Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Chris Vicious

BROWNSVILLE

Summary

To obtain a position in Healthcare Management, Healthcare Clinical setting or Administration where I can utilize my
knowledge, skills, and experience by providing efficient and excellent services for a healthcare facility, office, or government space.

Overview

21
21
years of professional experience

Work History

Coverage Determinations and Appeals Representative

CVS Caremark
09.2024 - Current
  • Assist provider on obtaining prior authorizations for non-formulary medications via Cover My Meds.
  • Approve or deny a medication request based on clinical guidelines, formulary restrictions, and patient medical history.
  • Communicate with healthcare providers to gather additional information regarding the patient's medical condition and treatment plan.
  • Research specific medical conditions, drug interactions, and treatment options for complex appeals.
  • Evaluate patient requests for prescription coverage appeals, determining if the requested medication falls within the benefit plan parameters.

Provider Representative

BroadPath Healthcare Solutions
11.2020 - 08.2022
  • Responsible for verifying member coverage, benefit types, eligibility.
  • Claim adjudication/appeals, and payment/statuses for providers.
  • Estimate members out of pocket expenses for select procedures or services and explain member co-payments.
  • Maintain relationships with providers calling in on contracted rates.
  • Comply with all CMS guidelines and HIPAA regulations.

— Internal Network Provider Representative II HCSC

Blue Cross Blue Shield of Texas
07.2017 - 02.2019
  • Generate PPO, HMO, Medicare, Medicaid and other lines of business contracts and email to providers/ groups Develop and maintain relationships with providers and medical groups.
  • Provide physicians/groups with updates on their credentialing and contract status, submitting changes on terming, demographics, network additions as needed.
  • Execute special projects in a timely manner by prioritizing changes for providers/groups.
  • Email updated Provider Fee Schedules to multiple physicians/groups.
  • Follow all HCSC/HIPAA guidelines to ensure provider/member privacy and other sensitive information.
  • Attend meetings with stakeholders to keep up to date on new changes within the corporation.
  • Collaborate with multiple provider offices/healthcare facilities regard the IVA (Initial Validation Audit) conducted by CMS (Centers for Medicare and Medicaid Services).

Administrative Assistant II

University Health System, University Hospital
10.2016 - 03.2017
  • Coordinate patient care with Surgeons, Hepatologist, Interventional Radiologist, Physician Assistants, Dietitian and Social Workers.
  • Attended Tumor Board meetings weekly where physicians discuss plan of treatment and ordered new procedures for patients e.g. liver transplants, resections, radiation therapy.
  • Obtain financial approval/prior authorizations for new patients.
  • Order medical records / imaging CDs from multiple healthcare facilities.
  • Ensure secure PHI/HIPAA compliant.
  • Schedule patients appointments/contact confirm patients for the upcoming appointments.
  • Upload medical records to EMRs.
  • Attend weekly huddles to discuss productivity and patient outcomes.
  • Served as a Qualified "Spanish" Medical Interpreter.

Assistant Manager

Seasons Alzheimer’s Care and Assisted Living
03.2016 - 10.2016
  • Comply with all Texas Department of Aging and Disability Services "DADS" mandates and documentations.
  • Managed all CNA's, Med Techs and Patient Providers.
  • Train Med Techs on properly keeping the Medication Administration Record (MAR) up to date Intake new residents / discharge residents.
  • Speak with family members and give tours of the facility for all new residents.
  • Make rounds with attending patient physicians to ensure all new orders are executed Monitor RN's / LVN's, Therapists and other attending Physicians.
  • Make hourly rounds to ensure the safety of all residents and staff.
  • Quality checks in and out of facility/building.
  • Interview / process employment applications, run random drug testing on applicants / employees.
  • Manage employee scheduling, assigned work and evaluated employees' performance.

Medical Assistant

Doctor At Your Service (D.A.Y.S.)
08.2015 - 03.2016
  • Travel with Dr. Antonio Cavazos or with a PA“ Physician Assistant “/ NP “Nurse Practitioner”
    throughout the City of San Antonio, TX. making house calls to treat/monitor geriatric patients in
    assisted living facilities and private homes.
  • Checking vital signs and report to provider. Perform wound care to multiple sites / multiple stages of wounds.
  • Document treatment and prognosis of wound(s).
  • Communicate with various specialty groups to refer patients for services.
  • Removed impacted cerumen, collect urine / blood samples.
  • Monitor patient’s medications for refills and notify provider of any Narcotic refill needed.
  • Administer injections e.g. Rocephin , Vitamin b12 , Solumedrol, Toradol.
  • Input chief complaint, vitals and medications to Aprima ® EMR, refer patients to specialist / home health / hospice / physical therapy etc.
  • Inform Dr. Cavazos on any abnormal labs results.

