CRISTINA J DEL ROSARIO
The Bronx,NY
Summary
Detail-oriented team player with strong organizational skills and a proven track record of success in healthcare administration. With a background in administrative roles, I excel at handling multiple projects simultaneously with a high degree of accuracy. As a self-motivated and practical professional, I bring a proactive approach to problem-solving and a commitment to delivering exceptional results. My ability to prioritize issues, resolve conflicts, and effectively communicate with all levels of the organization has been instrumental in achieving operational efficiency and ensuring quality patient care. I am dedicated to maintaining HIPAA compliance and have a solid foundation in healthcare systems and protocols. With a master's degree in Health Services Administration and Business Administration, I bring a well-rounded perspective to healthcare management, coupled with a passion for process improvement and a commitment to excellence.
Overview
10
10
years of professional experience
Work History
CASE MANAGEMENT ANALYST
Memorial Sloan Kettering Cancer Center
10.2020 - Current
- Provide timely and accurate information to insurance carriers requesting clinical status, adhering to established protocols for escalation to clinical staff and management within the Department, for assigned populations of inpatients.
- Review internal systems and organize training plans to address areas in need of improvement.
- Review internal systems and organize training plans to address areas in need of improvement.
- Collaborate with Patient Financial Services when there are discrepancies in insurance and/or changes in coverage.
- Identify potential denials and escalate these cases to Nurse Case Manager as per Case Management policies and procedures.
- Evaluate current processes to develop improvement plans for current and future employees.
- Review 14-day list weekly and document the follow-up in CarePort for all patients on 14-day list per the expectations of the department.
- Practice critical thinking to break down problems, evaluate solutions, and make decisions.
- Coordinate retrospective reviews with insurance contacts and Utilization Specialist.
- Identify potential denials and escalate these cases to the Nurse Case Manager and management team per Case Management policies and procedures.
- Request peer-to-peers with physicians from outside company R1.
- Request peer-to-peers with physicians from outside company R1.
CASE MANAGEMENT ASSISTANT/INSURANCE LIAISON
Memorial Sloan Kettering Cancer Center
12.2017 - 10.2020
- Performed administrative tasks that support different programs in Case Management Department.
- Managed a process re-engineering project to improve and consolidate end-to-end service processes; restructured communication flow among Case Management department and reduced paperwork by 75%.
- Proficient in the use of manual and automated systems (SMS, RAM P8, ACM Computer Program, PC word processing application, RMS, and essential spreadsheet functions) utilized by the department in day-to-day activities.
- Continued tracking system to ensure timely follow-up of denials received and appeals submitted within timeframes of outside insurers.
- Maintained up-to-date and accurate contacts and progress note records.
- Assisted in conducting needs assessments to identify key areas of service needs.
- Developed and implemented strategies to enhance quality of social services.
- Developed and maintained accurate records of programs and services.
BUSINESS ASSOCIATE II
Morris Heights Health Center SBHC
09.2015 - 12.2017
- Documented patient data into School-Based Health Networks, Online School Clinic Data Repositories, and E-Clinical Works.
- Applied core knowledge to communicate sensitive or technical information while adhering to regulatory guidelines.
- Reviewed invoices, payment requests, advance requests, expense reimbursements, and proper coding before approval.
- Confirmed patients' health insurance coverage and identified uninsured patients to refer for enrollment with public health insurance options.
- Collaborated with medical and mental health providers to improve administrative flow within School-Based Health Network
- Applied core knowledge to effectively communicate sensitive or technical information while adhering to regulatory guidelines.
FRONT DESK RECEPTIONIST/BILLING ASSOCIATE
Theradynamics Physical Rehabilitation
03.2014 - 09.2015
- Billed corresponding primary insurances, secondary, third party, Medicare, no-fault, and worker's compensation.
- Researched and verified the status of medical practitioners' NPI, state license, and DEA license numbers.
- Called insurance for verification of eligibility and authorizations.
- Registered new patients, upgraded existing patient demographics, and scheduled follow-up appointments.
- Preserved files and records by implementing effective filing systems that boosted efficiency and organization.
- Designed employee work schedules to address complete operational needs.
Education
Master of Health Services Administration/Master of -
University of Phoenix
Phoenix, AZ06.2021
BBA - Health Services Administration
Monroe College
Bronx, NY04.2017
Skills
- Healthcare Administration
- Process Improvement
- Administrative Efficiency
- HIPAA Compliance
- Healthcare Systems and Protocols
- Project Management
- Problem Solving
- Communication
- Organizational Skills
- Multitasking
- Strategic Planning
- Microsoft Office Suite
- Data Analysis
- Office Operations
- Client Relationship Management
- Multitasking
- Teamwork
- Software Proficiency (EHR, CarePort)
- Report Generation
- Patient Data Management
- Project Coordination
- Records Management
Affiliations
- Project Management Institute (PMI)
- PMI NYC Chapter
- Women on the Move ERN
- Black, Latino, Asian, and Multi-Racial (BLAM) ERN
Languages
Spanish
Native or Bilingual
Timeline
CASE MANAGEMENT ANALYST
Memorial Sloan Kettering Cancer Center
10.2020 - Current
CASE MANAGEMENT ASSISTANT/INSURANCE LIAISON
Memorial Sloan Kettering Cancer Center
12.2017 - 10.2020
BUSINESS ASSOCIATE II
Morris Heights Health Center SBHC
09.2015 - 12.2017
FRONT DESK RECEPTIONIST/BILLING ASSOCIATE
Theradynamics Physical Rehabilitation
03.2014 - 09.2015
Master of Health Services Administration/Master of -
University of Phoenix
BBA - Health Services Administration
Monroe College
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