ANA YESCAS
Murrieta,CA
Summary
Experienced Office Management and Administration Professional experienced optimizing productivity, efficiency and service quality across various environments. Highly dependable, ethical and reliable support specialist and leader that blends advanced organizational, technical and business acumen. Works effectively with cross-functional teams in ensuring operational and service excellence.
Overview
11
11
years of professional experience
Work History
Administrative Coordinator for Case Management/Social Work Department
Scripps Mercy Hospital
06.2018 - Current
- Informing via email Social Work team of any hearing dates and hearing findings
- Direct callers to correct Case manager or Social Worker
- Processing invoices
- Distribute and order taxi vouchers and bus passes to all floors
- Keeping employee records updated
- Ordering office supplies and cell phones for new employees for San Diego and Chula Vista Scripps Hospitals
- Maintaining office equipment and making sure it is working properly (San Diego & Chula Vista)
- Communicating effectively and clearly with case managers and social workers
- Send referral through all Scripts/ECIN to SNF requesting placement for our patients
- Submitting access requests for new employees.
Access Representative II Utilization Management/Complex Case Management/Placement Coordinator
Scripps Health Plan Services
10.2017 - 06.2018
- Receive referral requests from SNF Case Managers
- Fax last cover dates for patients that are exhausting their medical benefits at SNF
- Scan all clinical notes into patient accounts
- Process requests for DME, Home Health (PT, OT, ST& RN) with orders attached and send them to the corresponding companies
- Communicate with Care Managers of outcomes regarding acceptance to facilities for patients needing Skilled Nursing Facility
- Contact HMO, PPO, POS, EPO & Medicare, Medi-Cal insurance to verify if pre-certification is needed
- Arrange for transportation for patients who are discharged from hospital
- Emailing Care managers with authorization numbers, Home Health agencies, DME arrival time, Skilled Nursing Facility final acceptance, Doctor to follow patient, & number for report.
- Assisted in reducing administrative errors through meticulous attention to detail in data entry tasks related to billing codes, service charges, and demographics.
Member Services Representative
Scripps Health Plan HMO
11.2016 - 10.2017
- Performs a variety of customer service functions such as providing resources to patients, provider's offices, and managed care operations
- All functions that may include ability to effectively answer high-volume phone systems while multi-tasking, research and respond to insurance verification questions, referral and authorizations monitoring and follow-up, claims status, provider dispute resolution, PCP selection, gathering information and analysis of patient accounts to decipher eligibility, benefits, and copayment responsibility
- Provided excellent customer service
- Educating customers and providers with Scripps Health Plan benefit structure
- Help troubleshoot any claims or referral issues
- Make sure to exercise HIPPA policies when dealing with customers.
- Enhanced customer satisfaction by efficiently addressing and resolving inquiries and concerns.
Customer Service Representative II
Scripps Health Plan Services
11.2015 - 11.2016
- Performs a variety of customer service functions such as providing resources to patients, provider's offices and managed care operations
- All functions that may include ability to effectively answer high-volume phone system while multi-tasking, research and respond to insurance verification questions, referral and authorizations monitoring and follow-up, claims status, provider dispute resolution, PCP selection, gathering information and analysis of patient accounts to decipher eligibility, benefits, and copayment responsibility
- Manages all Spanish calls regarding benefits, primary care physicians, and authorization inquiries
- Answer inbound calls from customers, providers, and health insurance plans
- Managed claims or referral issues
- Knowledgeable in HMO, PPO, EPO, POS, Medicare, and Medi-Cal programs.
- Handled customer inquiries and suggestions courteously and professionally.
- Actively listened to customers, handled concerns quickly, and escalated major issues to supervisor.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Clarified customer issues and determined the root cause of problems to resolve product or service complaints.
- Educated customers about billing, payment processing, and support policies and procedures.
Financial Counselor II (temporary Assignment Thru ATI Staffing Solutions)
Rady Children's Hospital
03.2015 - 08.2015
- Coordinating reimbursement sources for patients and their families
- Working with third-party payers (federal, state, and private plans)
- Assists families who are uninsured or underinsured to help apply for government-sponsored programs
- Implements payment plans for families
- Resolving outstanding balances
- Visiting families at their bedside when are unable to visit office
- Processing any payments received
- Verify Eligibility and benefits
- Translating any info in English to Spanish for patients who do not speak English
- Verifying eligibility through various web sites for patients.
