Deserie Siqueiros
Rio Rancho,NM
Summary
Dedicated Care Coordinator committed to the timely and accurate completion of patient assessments and driving the development of comprehensive care plans. Expertise in collaborating with interdisciplinary teams to monitor patient progress and adapt strategies for optimal outcomes. Over 27 years of experience in managing operations with a variety of patient-centric medical organizations, consistently overseeing patient services while fostering a productive environment for member care. Proven ability to enhance high-volume medical practices through exceptional customer service and a focus on continuous improvement in member care.
Overview
27
27
years of professional experience
1
1
Certification
Work History
Care Coordinator
Presbyterian Healthcare Services
01.2015 - Current
- Meeting HSD guidelines by completing Health Assessments, and experience with completing Comprehensive Needs Assessments for long-term care services.
- Experience with submitting budget reviews.
- Experience with submitting annual NFLOC reviews.
- Experience with submitting documentation to determine if a member meets continuous NFLOC criteria.
- Experience with submitting LTC UM reviews for EMOD approval, or EMOD approval.
- Completing Care Plans.
- Experience with completing the allocation tool for personal care service criteria.
- Expereince with completing Change in Condition CNA’s to determine member needs and determine need for level of care change.
- Currently monitoring 715 Dual Plus members for changes in condition.
- Experience with scheduling comprehensive needs assessments.
- Assist with scheduling members' appointments.
- Experience with assisting members with renewing or helping them understand how to reinstate their Medicaid benefits.
- Experience with completing reassessment/pre-assessment.
- Experience with completing required telephonic and in-person visit touchpoints.
- Experience with completing Nursing Facility quarterly visits.
- Experience with attending Care Conference Nursing Facility meetings.
- Provide resources and support to assigned members.
- Assist members’ with gaps in care
- Past responsibilities include monitoring assigned members’ ER visits, inpatient stays, upcoming procedures missed or attended, and upcoming doctors’ appointments.
- Critical thinking skills to assess changes in condition.
- Monitoring changes in Medicaid status and prism risk score.
- Monitoring changes in Dual Plus eligibility.
- Follow up with the member regarding any changes in condition.
- Experience with following up with members' assigned PCPs to determine and gather provider input.
- Assisted members with submitting Life Planning, Advance Directives, and Power of Attorney documents to the Presbyterian Regulatory Department.
- Experience with submitting requests for pharmacy reviews for Dual Plus members.
- Provide continued support to members.
AMBULANCE REV CYCLE SPEC II, CAC
Albuquerque Ambulance, Presbyterian Healthcare
05.2010 - 03.2015
- Ambulance Coding
- Registration
- Follow up on claim submission
- Submit appeals for underpaid and rejected claims for commercial, workers compensation, Auto, Medicare and Medicaid claims
- Billing charges
- Posting charges
- Review & correct for upgrade/downgrading for HCPC charges review and update corrections to modifiers.
