BLANCA MACIAS
Los Angeles,CA
Summary
Motivated and dedicated new graduate Licensed Vocational Nurse looking to begin a fulfilling career in nursing. Committed to maximizing my skills and abilities delivering safe, compassionate care, ensuring patient comfort and recovery.
Overview
8
8
years of professional experience
1
1
Certification
Work History
UM Coordinator II
Altamed Medical Health Group
06.2019 - Current
- Processing Health Net authorizations through SHARE program
- Worked with CPT and ICD codes on a daily basis
- Accurately processed share inquiries submitted by provider/health plan as directed by supervisor within TAT time frames
- Worked closely with nurses and Medical Director for timely referral processing
- Worked closely with providers, hospitals and authorizations departments to redirect patient to correct capped providers
- Processed DME authorizations
- Verifying member benefits and eligibility when processing authorizations
- Utilized authorization matrix, ancillary rosters, DOFR, and/or delegation agreements to drive decision-making
- Working with outpatient and inpatient, UM Coordinators
- Coordinated for out-of-network cases and facilitates letters of agreement (LOA) processing in collaboration with Medical Directors and Leadership
- Processed delay letters in request of medical director
- Worked with Capitated hospitals such as Adventist White Memorial Medical Center and Citrus Queen of the Valley and many more
- Worked on a daily basis with providers and hospitals for further information needed
- (notes, reports etc.)
- Verified member notes belong to correct member, requiring two pt identifiers
- Provided help within the department as needed and directed my supervisor
- Worked directly with other um coordinators and supervisors to achieve AltaMeds Vision and goals within the department
Patient Advocate I
Altamed Medical Health Group
08.2018 - 06.2019
- Register Patients for their Dental Appointment
- Provide my Aidet skills with my patients and team at all times
- Work closely with my team, which includes My provider, RDA (Register Dental Assistant), DA (Dental Assistant)
- Audit Dental Charts on a daily basis
- Explain treatment plans to patients
- Schedule dental appointments for recalls
- Process Referrals as needed by doctors
- Collected payments
- Verify eligibility and work closely with dental Plans
- (Medi-cal, Access Dental, Health Net Dental, Liberty Dental)
- Check out patient and schedule next dental appointment as needed
- Keep work area clean and sanitized
Referral Specialist I
Altamed Medical Health Group
03.2017 - 05.2018
- Prepared denial letters by using medical terminology for review by medical director
- Created denial letter and mailed to patient
- Worked with CPT codes and ICD Codes on a daily basis
- Pulled files for health plan audits under direction of the supervisor
- Worked in the mail room preparing the mail to sent out within proper time
- Entered and processed referrals in to AltaMed Net System
- Attached Medical records to the AltaMed Net System
- Worked with capitated hospitals such as White Memorial Medical Center and Citrus Queen of the Valley etc
- Worked closely with providers, hospitals and authorizations departments to redirect patient to correct capped providers
- Accurately process Altamed net inquiries submitted by provider/health plan as directed by supervisor within turn around time frames
- Provided help within the department as needed and directed my lead and supervisor
- Worked directly with other referral specialist, supervisors on a daily basis
Education
Licensed Vocational Nursing -
Medical Allied Career Center
12631 Imperial Hwy. D108, Santa Fe Springs, CA 90607-2025
Certified Dental Assistant
American Dental Academy
212 S Atlantic Blvd #103, Los Angeles, CA 9002208-2010
Skills
- Patient Care
- Patient assessment
- Nursing care planning
- Charting and documentation
- Vital signs monitoring
- Infection control
- Medication administration
- Tracheostomy care
- Catheter care
- Surgical care
- Emergency care
- Disease prevention
- Patient hygiene assistance
- Patient education
- Patient relationship building
- Geriatric care
- Reliable team worker
- Multi-tasking and prioritization
- Fast learner
- Self-motivated
- Works well under pressure
- Bilingual Spanish/English
- Case management
- HIPAA protocol adherence
- CPT and ICD coding
Clinical and Medical Experience
Imperial Healthcare Center , Nursing Home
11926 La Mirada Blvd, La Mirada, CA 90638
Rio Hondo Subacute and Nursing
273 E Beverly Blvd, Montebello, CA 90640
Norwalk Community Hospital
13222 Bloomfield Ave, Norwalk, CA 90650
Certification
- American Heart Association, CPR Certified
- Management Of Assaultive Behavior Certification
- AORN LA Chapter 0507 Perioperative
Patient Safety Seminar and 3rd Mini-Convention Certification.
- Radiation Safety Course, X-ray Certified
Timeline
UM Coordinator II
Altamed Medical Health Group
06.2019 - Current
Patient Advocate I
Altamed Medical Health Group
08.2018 - 06.2019
Referral Specialist I
Altamed Medical Health Group
03.2017 - 05.2018
Licensed Vocational Nursing -
Medical Allied Career Center
Certified Dental Assistant
American Dental Academy
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