CLAUDIA HERNANDEZ
La Mesa,CA
Summary
Dynamic leader with over 20 years of experience in healthcare, specializing in strategic planning and team leadership. Knowledge in healthcare provider contracting models and adept at bilingual communication, consistently enhancing operational efficiency and compliance within teams. Career goals include further driving innovative solutions in healthcare delivery. Motivational leader and organizational problem-solver with advanced supervisory, team building and customer service skills. Experience stepping into roles and quickly making positive changes to drive company success. Focused on using training, monitoring and morale-building techniques to maximize employee engagement and performance.
Overview
18
18
years of professional experience
Work History
Practice/Network Manager- Accountable Care Org.
Palomar Health Medical Group
San Diego, CA
01.2019 - Current
- Facilitate and manage annual CMS quality reporting compliance requirements for the ACO and provider practices.
- Develop workflows to capture quality metrics, annual hierarchical condition categories (HCC) capture, scheduling annual wellness visits, and cost savings incentives.
- Effectively communicate with providers and office managers about the ACO goals, summary development, distribution, and education on quality and cost reports, necessary actions to achieve cost savings, quality, and patient satisfaction, and track measurable progress.
- Collaborate with the strategic initiatives with implementation plan, ongoing process, progress, and in-service meetings twice a month.
- Monitor and support quality, and the multiple network partnerships, to ensure effectiveness.
- Collaborates with leadership, TIN owners, providers, and other key stakeholders to offer new program ideas and solidify existing service lines needed to meet CMS benchmarks and achieve the annual Shared Savings.
- Review ACO financials, benchmarks, and find areas of cost-saving opportunities.
- Develop and roll out marketing, educational, and compliance materials targeted toward providers, clinical staff, and office staff.
- Collaborate with each practice to identify their opportunities, and work together on special projects and education as identified.
- Oversee the ACO Beneficiary (patients) population of 13,000 to 15,000 per performance year.
- Facilitate Board and Committee Meetings, minutes, and agendas.
- Successfully achieved CMS Shared Savings, with a shared savings back to our ACO and its participants of over $15 million dollars over the performance years 2020–2023, and trending positively for PY 2024.
Lead Physician Resource Coordinator
Scripps Health, Hospice Palliative Care
San Diego, CA
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, Medical Support, intake, regulatory, etc.).
- Address provider staff, training support, and patient needs in a timely manner.
- Speak to patients when there are issues or concerns.
- Ability to meet deadlines and prioritize by balancing key priorities.
- Supervised and supported two Palliative Care Coordinators (onboarding, training, and support).
- Participated in the development workflow, implemented policies and procedures for effective practice management and compliance: End of Life Act Policy, workflow, and implementation; prescription pad ordering and tracking; and created a library for Scripps Health Inpatient Providers Medical Group.
- Tracked and reported performance metrics, bonuses, and overseeing payment distribution of more than $40,000 for providers and the medical group.
- Developed and implemented an outpatient medical supply ordering process.
- Employee 100, Graduate.
Provider Schedulers Group Supervisor
San Diego Hospice and The Institute for Palliative Medicine
San Diego, CA
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
Education
Master of Business Administration -
University of Phoenix
San Diego, CA07.2017
Bachelor of Arts - Project Management
University of Phoenix
San Diego, CA03.2013
Associate of Arts - Business
University of Phoenix
San Diego, CA03.2011
Skills
- Proficient in Spanish speaking, reading, writing, and translation
- Schedule, coordinate, and manage timelines, and critical deadlines
- Ability to work independently, take initiative, and use good judgment
- Timeline management
- Knowledge of medical billing, health systems
- Business operations
- Healthcare provider contracting models
- 20 years of administrative experience
- Network support
- Proficient in Microsoft Suite
- Project management
- Basic Technical Support
- Team leadership, onboarding and training
- Understanding medical industry regulations
- Process and operational improvement
- Proficient in various population health analytic tools, performance, and quality metrics
- Exemplary verbal and written communication
- Critical thinker
- Data analysis
- Staff management
- Proven organizational skills, and the ability to balance multiple projects
- Team player
- Follow HIPAA and confidentiality policies and procedures, and the ability to manage highly confidential and sensitive patient, provider, and staff information
- Confidentiality management
- Dashboard and analytics development and reporting
Languages
Spanish
Native/ Bilingual
English
Native/ Bilingual
Accomplishments
- Scripps Health Employee 100 Leadership course Graduate
Timeline
Practice/Network Manager- Accountable Care Org.
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
Master of Business Administration -
University of Phoenix
Bachelor of Arts - Project Management
University of Phoenix
Associate of Arts - Business
University of Phoenix
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