NANCY LOZANO
Las Vegas,NV
Summary
Reliable Admitting-Discharge Specialist, with enduring confidence in public engagement, effortlessly maintaining professional and approachable demeanor. Efficient in managing up to 100+ patient registrations daily in fast-paced, customer-focused environment. Well-versed in hospital procedures, scheduling practices and forms.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Admitting-Discharge Representative
UMC of Southern Nevada
Las Vegas, NV
07.2020 - Current
- Register and discharge all inpatient/outpatient patients using HER-EPIC system.
- Verified and interpreted patient's insurance benefits (HMO, PPO, Medi-Cal, and Medicare) and direct to correct personnel if further assistance is needed.
- Collect co-pays according to patient insurance benefits.
- Process register and scheduled 1500+ patients for COVID-19 testing, Vaccines at Encore.
- Provide Spanish interpreting for non-English speaking.
- Cash balance register.
- Obtain authorization, and signatures on legal consents and insurance forms.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our COVID-19 Testing & Vaccine services.
- Adhered to social distancing protocols and wore mask or face shield at all times.
- Experienced and knowledgeable in EPIC EHR/CMS Medicare guidelines.
- Assessed information gleaned from interviews, educational, and medical records, consultation with other professionals and diagnostic evaluations to identify clients' abilities, needs and eligibility for services.
Community Liaison
Covenant Care Silver Ridge/Hills
Las Vegas, NV
12.2018 - 08.2019
- Serve primary point of contact between client and company throughout admission process.
- Uploading and updating all pre-admission information 24 hours prior to actual admission.
- Provide clinical and financial information for patient approval prior admission.
- Investigate and direct patient inquiries or complaints to appropriate medical staff members and follow up to ensure satisfactory resolution.
- Develop and distribute newsletters, brochures, or other printed materials to share information with patients or medical staff regarding facility.
- Explained program offerings and requirements to clients and answered related questions.
- Increased brand awareness by developing technical and non-technical marketing collateral and presentations, public relations campaigns, articles and newsletters.
- Handled admission processes and discharge procedures to transfer patients from hospital to home care, extended facility and self-care plans.
Community Liaison
Aloha Home Health
Las Vegas, NV
05.2018 - 12.2018
- Develop and build strong relationships with hospitals, SNF's, LTACH staff and case workers, social workers, and primary care physicians and orthopedic specialty.
- Plans, organizes, complete daily rounds in designated facilities and physician offices.
- Communicate effectively with hospitalist physicians, medical staff and orthopedics specialists to provide Aloha Home Health services.
- Identifies opportunities for additional growth or improved services to address patient's needs.
- Coordinated discharge planning to create smooth transitions into community.
- Collaborated with team members to identify and accomplish agency objectives.
- Met with clients to determine necessary services and make appropriate treatment recommendations.
- Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
Physician Office Assistant
IPC/TeamHealth
Las Vegas, NV
11.2015 - 02.2017
- Routinely collaborated with 10+ attending hospitalist physicians and medical staff to address patients concerns and improve medical care services.
- Operate office equipment such as fax machines, copiers, and phone systems, and use computers for spreadsheet, word processing, database management, and other applications.
- Open, read, route, and distribute incoming mail or other materials and answer routine letters.
- Managed and monitor patient's care for 90 days to avoid any re-admissions within 30 days of post discharge.
- Handled identification and management of eligible BPCI patients (Remedy), input next of care information, maintenance of daily statistics, routing generation of daily worksheets and reports.
- Proactively solves complex problems and address issues that could occur between patients and physicians.
- Serve as point of contact between IPC/TeamHealth, hospital staff and physicians for related administrative functions (meetings, paperwork, calendar, signatures for credential approval etc.).
- Arranged and scheduled primary care, orthopedic specialists, and wound care appointments for patients within seven days of post discharged from hospital.
- Discharge planning under supervision of hospitalist physician, or RN case manager, to include post-acute referrals, SNF/LTAC rehab, Wound Care therapy.
- Prepared and maintain records and case files, including documentation of patients demographics and eligibility information.
- Established and updated physicians work schedules to secure attending physician coverage in acute setting.
- Oversaw HR training, coaching, mentoring and staff retention.
Management Liaison
WellPoint Anthem Quality
Las Vegas, NV
05.2014 - 06.2015
- Investigated and submitted information to Quality Department regarding patient's complaint.