- Worked directly with clients to provide financial counseling and education using individualized counseling model and personal finance course.
- Managed caseload effectively, ensuring timely follow-up appointments and communication with clients.
Insurance Representative (temporary Assignment Thru ATI Staffing Solutions)
Sharp Health Plan
09.2014 - 10.2014
- Answered inbound calls regarding insurance eligibility, enrollment process, payments, and troubleshooting
- Provided all customers with exceptional service
- Interprets, identifies, communicates, and documents this information by way of inbound calls, e-mails, and faxes
- Processed payments
- Updated all information for customers
- Answered question regarding government funded programs
- Gave information to uninsured customers and insured customers
- Managed all Spanish inbound calls
- Resolving customer account balances.
Military and Veterans Customer Service Referral Representative
UnitedHealth Group
02.2013 - 03.2014
- Processed enrollment applications, payments, and referrals in their respective programs
- Educated customers on Medicare and the choices available.
- Research authorizations and claims information using online systems
- Documents customer inquiries in the system and processes online tasks to include payments, follow-ups as needed, updates to personal information, and any other changes to coverages
- Communicate superior customer service regarding medical benefit programs while providing one-stop resolutions
- Promote good working environment
- Responsible for enrollment/access issues that are related to all eligible beneficiaries with civilian and Military Treatment Facility (MTF) providers
- Educate beneficiaries on enrollment options, their financial responsibilities, limitations, and health insurance choices
- Referenced as subject matter expert to provide guidance and educational assistance to colleagues
- Assigned difficult beneficiaries with complex issues to ensure service is complete and to their satisfaction
- Referral Management
- Follow HIPAA guidelines and advise of protocol for disclosure of personal information or legal documentation.
- Handled customer complaints quickly and professionally to restore customer confidence and prevent loss of business.
- Developed and maintained positive customer relations and coordinated with team members to properly handle requests and questions.
- Greeted customers warmly to set tone of customer experience and provide welcoming and friendly atmosphere.
- Learned and followed all organizational policies and procedures to maintain safe and professional working environments.
- Assisted in training new hires and offered ongoing support to help them reach their full potential.
- Improved client retention rates by building strong relationships and offering personalized solutions to their needs.
Education
Bachelor of Arts - Healthcare Administration
University of Arizona
Tucson, AZ07.2020
Skills
- 17 years in healthcare industry
- Medi-Cal / Medicaid/Medicare
- Bilingual: English/Spanish
- Project Management
- Knowledge of HMO/PPO/POS
- Trainer
- Data Entry
- Records Management
- Claims Processing
- Accounts Receivable
- Authorizations
- Administrative Support
- CPT/HCPC/MODIFIERS
- PowerPoint
- Microsoft Word
- SharePoint
- Care One
- EMR
- EPIC
- ECIN (All Scripts)
- Kronos
- File Organization
- Attention to Detail
- Team Collaboration
- Office Administration
- Microsoft Excel
- Inbound phone call handling
- Documentation and Recordkeeping
- Office inventory management
- Project Support
- Microsoft Office
- Customer Service
- Phone and Email Etiquette
- Administrative Management
- Office Management
- Team Leadership
- Decision-Making
- Database Administration
- Administration and Operations
- Relationship Building
Training Education
- Chula Vista High School, 820 Fourth Ave, Chula Vista, CA, 91911, H.S Diploma, 06/1993
- University of Arizona Global Campus (Online), B.A. in Healthcare Administration, 2021
References
Available upon request
Languages
Spanish
Professional Working
Timeline
Administrative Coordinator for Case Management/Social Work Department
Scripps Mercy Hospital
06.2018 - Current
Access Representative II Utilization Management/Complex Case Management/Placement Coordinator
Scripps Health Plan Services
10.2017 - 06.2018
Member Services Representative
Scripps Health Plan HMO
11.2016 - 10.2017
Customer Service Representative II
Scripps Health Plan Services
11.2015 - 11.2016
Financial Counselor II (temporary Assignment Thru ATI Staffing Solutions)
Rady Children's Hospital
03.2015 - 08.2015
Insurance Representative (temporary Assignment Thru ATI Staffing Solutions)
Sharp Health Plan
09.2014 - 10.2014
Military and Veterans Customer Service Referral Representative
UnitedHealth Group
02.2013 - 03.2014
Bachelor of Arts - Healthcare Administration
University of Arizona
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