- Identify and document incoming correspondence
- Insurance verification/updates for clean claim submissions
- Scrub claims
- Responsible for accounts receivable reimbursement analysis, auditing refunds
- Identifying overpayments and processed refunds
- Participated in PEP Six Sigma program, for Albuquerque Ambulance
- Assisted with UMI, training incoming hires, creating department policies and procedures
- Determine Medicare, Medicaid eligibility
- Determine commercial insurance eligibility and coordination of benefits
- Follow up with patients for possible third party/ workers compensation claims
Client Remote Liaison
The Outsource Group
07.2009 - 05.2010
- Coordinated claim submission for third party liability and worker's compensation claims
- Analyzed/Audited accounts for correct map rates within the state of New Mexico
- Submitted appeals for underpayments and rejected claims
- Reviewed explanation of benefits for accounts receivable
- Identified and documented incoming correspondence
- Bundled/corrected necessary CPT codes for adjudication process
- Appealed Department of Labor denials for claims resolution
- Customer service, claims follow up
- Verified and updated insurance information for clean claim submissions
- Ran daily Chrystal reports for verification of incoming revenue and account audits
- Ensured client satisfaction
High Dollar Collector
Loma Linda University Medical Center
04.2006 - 07.2009
- Analyzed/Audited for correct reimbursement rates, collections
- Submitted initial claim and interim claims
- Followed up on timely adjudication process
- Appealed rejected claims
- Reviewed and corrected rejected revenue codes, CPT / HCPC, Icd-9 codes for clean claim submission
- Verified Insurances, coordination of benefits
- Updated patient demographic information
- Screened patients for payment options, financial assistance
- Customer Service
- Resolved patient complaints with a positive outcome
Medical Assistant, Collector/Billing
Apple One
09.2005 - 04.2006
- Pull and prep charts for missionary clinic
- Room patients for scheduled appointments
- Collections
- Customer service
- Documented all incoming mail
- Medical Billing
- Screened patients for financial assistance
- Updated patient insurance for claim submission
- Posted explanation of benefits to accounts receivable
- Distributed medical records for missionary clinic
- Resolved patient complaints with a positive outcome
- Pull Medical Records for patient and MD requests
- Verify correct release of information obtained prior to record release
Medical Assistant
Riverside Medical Clinic
01.2001 - 09.2004
- Floated into various Internal Medicine, Pediatric, Neurology, Gastroenterology, Endocrinology, Dermatology, Surgery offices, Urgent Care
- Processed incoming patients
- Entered ICD-9/ CPT coding for billing
- Charting all office visits
- Submit patient referrals for procedures, specialty referrals and lab work
- Follow-up on all procedures, lab work and referrals to verify patient visit was completed
- Completed logs to verify patient results were received and reviewed by MD
- Verify MD reviewed all results, submitted all normal results to patients, scheduled follow- up appointments with MD for abnormal results.
Medical Assistant
Riverside Medical Clinic
01.2001 - 09.2004
- Prepped Charts for Diabetic Clinic
- Completed reminder calls for Diabetic Clinic
- Prepped patients for MD appointments by taking vitals, blood pressures, charting visit information
- Administered injections for various medications/immunizations per MD orders
- Charted all immunizations/injections/patient interaction
- Completed MD orders for patient EKG’s
- Submitted HMO authorizations for medications and various office/outpatient procedures including MRI, CT scans, Colonoscopy etc.
- Assisted in minor office procedures
- Assisted with Health Education Classes
- Safety Coordinator
- Ordered supplies, faxed, copied, answered phones, and Insurance verification
- Ordered Medications
- Audited Medicine Cabinet for expired medications, disposed expired medications
- Ordered Medications for MD
- Posted charges for super billing for cardiology office
- Prepped scopes for Gastroenterology for flexible sigmoidoscopy
- Follow-up to provide patient community resources on programs available
- Prepped patients for MD at urgent care clinic
- Set up procedure trays for patient office procedures
Medical Specialist/Riverside Medical Clinic
All's Well Healthcare Services
08.2000 - 01.2001
- Floated into various clinical offices including Urgent Care to Prep patients for MD appointments
- Charting all patient interactions
- Prepped patients for MD appointments by taking vitals, blood pressures, charting visit information
- Completing MD orders for drawing blood
- Completed MD orders for injections, various medications and immunizations
- Completed MD orders for patient EKG’s
- Submitting HMO authorizations for MD requests on various outpatient procedures including: MRI, CT scans, Colonoscopy etc.
