Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic
Chanel Pineda

Chanel Pineda

Violet

Summary

My name is Chanel Pineda, and I was born and raised in New Orleans, Louisiana. I earned my Bachelor’s degree in Psychology in 2017 and went on to complete my Master of Social Work (MSW) in 2022 at Southern University at New Orleans. I am a Licensed Certified Social Worker (CSW) and bring over eight years of experience in the Social Work and Social Services field.

Throughout my career, I have gained diverse and meaningful experience across various sectors. I spent five years as a Case Manager with the Medicaid Waiver program, providing services to individuals with intellectual disabilities. I then served for two years as a Medical Social Worker and Team Lead, followed by ten months as the Director of Social Work in a Long-Term Care setting. Most recently, I held a leadership position in a nonprofit organization, focusing on Social Service Administration for nine months.

My ultimate goal is to continue growing as a leader in the field of Social Work, with a focus on administration and organizational development. I am passionate about creating systems that enhance service delivery and improve outcomes for vulnerable populations.

Overview

11
11
years of professional experience
1
1
Certification

Work History

Case Management Team Lead

Slidell Memorial Hospital
09.2024 - Current
  • Guides care management staff in all daily operational performance matters.
  • Uses all available financial and performance management information to monitor and measure the performance of the department as a team as well as the individual performance of team members.
  • Serves as model in customer service matters and educates care management staff in delivering outstanding customer service.
  • Strategizes with leadership in order to achieve departmental and organizational goals.
  • Adapts behavior to the specific patient population, including but not limited to respect for privacy, method of introduction to the patient, adapting explanation of services or procedures to be performed, requesting permissions and communication style.
  • Performs other related duties as required.

Payment Application Specialist

EyeSouth Partners
09.2017 - Current
  • Posts EOB/ERA, check, credit card and lockbox payments electronically or manually using Practice Management System (PMS).
  • Balances payment batches against daily deposits.
  • Independently evaluates EOBs from third party payers and communicates effectively and timely to the collections team and management when a contractual error is noted.
  • Determines denial codes used for each transaction that will determine a patient's balance and/or possible patient balance due statement to be processed.
  • Research unidentified payments and/or recoupments to determine correct transaction.
  • Maintains high level of productivity through speed and accuracy.

Social Service Administration Specialist

Operation Restoration
01.2024 - 09.2024
  • Develop effective integration strategies for clients, including but not limited to supervising the implementation of plans of care for OR clients
  • In collaboration with the Senior Advisor Quality Care Innovator, the Social Services Administration Specialist creates, implements and monitors control measurements for all Social Services programs
  • Develop and maintain relationships with community agencies for referral purposes.
  • Manage and assign responsibilities to Social Services staff, interns, and volunteers
  • Recruit, train and supervise staff members, interns and volunteers working for Operation Social Services
  • Ensure all Social Services information and data is properly maintained in electronic and paper files by conducting audits on a routine basis.
  • Provide written and oral updates to the senior management team on a regular basis.
  • Support fund development staff with research and grant applications
  • Coordinate Social Services across programs to make sure all OR clients, students and program participants receive high quality case management services
  • Improve and maintain processes and procedures to implement support groups for formerly incarcerated women focused on specific issues. This includes but is not limited to identifying opportunities for OR Social Services staff to obtain certifications.
  • Manage the Social Services annual budget by keeping track of expenditures and revenues
  • Manage the Social Services shared drive to ensure documentation is up to date and available to other team members
  • Conduct weekly team meetings with all Social Services staff and report outcome to direct supervisor
  • Meet weekly with the executive team to report escalating issues or events that impact client services.
  • Provide directly or identify Subject Matter Experts (SME) to conduct regular training for organization’s staff to improve their job performance and maintain a tracking system of all training provided and completed by staff.
  • Supervise all Social Services programs, and identify opportunities to expand and improve all Social Services programs
  • Collaborate with key staff to ensure reporting and compliance metrics for Employment and Training program are captured and submitted under the SNAP E&T Program
  • Oversees the management of the Rapid Response Program
  • Recruit volunteers and interns as needed by the agency to support specific programmatic needs
  • Represent Operation Restoration at fundraising and community events
  • Collaborate daily with Operation Restoration staff to ensure departmental effectiveness
  • Perform miscellaneous job-related duties related to Operation Social Services, as assigned

Social Service Director

St Margaret’s at Mercy
05.2023 - 01.2024
  • Participate in admission and discharge planning, and the development of care plans.
  • Coordinate the overall psychosocial care plan for residents.
  • Provide support and advocate for resident/patient and their family.
  • Maintain knowledge of community resources including the arranging of interpreters for residents/patients with English as a second language or with no understanding of English.
  • Inform residents/patients, families, and responsible party of their rights.
  • Demonstrate knowledge of federal and state regulations as well as community policies and procedures.
  • Coordinate the discharge planning for residents/patients to any destination including the home health services, medical equipment, meals, and other supports for a safe and successful discharge.
  • Perform other duties, tasks and/or projects as assigned

