Cynthia Valencia
Sacramento,CA
Summary
Healthcare operations professional with 8+ years of experience in managed care, clinical operations and insurance processes. Proven ability to manage complex caseloads, while serving as a central point of coordination for patients and clinical teams.
Overview
12
12
years of professional experience
Work History
Case Manager
PACS
08.2019 - Current
- Coordinated discharge planning and care transitions for Medicare, managed care and long-term care populations.
- Managed authorizations, TARs, coverage dates, payor communications and discharge barriers to support length of stay.
- Audited therapy, treatment and nursing documentation to support authorizations, reimbursement and discharge planning
- Facilitated interdisciplinary team meetings and care conferences to address patient progress and discharge readiness.
- Managed ancillary referrals, post-acute services and community resources.
- Assisted patients and families with Medi-Cal, SSI, long-term care and financial assistance applications.
Patient Services Lead
Center for Interdisciplinary Spine
10.2017 - 04.2019
- Supervised daily back office operations to ensure efficient patient flow and provider support.
- Served as primary point of contact for patient concerns, complex scheduling issues, and escalations.
- Coordinated appointments, procedures, referrals and follow up care for multiple providers within a high volume specialty practice.
- Collaborated with physicians, pharmacies and insurance carriers to resolve treatment, medication and authorization concerns.
Eligibility & Claims Representative
Health Net
07.2014 - 10.2017
- Provided support to Medicare and Medi-Cal members regarding eligibility, benefits, claims processing, provider networks and coverage determinations.
- Investigated claims issues and coordinated with providers and internal departments to facilitate resolution.
Skills
- Admission Assessments
- Appeals & Grievances
- Authorizations & TAR Management
- Business Office Operations
- Care Coordination
- Discharge Planning
- EMR Systems (EPIC, PointClickCare)
- Insurance Verification
- Managed Care
- Medical Records Management
- Medicare & Medi-Cal
- Referral Management
- Revenue Cycle Support
Timeline
Case Manager
PACS
08.2019 - Current
Patient Services Lead
Center for Interdisciplinary Spine
10.2017 - 04.2019
Eligibility & Claims Representative
Health Net
07.2014 - 10.2017