Summary
Overview
Work History
Education
Skills
LANGUAGES
Timeline
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DAYAMI GARCIA

Hialeah Gardens,USA

Summary

Healthcare insurance professional with over 15 years of experience in Medicare HMO operations including Case Management, Special Needs Plans, Provider Relations, Enrollment, Compliance, Utilization Management, and Member Services. Holds both a Bachelor's and Master's Degree in Health Services Administration. Passionate about continuous improvement and enhancing patient care and satisfaction. Deep industry knowledge to navigate complex Medicare guidelines while delivering results.

Overview

15
15
years of professional experience

Work History

Medical Management Specialist II

Simply Healthcare Plans - Elevance Health
03.2019 - Current
  • Promote patient and provider satisfaction and loyalty by addressing and resolving problems in a proactive and knowledgeable manner
  • Provide skilled administrative work to support clinical staff and operational requirements
  • Serve as resource to clients and community partners
  • Working closely with clinical staff to improve patient care and practice procedures
  • Develop and strengthen relationships with providers to maintain expertise and address problems in timely manner
  • Adhere to all facility, company, and legal guidelines
  • Facilitate referrals to other healthcare professionals and medical facilities
  • Produce and distribute brochures, flyers and packets covering Special Needs Program information and benefits to support community outreach and program initiatives
  • Provide program presentations to prospective providers in collaboration with Provider Relations Team
  • Implement innovative case management strategies that resulted in reduced lengths of stay for patients receiving complex treatments
  • Reduce hospital readmission rates through careful monitoring of patient progress and proactive follow-up measures.
  • Mentor junior staff members, helping them develop their skills as Medical Management Specialists while also fostering a positive work environment
  • Analyze data on patient outcomes to identify areas for improvement in service delivery and resource allocation
  • Identify opportunities for cost savings in healthcare delivery, ultimately contributing to overall organizational profitability

Medical Management Specialist

Simply Healthcare Plans - Anthem
03.2015 - 03.2019
  • Improved patient satisfaction scores by addressing concerns promptly and providing personalized attention.
  • Collaborated with healthcare providers for better coordination of patient care plans, resulting in more seamless treatment experiences
  • Conducted thorough audits of medical records to ensure compliance with legal requirements and industry best practices
  • Maintained accuracy, completeness, and security for medical records and health information.
  • Utilized electronic medical record systems to store, retrieve and process patient data
  • Verified accuracy of patient information in medical records
  • Used classification manuals to gain additional knowledge of disease and diagnoses processes

Utilization Management Coordinator

Simply Health Care Plans
03.2013 - 03.2015
  • Collaborated with multidisciplinary teams to develop individualized care plans for patients
  • Contributed to the development of departmental goals, objectives, and performance improvement initiatives for continuous enhancement of services provided
  • Promoted a culture of continuous learning by conducting regular staff meetings focused on team collaboration and best practices sharing within the utilization management team.
  • Enhanced patient care by efficiently coordinating utilization management processes and reviewing medical records for case appropriatenes
  • Actively participated in interdisciplinary team meetings to provide input on patient care, discharge planning, and resource utilization
  • Managed complex cases effectively, working closely with interdisciplinary teams to develop comprehensive care plans tailored to individual needs
  • Ensured regulatory compliance by staying updated on industry guidelines and applying them to daily tasks and assessments

HEDIS Medical Records Specialist

AvMed Health Plans
12.2009 - 12.2012
  • Visited multiple medical offices and hospital throughout Miami-Dade and Broward County regions in order to collect medical records
  • Successfully scheduled appointments with providers for collection of medical records (physical and/or electronic forms)
  • Securely transported and uploaded records to patient’s private vault
  • Participated in meetings and transcribed meetings minutes
  • Created PowerPoint presentations for business development purposes
  • Coached new employees on administrative procedures, company policies, and performance standards

Education

Master - Health Services Administration

Florida National University
Hialeah, FL
01.2018

Bachelor - Health Services Administration

Florida National University
Hialeah, FL
01.2016

Skills

  • Healthcare Management
  • Special Needs Plans
  • Empathy
  • Honest & Ethical
  • Organized & Detail-Oriented
  • HIPAA compliance
  • Verbal & Written Effective Communication (bi-lingual)
  • Analytical Thinking
  • Relationship Building & Retention
  • Problem-Solving
  • Reliability
  • Adaptability and Flexibility
  • Microsoft Office

LANGUAGES

Bilingual (Spanish & English) interpersonal and written communication skills

Timeline

Medical Management Specialist II

Simply Healthcare Plans - Elevance Health
03.2019 - Current

Medical Management Specialist

Simply Healthcare Plans - Anthem
03.2015 - 03.2019

Utilization Management Coordinator

Simply Health Care Plans
03.2013 - 03.2015

HEDIS Medical Records Specialist

AvMed Health Plans
12.2009 - 12.2012

Bachelor - Health Services Administration

Florida National University

Master - Health Services Administration

Florida National University

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DAYAMI GARCIA