Social Worker Case Manager

Slidell Memorial Hospital
11.2022 - 06.2023
  • Assessment of patient's ability to cope with illness/hospitalization; evaluation of family support systems; provision of emotional support.
  • Psychosocial assessment, including evaluation of family/home/financial support, and/or another high-risk social factor.
  • Team member of the Weekly Interdisciplinary Meeting to aid in continuity of care after discharge to identify psychosocial needs.
  • Provides crisis intervention; advocacy; counseling as needed.
  • Knowledge of payor source impact on discharge needs and placement options including patient without healthcare coverage.
  • Coordination and patient support of abuse/neglect cases, domestic violence, substance abuse issues, crime victims, high-risk mothers, and adoptions.
  • Referral to community support agencies/mental health services as indicated. Assists with home health and placements to psychiatric facility, nursing home, SNF, rehab, LTAC, hospice, foster care, and shelters.
  • Responsible for getting Important Message from Medicare signature from patient within 48 hours of discharge.

Support Coordinator

Quality Support Coordination
01.2018 - 03.2023
  • Developed appropriate care plans for at-risk individuals and high-risk families.
  • Informed patients and families of treatment options, medications, and at-home care strategies.
  • Coordinated support services and optimized communication between healthcare workers and clients.
  • Procured resources from diverse providers to develop specified intervention plans for clients.
  • Reviewed treatment plans against individual goals and healthcare standards.
  • Maintained lists of resources helpful to clients.
  • Maintained thorough case history records and wrote detailed reports.
  • Completing initial assessments, monthly contacts and quarterly home visits for over 50 clients.
  • Work with NOW, ROW, Supports, and Children's Choice Waiver
  • Imputing Critical Incidents into SIMS system
  • Completing and Submitting Care Plan via LASRS.

Billing Manager

New Beginnings Behavioral & Family Services
08.2022 - 11.2022
  • Conduct insurance verification and pre-authorization, coded Behavioral/Mental Health procedures and managed patient charts.
  • Set up and maintained ShareNotes electronic billing system.
  • Managed billing calendar and scheduled claims for payments
  • Engaged in oversight of all billing for Medicaid, Medicare, Humana and Humana Military
  • Led team of 6 staff handling more than $80,000 in monthly charges
  • Resolved billing issues by applying knowledge and completing in-depth research.
  • Maintained informational resources, tracking and documenting requests for updates, certification and credentialing.
  • Performed primary source verifications such as criminal histories, licenses and board certifications.
  • Checked applications for missing information and organized all paperwork.
  • Confirmed facility and user credentials to initiate and maintain registration and enrollment processes.
  • (Healthy Blue, Amerihealth, Aetna, and Louisiana Healthcare Connections) Completed enrollments into Medicaid, Medicare and private insurance plans.
  • Set up NPI numbers for providers and facilities and updated current profile information

Receptionist

Heitmeier Eyecare
08.2014 - 09.2017
  • Scheduled and confirmed appointments.
  • Answered and directed incoming calls using multi-line telephone system.
  • Maintained daily calendars, set appointments with clients and planned daily office events.
  • Processed payments and updated accounts to reflect balance changes.
  • Oversaw office inventory by restocking supplies and submitting purchase orders.
  • Welcomed patients to front desk and engaged in friendly conversations while conducting check-in process.
  • Checking in patients and collecting co-pays
  • Insurance Verification
  • Optician
  • Billing and coding

Education

Master of Social Work -

Southern University at New Orleans
New Orleans, LA
01.2022

Bachelor of Arts - Psychology

Southern University at New Orleans
New Orleans, LA
01.2017

Skills

  • 2 years of management Experience
  • First Aid/CPR
  • CPI Certified
  • MS Office
  • Customer service
  • Psychosocial assessments expert
  • Organization
  • 5 years of Budgets
  • Knowledge of medical and psychiatric terminology
  • 5 years of Medical Billing and Coding
  • 2 years of Behavioral Billing and Coding
  • 5 years of Case Management
  • 6 years of HIPPA Knowledge
  • 2 years of EPIC Healthcare Software
  • 4 years of Louisiana Service Reporting System (LASRS)
  • 2 years of Discharge Planning

Certification

  • First Aid/CPR Certified
  • CSW License #17453

Timeline

Case Management Team Lead

Slidell Memorial Hospital
09.2024 - Current

Social Service Administration Specialist

Operation Restoration
01.2024 - 09.2024

Social Service Director

St Margaret’s at Mercy
05.2023 - 01.2024

Social Worker Case Manager

Slidell Memorial Hospital
11.2022 - 06.2023

Billing Manager

New Beginnings Behavioral & Family Services
08.2022 - 11.2022

Support Coordinator

Quality Support Coordination
01.2018 - 03.2023

Payment Application Specialist

EyeSouth Partners
09.2017 - Current

Receptionist

Heitmeier Eyecare
08.2014 - 09.2017

Bachelor of Arts - Psychology

Southern University at New Orleans

Master of Social Work -

Southern University at New Orleans

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