Andrea Llamas
Las Vegas,NV
Summary
Proactive Clinical Coordinator excited to transition into a new position where superb leadership and coordination abilities can be utilized. Successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Clinical Support Coordinator
Optum Serve
04.2023 - Current
- Evaluate and approve Veterans Benefit Administration Order Requests
- Ongoing communication within VA Clinical Operations Department to ensure order requests meet contractual requirements prior to approval
- Create outline of relevant medical documentation found within claims file to assist providers in performing accurate, timely Disability Benefit Questionnaires
- Accurate review of Veteran's claims file and correctly labeling relevant evidence during order request process.
Quality Specialist
Optum Serve
05.2021 - 04.2023
- Review orders for quality and accuracy including issue resolution
- Administer multiple quality reports to ensure quality standards within department are being upheld
- Retrieve, evaluate and track quality monitoring of orders and calls for staff in the department in accordance with monitoring program guidelines
- Trained specialists on multiple processes and provided feedback to improve quality.
Health Information Specialist
Logistics Health Incorporated
01.2018 - 05.2021
- Summarize, comment and document discrepancies and recommendation on health forms for practitioner network
- Assess adequacy of health record documentation to ensure it supports all diagnoses and procedures
- Verify data in Vision, PHA and Audio forms for accuracy, completeness and authenticity
- Helped process tasks due to back log in various departments such as Customer Service, Provider Network Management and MEPCOM.
Clinical Admin Coordinator/Authorization and Referral Operations
United Health Care Military and Veterans
03.2015 - 01.2018
- Manage referral process, process incoming and outgoing referrals and prior authorizations
- Handle admission/discharge information post-notification
- Entering notifications and providers' status of an existing notification and determining if notification is required
- Complete notification wizard along with ICD-9/ICD-10 and CPT coding.
Military Service Representative
United Health Care Military and Veterans
09.2013 - 03.2015
- Properly disclose to providers and beneficiaries information regarding authorizations and referrals
- Handle provider and beneficiary inquiries regarding coverage, benefits and eligibility
- Research and document all necessary information to ensure that beneficiary has proper knowledge of how Tricare health insurance functions, along with in-network and out of network benefits
- Properly disclose and verify proper copayments and deductibles for patients.
Education
Associate in Science Degree -
Casa Loma College
Anaheim, CaliforniaSkills
- Ability to recognize and identify discrepancies in history records and files and determine their relevancy and importance for inclusion in record summary
- Able to perform detailed work with high degree of accuracy
- Process Improvements
- Proficient in computer applications to include Microsoft Excel, Word and PowerPoint
- Documentation and Reporting
- Team Collaboration
- Issue Resolution
Certification
- Security Clearance ADP2/IT2
- National Agency Check (NAC)
- HIPPA Trained
Languages
English
Full Professional
Spanish
Full Professional
Timeline
Clinical Support Coordinator
Optum Serve
04.2023 - Current
Quality Specialist
Optum Serve
05.2021 - 04.2023
Health Information Specialist
Logistics Health Incorporated
01.2018 - 05.2021
Clinical Admin Coordinator/Authorization and Referral Operations
United Health Care Military and Veterans
03.2015 - 01.2018
Military Service Representative
United Health Care Military and Veterans
09.2013 - 03.2015
Associate in Science Degree -
Casa Loma College