, payment denials.
- Improved monthly collection goals by 30%
- Ensured timely billing of claims to maintain DSO goals
- Acted as Administrator for payor portals
- Provided coverage in Medical Billing, Collections and Appeals
Education
Associate of Arts - Business Management
Glendale Community College
Glendale, CAHigh School Diploma -
Herbert Hoover High School
Glendale, CA06.1994
Skills
- Relationship Building & Team Collaboration
- Verbal and Written Communication
- Process Implementation & Monitoring
- Work Planning , Prioritization & Deadline Adherence
- Healthcare Insurance Knowledge (Medicare, Medi-cal, Managed Care, Commercial Plans)
- Contracts & Fee Schedules
- HCPCPS & Diagnosis Codes
- Microsoft Office (Word, Excel, Outlook, Skype, Power Point)
- Software (CPR , Specialized Clinicians, I-Emphsys, MRO)
- Management Systems (Sharepoint, Reference Point, Kronos - Workforce)
Accomplishments
- My Department was recognized as a model training site
- Recognized for maintaining company's bad debt reserve for 8 consecutive years
- Selected as Representative to attend the National Summit Meeting
- Summited Mount Whitney - Highest mountain in CA and the contiguous United States - 22 miles, 12000 ft elevation gain
- Completed 4 National Park Half Marathons - 13.1 miles
- Completed the Grand Canyon Rim to Rim Hike - 23 miles, 5000 ft elevation loss, 4800 ft elevation gain
Volunteer Work
- Trail Safety Patrol
Timeline
Reimbursement Specialist
Option Care
03.2018 - 11.2019
Intake Manager
Walgreens/Option Care
09.2009 - 03.2018
Reimbursement Manager
Walgreens Infusion Services
12.2007 - 09.2009
Reimbursement Supervisor
Walgreens Infusion Services
12.2005 - 12.2007
Associate of Arts - Business Management
Glendale Community College
High School Diploma -
Herbert Hoover High School