Amy Munoz
Colorado Springs,Colorado
Overview
17
17
years of professional experience
Work History
Senior Provider Relations Advocate
United Health Care
01.2023 - 04.2025
- Manage provider relations and service interactions at United Health, including claim and call quality, physician portal usability, service enhancements, and external provider education programs training and development
- Creates programs to foster positive relationships between the health plan and providers
- Directed and implemented strategies for developing and managing a provider network, identifying gaps in network composition
- Identifies operational deficiencies and addresses them through reports and provider feedback
- Research and remediate claims
- Expertise in HCFA-1500 and UB-04 billing forms for accurate and efficient claims submissions
- Analyzed and investigated data (e.g., claim/prior authorization data) to determine call drivers and develop action plans
- Assisted in driving process improvement for all lines of business (Commercial, Medicare and Medicaid) to help reduce provider contact rates
Customer Care Rep Lead/Manager
Centura Health At Home-Penrose St. Francis Health Services
Colo. Springs, CO
11.2012 - 12.2022
- Onboarding New Associates: Back Office and Clinical Staff
- Oversee and manage the Intake department through the leadership of QAPI meetings, intake meetings, facilitation of daily staff duties, creation of employee schedules, conducting performance reviews, and supporting team members' well-being
- Supports the Director and Executive Leadership in executing various initiatives: Collaborate on trended outcomes through quality metric data, patient experience, and process measures
- Evaluate incoming Home Health referrals: Input/verify patient information
- Schedule patient admissions, troubleshoots scheduling conflicts and collaborate with all clinical staff regarding patients’ course of care
- Insurance verification and obtain/manage authorizations for all insurance types (Medicaid, Managed Medicare, and Commercial) and work in collaboration with Billing department to ensure accounts are billed correctly
- Manage Intake and Billing work-ques
C.N.A/Unit Secretary/Patient Access Rep
Penrose Community Urgent Care/Penrose Main ER
Colorado Springs, CO
06.2010 - 11.2012
- Triage: Record patient histories, check vitals, prepare treatment areas, and organize discharges
- Run patient data reports
- Check and review patient charts
- Register patients: Verify insurance details and copay information
- Collaborate with Physicians, Nurses and Lab staff regarding patient course of care
C.N.A Team Lead/Preceptor
Columbine Health Systems-Columbine West Health and Rehab
Fort Collins, CO
12.2007 - 05.2010
- Direct and manage CNA shift duties, schedules, staff concerns and train new CNA’s
- Obtain Accurate Vital Signs and document clinical information correctly
- Work with Dementia/Alzheimer, Hospice, Long Term Care and Medicare/Rehab Residents
Education
Bachelor's - Biology
Colorado State University
Fort Collins, COSkills
- Financial acumen
- Provider network development
- Health plan interpretation
- Educational presentations
- Policy interpretation
- Teamwork and collaboration
- Multitasking Abilities
- Reliability, Adaptability and flexibility
- Excellent communication
- Operational efficiency
- Task prioritization
- Self motivation
- Interpersonal skills
- Conflict resolution
- Interpersonal communication
- Quality assurance
- Project management
- Data analysis
- Workflow optimization
Accomplishments
- SME specific for Home Health Claims and ACA RAF Chart Connection/Retrieval Program
- Led the Chart Connection program with a 99% turnaround on chart retrieval
- Completion of First Level Leadership Program
- Make it Matter Recipient
- Service Hero Finalist
Timeline
Senior Provider Relations Advocate
United Health Care
01.2023 - 04.2025
Customer Care Rep Lead/Manager
Centura Health At Home-Penrose St. Francis Health Services
11.2012 - 12.2022
C.N.A/Unit Secretary/Patient Access Rep
Penrose Community Urgent Care/Penrose Main ER
06.2010 - 11.2012
C.N.A Team Lead/Preceptor
Columbine Health Systems-Columbine West Health and Rehab
12.2007 - 05.2010
Bachelor's - Biology
Colorado State University