Summary
Overview
Work History
Education
Skills
Timeline
Generic

ALYSSIA CHAVEZ

San Antonio

Summary

Healthcare professional with expertise in coordinating and managing patient care. Proven track record of integrating care plans across multidisciplinary teams, fostering strong collaboration to achieve optimal patient outcomes.

Experienced with managing complex authorization workflows and ensuring regulatory compliance. Utilizes effective communication and problem-solving skills to streamline processes.

Overview

10
10
years of professional experience

Work History

Virtual Assistant

Independent Contracting
12.2019 - Current
  • Devised processes to boost long-term business success and increase profit levels
  • Developed complete business plans and operational strategies for new and existing business
  • Evaluated situations and delivered targeted solutions using various tools and resources
  • Applied performance data to evaluate and improve operations, target current business conditions and forecast needs
  • Managed business operations, warehouse inventory and price negotiations
  • Displayed strong telephone etiquette, effectively handling difficult calls
  • Organized schedules, workflows and shift coverage to meet expected business demands
  • Monitored payments due from clients and promptly contacted clients with past due payments
  • Managed office inventory and placed new supply orders
  • Used judgment and initiative in handling confidential matters and requests

Care Management Support Coordinator II

Centene Healthplan
08.2024 - 03.2025
  • Initiate authorization requests for output or input services in keeping with the prior authorization list.
  • Research claims inquiry specific to the department and responsibility.
  • Screen for eligibility and benefits. Identify members without a PCP and refer to Member Service.
  • Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations.
  • Responsible for working with multiple states to support the Medicaid Program.
  • Answer phone queues and process faxes within established standards Data enters authorizations into the system.

Training Specialist

Amazing Care Home Health Services
08.2021 - 02.2022
  • Trained and mentored new personnel hired to fulfill various roles
  • Designed and facilitated training courses, aligning new learning development and solutions to organization's strategic goals, mission and vision
  • Coordinated administrative functions necessary to deliver and document training programs
  • Documented participation and evaluated learning for each participant
  • Utilized cross-training techniques to boost productivity and develop each team member's individual skills set
  • Cross-trained employees to do other jobs within business, increasing job skills and productivity
  • Trained employees on new software with minimum level of frustration and training friction
  • Evaluated and communicated trainee participation and performance in reports to management
  • Conducted training needs assessments to identify individuals' current level of skill compared to required competency for position
  • Identified and communicated to management regarding areas needing additional training
  • Conducted ongoing evaluations to determine effectiveness of programs and make recommendations for necessary modifications
  • Produced high-quality videos for future training purposes
  • Evaluated effectiveness of training programs and recommended improvements to upper management

Intake Specialist

Ohana Pediatric Home Health
02.2018 - 08.2019
  • Answered phone calls and provided new clients with required paperwork to initiate service
  • Completed intake assessment forms and filed clients' charts
  • Offering compassionate and attentive guidance to patients during moments of crisis and trauma
  • Explained insurance eligibility requirements
  • Collected, verified, recorded and processed client demographics, insurance payments and referral information
  • Communicated with referral sources, physicians and associated staff to check documentation for proper signatures
  • Interacted with insurance providers to obtain necessary documents to complete registration
  • Entered referrals into appropriate systems based on the type of referral obtained
  • Reviewed account information to confirm patient and insurance information is accurate and complete
  • Read through patient health data, histories, physician diagnoses and treatments to gain understanding for coding purposes
  • Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing
  • Quickly responded to staff and client inquiries regarding CPT codes
  • Entered patient insurance, demographic and health information into software and confirmed records
  • Pulled patient records and transferred information to appropriate parties
  • Set up patient charts and documented information in various company software
  • Identified errors and re-filed denied or rejected claims quickly to prevent payment delays
  • Completed appeals and filed and submitted claims
  • Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under policies
  • Prepared billing statements for patients, ensuring correct diagnostic coding
  • Posted charges, payments and adjustments
  • Contacted insurance providers to verify insurance information and obtain billing authorization

Human Resources Specialist

Adaptive Health Services
09.2015 - 02.2018
  • Reviewed and screened applicant resumes to identify qualified candidates
  • Oversaw and managed hiring process and assisted human resources
  • Partnered with senior leadership to establish and develop corporate and HR policies and procedures
  • Planned and managed recruitment activities for new hires using strategic personnel, staffing and position management practices
  • Scheduled and confirmed appointments
  • Answered and directed incoming calls using multi-line telephone system
  • Scheduled and confirmed appointments and meetings for management team
  • Oversaw office inventory by restocking supplies and submitting purchase orders
  • Explained eligibility details and affordability options to patients with kindness and respect
  • Answered and logged incoming inquiries via phone, fax and email
  • Maintained clinical records and required paperwork in compliance with agency standards
  • Verified insurance eligibility, benefits and patient liabilities for defined services
  • Received inbound calls to obtain clinical information from providers to create authorizations and referrals
  • Updated patient information on computer system to maintain billing accuracy
  • Processed paperwork, obtained billing forms and secured confidential information
  • Handled sensitive employee and company information with highest level of confidentiality and discretion
  • Encouraged open communications, promoting positive and pro-employee work environment
  • Directed HR programs, policies and processes to improve operational efficiency
  • Initiated employee evaluation process and recommended policy changes to help staff progress toward desired readiness goals
  • Provided HR consultation services to leadership and department heads
  • Maintained electronic medical records for all clients
  • Kept department clean, organized and professional
  • Organized patient charts, gathering medical histories, lab results and consents
  • Maintained strict confidentiality with adherence to HIPAA guidelines and regulations
  • Submitted clean claims to insurance companies electronically to secure payments

Education

Associate of Applied Science - Healthcare Administration

Palo Alto College
San Antonio, TX
05.2022

Skills

  • Medical Billing Expertise
  • Operational Strategy Adjustment
  • Quality Management Skills
  • Telecommunications Technology
  • Operational Implementation
  • Project Management
  • Staff Training and Development
  • Records Maintenance Proficiency
  • Experienced with Software Tools
  • Commercial and Private Insurance
  • Claims Management
  • Medical Terminology

Timeline

Care Management Support Coordinator II

Centene Healthplan
08.2024 - 03.2025

Training Specialist

Amazing Care Home Health Services
08.2021 - 02.2022

Virtual Assistant

Independent Contracting
12.2019 - Current

Intake Specialist

Ohana Pediatric Home Health
02.2018 - 08.2019

Human Resources Specialist

Adaptive Health Services
09.2015 - 02.2018

Associate of Applied Science - Healthcare Administration

Palo Alto College

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ALYSSIA CHAVEZ