- Resolved complaints for about 1000 members regarding enrollment, benefits, and appeals.
- Communicated Amerigroup Members of their rights, complaints and responsibilities regarding their manual hand book.
- Respond and handle resolution/inquiries from Amerigroup members or providers that include benefits, pharmacy eligibility benefits.
- Pull medical cases from queue research medical case pertaining to Appeals/Grievances.
- Monitored and Managed multiple databases to keep track of all Amerigroup member.
- Reconcile accounts to include payments, adjustments, denials, and under pays.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Tracked all pending authorizations to resolve discrepancies and avoid revenue loss.
- Communicated effectively with staff, including members of operations, finance and clinical departments.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Managed processing of all benefits applications, including those for financial assistance.
- Educated patients on eligibility and affordability options by offering insightful information.
- Scheduled appointments with applicants to gather information and explain benefits processes.
- Reviewed patient records, identified medical codes and created invoices for billing purposes.
- Processed insurance company denials by auditing patient files.
- Researching procedures and diagnostic codes to determine proper reimbursement.
- Communicated with insurance providers to resolve any denied claims and resubmit.
- Oversaw all billing for Medicaid PCA, waiver and skilled claims, commercial insurance and private pay clients.
- Posted surgical charges for seven doctors in orthopedics clinic.
- Verified proper ICD-9 coding on claims.
- Enforced operational compliance with state and federal laws and JCAHO standards.
- Collected payments and applied to patient accounts.
- Scheduled patients in Medical Manager System.
- Reviewed outgoing bills for eligibility and accurateness.
- Prepared billing statements for patients and verified correct diagnostic coding.
Professional Community Liaison
Infinity Hospice/Pro Care Hospice/Spring View
Las Vegas, NV
01.2012 - 05.2014
- Provided Palliative care information for up to 10 physicians, nurses, case managers in group class session.
- Developed and implemented weekly sales plan to bring 10 new patients monthly.
- Marketing/Sales in home health, assisted living facilities, skilled nursing facilities, or other healthcare sales experience.
Clinical Administrative Coordinator
UnitedHealth Care
Las Vegas, NV
11.2000 - 03.2012
- Processed Work Comp care injuries reports from employers, and injured workers.
- Handled and Coordinate admission processes and discharge procedures to transfer patients from hospital to home care, extended facility and self-care plans.
- Established patients with choice list.
- Maintained coding requirements, through continuing education and certification renewal.
- Coordination of benefits, obtain authorizations, pre-certification, and referrals.
- Relation building, networking, and marketing management.
- Communicate and handle resolutions/inquiries from members to Chief Hospitalist and case managers.
- Experience working and handle 99+ calls in call center department filing Worker's Compensation claims in manner consistent with claim quality standards and goals.
- Researched patient's eligibility and claims status with insurance agencies.
Education
No Degree - Health Administration
WGU
OnlineSome College (No Degree) - Criminal Justice
University Of Phoenix
Las Vegas, NVSkills
- Customer Service
- Problem-Solving
- Teamwork Skills
- Excellent work Ethic
- Project Planning
- Strong clinical assessment and decision making
- EPIC EHR, EMR/Tiger, Cerner Works, HCA hcare, TeamWorks, Remedy Connect, Macess, Facets/Check Mate-Kramer, Krono
- Excellent work ethic and Flexible and Adaptable
- Certified Spanish Interpreter
- Hospice resources
- Community Resource advocacy
- Medical billing (authorizations, cash balance)
- Patient interviewing skills
Certification
- PCA Training - 2016
- Certified Spanish Interpreter
Timeline
Admitting-Discharge Representative
UMC of Southern Nevada
07.2020 - Current
Community Liaison
Covenant Care Silver Ridge/Hills
12.2018 - 08.2019
Community Liaison
Aloha Home Health
05.2018 - 12.2018
Physician Office Assistant
IPC/TeamHealth
11.2015 - 02.2017
Management Liaison
WellPoint Anthem Quality
05.2014 - 06.2015
Professional Community Liaison
Infinity Hospice/Pro Care Hospice/Spring View
01.2012 - 05.2014
Clinical Administrative Coordinator
UnitedHealth Care
11.2000 - 03.2012
No Degree - Health Administration
WGU
Some College (No Degree) - Criminal Justice
University Of Phoenix