Scheduled routine appointments including imaging and preoperative appointments.
Submitted prescription refill requests, authorizations, and referrals to providers for approval.
Obtained patients' demographics, health insurance information, and medical records.
Communicated with patients, insurance companies, and medical facilities over phone.
Regulatory Affairs Specialist
Partnership HealthPlan Of California
12.2017 - 07.2018
Investigated fraud cases and mitigated risks related to loss of protected health information.
Managed privacy incident caseload and initiated HIPAA reports to DHCS privacy office.
Collected data for recurring managed care reports due to federal, state, and other entities.
Audited departments to ensure activities were properly performed for a DHCS or DMHC audit.
Appeals and Grievances Coordinator
Blue Shield Of California
08.2016 - 11.2017
Examined insurance claims, contract agreements, and policies to determine health coverage.
Resolved time-sensitive cases in compliance with legal and regulatory requirements.
Responded to inquiries regarding case statuses in a competent and professional manner.
Prepared response letters for member and provider complaints, grievances, and appeals.
Education
Bachelor Of Science - Business Administration
California State University
Sacramento, CA
05.2025
Certificate Of Achievement - Legal Studies
Sacramento City College
Sacramento, CA
05.2025
Associate of Arts - Economics
American River College
Sacramento, CA
12.2022
Skills
Strong problem-solving aptitude
Excellent verbal and written communication
Professional, flexible, accurate, and detailed
Exceptional workflow
Excellent time management
Microsoft Office: Word, Excel, and Outlook
Professional Summary
Results-driven professional with experience in regulatory compliance, data analysis, and client support, who streamlined processes and enhanced organizational efficiency.