CLAUDIA HERNANDEZ
La Mesa,CA
Overview
17
17
years of professional experience
Work History
Network Manager- Accountable Care Organization (ACO)
Palomar Health Medical Group
San Diego
01.2019 - Current
- Facilitates the successful reporting of quality measures and other metrics for the ACO the Group Practice Reporting Option for CMS from the network participants
- Effectively communicates the ACO goals through distribution and education on quality and cost reports, necessary actions to achieve cost savings, quality, and patient satisfaction and access targets
- Communicates the strategic initiative into the implementation of a formalized plan and ongoing process
- Monitors and supports Network partnerships to ensure effectiveness
- Collaborates with leadership and other key stakeholders to offer new program ideas/solidify existing services lines needed to meet full adequacy of the ACO
- Review of ACO financial, benchmarks and find areas of cost saving opportunities
- Develops marketing and educational materials targeted towards physicians and office staff
- Oversee all internal and CMS compliance requirements are my ACO Participants Offices
- Provide ongoing in-services to physician offices for various ACO initiatives including performance reporting requirements from CMS
- Implements special projects and education as needed
- Oversee a Beneficiary Population of 13k - 15k per Performance Year
- Facilitate Board and Committee Meetings, Minutes and Agenda
- Successfully helped Accountable Care Organization achieve and exceed CMS threshold with a return of over $15 million over a performance year of 2020 - 2023, and trending positive for PY 2024.
Lead Physician Resource Coordinator
Scripps Health, Hospice Palliative Care
San Diego
03.2013 - 01.2019
- Coordinate daily Hospice and Palliative Care Providers Day-to-day operations and interactions with multiple departments and divisions (i.e., QA, performance compliance, med
- Support, intake, regulatory etc.)
- Address staff and patient needs in a timely matter
- Answer patient calls
- Ability to meet deadlines and prioritize by balancing key priorities
- Supervise two Palliative Care Coordinators (onboarding, training, and support)
- Created and implemented policies and procedures for effective practice management and compliance: End of Life Act Policy, workflow, and implementation; Prescription pad ordering and tracking; Created a library for Scripps Health Inpatient Providers Medical Group
- Tracked and reported performance metrics, bonus', overseeing payments more than $40,000
- Created outpatient medical supply ordering process.
Provider Schedulers Group Supervisor
San Diego Hospice and The Institute for Palliative Medicine
San Diego
07.2007 - 03.2013
- Human resource interface for recruiting, staffing, payroll, and compliance for provider practice schedulers
- QA and performance improvements support
- Special projects development (Allscripts Provider Portal, Allscripts Amplified, Vocera Paging System, Regional Scheduling)
- Medical staff support and administrative work for 20+ providers
- Coordinated and Organized 20+ physicians' monthly calendars in Outlook
- Coordinate providers homecare or nursing home visits for approximately 1,000 outpatients
- Provided limited IT support to Physicians
- Lead annual administrative training
- Electronic death registration system entry and exact completion
- Supervised a team of schedulers and health information department staff
- Provide support to patient accounting in correcting inaccurate and incomplete billing sheets
- Create patients' information packets for providers use
- Process provider dictations reports by adding in EMR.
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
Network Manager- Accountable Care Organization (ACO)
Palomar Health Medical Group
01.2019 - Current
Lead Physician Resource Coordinator
Scripps Health, Hospice Palliative Care
03.2013 - 01.2019
Provider Schedulers Group Supervisor
San Diego Hospice and The Institute for Palliative Medicine
07.2007 - 03.2013
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