Summary
Overview
Work History
Education
Skills
Timeline
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Andrea Diaz

Los Angeles,CA

Summary

Dynamic Outpatient UM Coordinator at MedPoint Management with expertise in data entry and decision-making. Proven track record in efficiently processing authorization requests and enhancing patient care through effective communication. Skilled in insurance verification and maintaining confidentiality, ensuring compliance with CMS and Medi-Cal guidelines while supporting team objectives.

Overview

16
16
years of professional experience

Work History

Outpatient UM Coordinator

MedPoint Management
07.2024 - Current
  • Process authorization requests per state and federal timelines regulations
  • Validate data entry process for errors
  • Verify member benefits and eligibility upon receipt of treatment authorization request
  • Utilizes authorization matrix, ancillary rosters, DOFR and/or delegation agreements to drive decision-making
  • Coordinates with referral Clinician and/or Medical Director for timely processing
  • Communicate with Medical Directors to facilitate Medical Reviews for non-clinical medical review referrals
  • Outreach to members on adjudication decisions
  • Outreach to providers offices when additional information is needed
  • Maintain knowledge of CMS and Medi-Cal policy guidelines as well as Medicare LCD vs NCD
  • Identify and inform Case Management Clinician on complex care diagnosis
  • Screen cases for possible California Children Services (CCS) eligible condition
  • Read and maintain email inquiries
  • Data entry for additional requested services
  • Assist with special projects
  • Assists the Client Support Center with a high volume of calls
  • Assists other team members with their workload



Medical Assistant

MD Revolution
07.2024 - 06.2025
  • Use a dialer phone system (Five9) to enroll patients into CCm and RPM services
  • Speak with patients to discuss their overall health and wellness and document those interactions into RevUp
  • Communicate with patients via direct messaging and online portal
  • Guide patients through their personalized health programs, establishing goals and create an achievable care plan
  • Assist with scheduling appointments and prescription refills
  • Recognize situations that require escalation services
  • Patient Monitoring for trends logged on RPM devices

Medical Assistant

The Heart Medical Group
09.2023 - 07.2024
  • Check patients in and out
  • Patient intake; measuring and recording vital signs, medication, and medical history
  • Assisting physicians with procedures
  • Maintaining cleanliness of exam rooms
  • Call in prescriptions
  • Perform EKGs and stress tests
  • Obtain and scan patient medical records into EMR eClinicalWorks
  • Collect copays, deductibles, out of pockets, and balances
  • Obtain patient information
  • Verify insurance and obtain prior authorizations
  • Schedule and confirm appointments
  • Submit patients referrals to health plans / IPAs


Quality Assurance

FedEx Ground
11.2020 - 07.2024
  • Ensures the proper handling and processing of packages
  • Identifying and resolving issues to damaged or improperly routed items
  • Inspecting packages, repacking damaged items, processing overgoods and returns, and investigating package damage
  • Maintain safety and operational standards

Medical Assistant

Marc L Ladenheim, MD FACC Inc
07.2009 - 06.2023
  • Concierge care
  • Reception
  • Schedule office appointments, imaging, hospital procedures, labs and insurance verification
  • Obtain prior authorizations and assist with peer to peer discussion
  • Obtain and scan medical records into EMR Aprima, AllScripts, Athena
  • Collect copays, deductibles, out of pockets and balances
  • Bill hospital and in office testing and procedures
  • Knowledge of ICD10 and CPT
  • Obtain patient information
  • Referrals
  • Call in prescriptions
  • Perform EKGs, Glucose testing, stress tests, and vitals

Education

Certificate of Technical Studies - Medical

Concorde Career College
North Hollywood
07-2009

Skills

  • Data entry
  • Decision-making
  • Discretion and confidentiality
  • Document management
  • Recordkeeping
  • Schedule management
  • Administrative leadership
  • Patient scheduling
  • Medical terminology
  • Insurance verification
  • Medical billing
  • Phone and email etiquette

Timeline

Outpatient UM Coordinator

MedPoint Management
07.2024 - Current

Medical Assistant

MD Revolution
07.2024 - 06.2025

Medical Assistant

The Heart Medical Group
09.2023 - 07.2024

Quality Assurance

FedEx Ground
11.2020 - 07.2024

Medical Assistant

Marc L Ladenheim, MD FACC Inc
07.2009 - 06.2023

Certificate of Technical Studies - Medical

Concorde Career College

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