- Set up procedure trays for patient office procedures
- Ordered supplies, faxed, copied, answered phones, and Insurance verification
- Follow-up to provide patient community resources on programs available
- Prepped patients for MD at urgent care clinic
- Charted all immunizations/injections/patient interaction
- Administered injections for various medications/immunizations per MD orders
Medical Assistant
Be Thin Medical Weight Loss Center
04.1999 - 09.1999
- Prepped patients for MD appointments by taking vitals, blood pressures, charting visit information
- Scheduling appointments
- Charting all patient interaction
- Dispensed medications, vitamins
- Completed MD orders for injections, various medications
- Completed MD orders for drawing blood
- Completed patient consults for patient prep
- Charting and monitoring patient weight loss
- Monitored patient ketosis goal
- Super Billing
- Submitted Cash Deposits
- Audited accounts receivable
- Data Entry
- Book Keeping
- Answered multi-phone lines
- Ordered supplies, faxed, copied, answered phones
Medical Assistant
Prime Care Medical Group
02.1999 - 04.1999
- Prepped patients for MD appointments by taking vitals, blood pressures, charting visit information
- Completed MD orders for injections, various medications
- Completed MD orders for drawing blood
- Completed MD orders for patient EKG’s
- Assisted MD with minor office procedures
- Entered ICD-9/ CPT coding for billing
- Charted all immunizations/injections/patient interaction
- Prepped charts for patient medication refill request from refill voicemail line
- Called MD approved medication refill request to Pharmacy
- Follow-up on all procedures, lab work and referrals to verify patient visit was completed
- Completed logs to verify patient results were received and reviewed by MD
- Answered multiple phone lines
- Completed charge sheets for billing
- Verified MD charges for all services provided included on super bill
- Set up procedure trays for patient office procedures
Intern Health Service Assistant/Medical Assistant
San Bernardino County Health Department
11.1998 - 01.1999
- Prepped patients for MD appointments by taking vitals, blood pressures, charting visit information
- Scheduling appointments
- Charting all patient interaction
- Completed MD orders for injections, various medications
- Completed MD orders for drawing blood
- Responsible for verifying all BIC state sponsored insurance eligibility (Medical/Medicaid)
- Responsible for CPSP connection meetings which includes follow-up with patients to verify MD orders for referrals were completed
- Prepped patients for maternal health visits
- Prepped patients for AIDS/HIV clinic visits
- Stocked medical supplies for in office procedures
- Set up procedure trays for patient office procedures
Education
Certificate - Certified Ambulance Coder
National Academy of Ambulance Coding
Mechanicsburg, PA03.2014
Associate of Applied Science - general education
CNM Community College
Albuquerque, NM01-2027
Diploma - Medical Assistant
Skadron College
San Bernardino, CA01.1999
Diploma - undefined
Colton High School
Colton, CA06.1995
Skills
- Coordinated care management
- Comprehensive health evaluations
- Expertise in Medicaid benefits
- Change in condition evaluations
- Patient advocacy
- Critical thinking
- Interdisciplinary collaboration
- Claims submission processes
- Proficient in medical terminology
- Appeals resolution expertise
- Insurance verification
- Exceptional customer service
- Compliance with regulations
- Data analysis and reporting
- Appointment scheduling
- Case management
- Documentation
- Patient education
- Organizational skills
- Documentation proficiency
- Multidisciplinary team collaboration
- Goal setting
- Policy adherence
- Scheduling
- Quality assurance
- Multitasking and organization
- HIPAA compliance
- Data entry
- Client relationship management
- Crisis intervention
- Process improvements
Certification
- CMA - Certified Medical Assistant
Timeline
Care Coordinator
Presbyterian Healthcare Services
01.2015 - Current
AMBULANCE REV CYCLE SPEC II, CAC
Albuquerque Ambulance, Presbyterian Healthcare
05.2010 - 03.2015
Client Remote Liaison
The Outsource Group
07.2009 - 05.2010
High Dollar Collector
Loma Linda University Medical Center
04.2006 - 07.2009
Medical Assistant, Collector/Billing
Apple One
09.2005 - 04.2006
Medical Assistant
Riverside Medical Clinic
01.2001 - 09.2004
Medical Assistant
Riverside Medical Clinic
01.2001 - 09.2004
Medical Specialist/Riverside Medical Clinic
All's Well Healthcare Services
08.2000 - 01.2001
Medical Assistant
Be Thin Medical Weight Loss Center
04.1999 - 09.1999
Medical Assistant
Prime Care Medical Group
02.1999 - 04.1999
Intern Health Service Assistant/Medical Assistant
San Bernardino County Health Department
11.1998 - 01.1999
Diploma - Medical Assistant
Skadron College
Diploma - undefined
Colton High School
Certificate - Certified Ambulance Coder
National Academy of Ambulance Coding
Associate of Applied Science - general education
CNM Community College