Office Manager / Clinical Coordinator

Miguel A. Molinas M.D., P.A.
02.2008 - 10.2013
  • Maintained accurate financial records by reconciling accounts payable/receivable transactions regularly to ensure balanced budgets.
  • Managed all Medical Assistants and Medical Office Specialist.
  • Managed billing, claims and patient benefits by verifying eligibility, resolving claim issues on
    rejected claims by providing correct CPT and ICD10 codes with appropriate medical records to
    back up services rendered.
  • Managed multiple medical software such as Praxis ® /Scanaway® /Medisoft®.
  • Referred patients to Home Health / Hospice “Face to Face encounters,” 485’s, T.O’s follow up on patients prognosis with admitting Home Health RNs.
  • On Call for Dr. Miguel A. Molinas during his rotation “Patient Calls, Home Health Nurse Calls”.
  • Managed, trained, and educated all students and new staff on office policies / procedures.
  • Conduct monthly staff meetings to discuss any problems / issues with clinic.
  • Managed employees’ work schedules to ensure coverage e.g. sick days / vacations / PTO.

Medical Assistant/Phlebotomist/EKG Monitor Tech

Valley Heart Consultants
07.2003 - 11.2007
  • Coordinated patient referrals to specialists or other healthcare providers as needed for comprehensive care management plans.
  • Perform EKG’S, blood pressure checks, ABI’S (ANKLE BRACHIAL INDEX TEST) apply 24hr holter
    monitors, Cardio Dynamics. prep patients for cardiolite stress test and CT/PET scans.
  • Monitor patients EKG Ryhythms and report any abnormal spikes e.g. PVC's,VT's, AFIBs during Stress testing and Cardio Dynamic testing.
  • Monitor PT/INR levels, LDL levels, review and report all abnormal lab results to physicians.
  • Call in new / refill medications and educate patients on medication dose.
  • Schedule patients for Pacemaker Clinic. Faxing lab results to hospitals on patients having Heart
    Catheterizations.
  • Assist all five Cardiologists in writing prescriptions and educating patients on new meds.
  • S/P PACEMAKER/DEFIB wound care.
  • Discharge and prepare patients for Heart Catheterization, Pacemaker implants and Lower Extremity /Carotid Artery Angiograms.
  • Educate patients on the importance of diet and exercise.

Education

Certification in Phlebotomy / Medical Assistant - Healthcare

The Partnership Institute
McAllen, TX
07-2003

GED -

ACE Adult Continuing Education
Brownsville, TX
12-1994

Skills

  • Microsoft office
  • Policy interpretation
  • Dispute resolution
  • Teamwork
  • Financial Management
  • Leadership Skills
  • Business Development Skills
  • Effective in Communication and Negotiation Skills
  • Prioritizing Multiple Projects
  • Computer Literate
  • Networking
  • Networking s, Problem Solving and Reasoning
  • Various POS Software/EMRS, Data Entry, ScanAway
    Skills, Salesforce, Medisoft

Languages

Spanish
Native or Bilingual

Timeline

Coverage Determinations and Appeals Representative

CVS Caremark
09.2024 - Current

Provider Representative

BroadPath Healthcare Solutions
11.2020 - 08.2022

— Internal Network Provider Representative II HCSC

Blue Cross Blue Shield of Texas
07.2017 - 02.2019

Administrative Assistant II

University Health System, University Hospital
10.2016 - 03.2017

Assistant Manager

Seasons Alzheimer’s Care and Assisted Living
03.2016 - 10.2016

Medical Assistant

Doctor At Your Service (D.A.Y.S.)
08.2015 - 03.2016

Office Manager / Clinical Coordinator

Miguel A. Molinas M.D., P.A.
02.2008 - 10.2013

Medical Assistant/Phlebotomist/EKG Monitor Tech

Valley Heart Consultants
07.2003 - 11.2007

Certification in Phlebotomy / Medical Assistant - Healthcare

The Partnership Institute

GED -

ACE Adult Continuing Education

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Chris Vicious