Diana Diaz
Henderson,USA
Summary
Dynamic healthcare professional with extensive experience at Molina Healthcare, excelling in care coordination and benefits verification. Proven track record in customer support, achieving a 95% resolution rate for member inquiries. Skilled in data entry and compliance regulations, with a strong commitment to enhancing patient outcomes through effective communication and advocacy.
Overview
7
7
years of professional experience
Work History
Care Review Processor
Molina Healthcare
Long Beach
12.2023 - Current
- Provide telephone, clerical, and data entry support for the Care Review team.
- Enter authorization requests, provider inquiries, such as eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges, and billing codes.
- Responds to requests for authorization of services submitted via phone, fax, and mail, according to Molina's operational timeframes.
- Contact physician offices according to Department guidelines to request missing information from authorization requests, or for additional information as requested by the Medical Director.
Health Plan Specialist II
Medica
, MN
12.2022 - 01.2023
- Responded to member inquiries and resolved issues in a timely and professional manner.
- Collaborated with cross-functional teams to address member concerns and improve the overall experience.
- Assisted members with account setup, troubleshooting, and billing inquiries.
- Handled escalated member complaints with empathy and professionalism, achieving a 95% resolution rate within the first contact.
- Conducted follow-up calls or emails after resolving issues to ensure customer satisfaction was maintained.
Case Management Support
The CSI Companies
12.2021 - 06.2022
- Assisted the case manager in coordinating and managing the client caseload, ensuring timely and accurate documentation.
- Conducted intake interviews with clients to gather the necessary information for case assessment and planning.
- Maintained confidential client files, ensuring the accuracy and completeness of records.
- Collaborated with interdisciplinary team members to develop comprehensive care plans for clients.
- Provided administrative support by preparing reports, correspondence, and other documents as needed
- Coordinated referrals to external service providers based on client needs and eligibility criteria
- Monitored progress of clients' goals and objectives outlined in their care plans
- Supported case manager in conducting home visits or accompanying clients to appointments when necessary
Non-Medical Case Manager
Access to Healthcare Network
Las Vegas, NV
01.2020 - 01.2022
- Conducted comprehensive assessments of clients' needs, strengths, and barriers to develop individualized service plans.
- Collaborated with a multidisciplinary team to coordinate and monitor the delivery of services to clients.
- Provided crisis intervention and support to clients in high-stress situations.
- Maintained accurate and up-to-date case records, ensuring confidentiality and compliance with legal requirements
- Advocated for clients' rights and connected them with appropriate community resources
- Assisted clients in accessing housing, healthcare, employment, education, and other essential services
- Developed strong relationships with community organizations to enhance service options for clients
- Facilitated group meetings and workshops on topics such as life skills development or parenting techniques
- Monitored client progress towards goals outlined in their service plans through regular check-ins and evaluations
- Implemented evidence-based practices to improve outcomes for Individuals served by the agency
- Participated in ongoing professional development activities to stay current on best practices in caseworker field
Medical Case Manager
Community Outreach Medical Center
Las Vegas, NV
01.2019 - 10.2019
- Managed a caseload of 40 patients, coordinating and overseeing their medical care from admission to discharge.
- Collaborated with healthcare providers, insurance companies, and community resources to develop comprehensive care plans for patients.
- Conducted thorough assessments of patient needs, including physical, emotional, and social factors, to determine appropriate interventions.
- Advocated for patients' rights, and ensured access to necessary medical services and treatments.
- Monitored patient progress regularly through phone calls, home visits, or clinic appointments.
- Coordinated interdisciplinary team meetings to discuss patient cases and develop integrated care strategies.
- Provided education and support to patients and their families regarding treatment options, medication management, and self-care techniques.
- Maintained accurate documentation of all interactions with patients in the electronic health records (EHR) system.
- Assisted in the coordination of hospital admissions and discharges for seamless transitions of care.
- Collaborated with healthcare professionals to identify potential barriers to treatment adherence, and developed strategies for overcoming them.
- Ensured compliance with regulatory requirements by staying up-to-date on industry standards and guidelines.
- Facilitated communication between different healthcare providers involved in a patient's care plan to ensure continuity of services.
- Coordinated transportation arrangements for patients requiring assistance getting to medical appointments.
Education
Certificate - Long Term Social Services
Social Services Consultant
Los Angeles, CA12.2005
Diploma - Education
California High School
Whittier, CA12.1997
Skills
- Hospital experience
- Microsoft
- Benefits verification
- Data entry
- Care coordination
- Compliance regulations
- Customer support
- Healthcare regulations
- Care plans
- Patient monitoring
- Customer service
- Medical records
- EMR systems
- Intake experience
- Case management
- Computer literacy
- Documentation
- Medical terminology
- Data collection
- ICD coding
- Software troubleshooting
- Medical scheduling
- HIPAA
- Conflict management
- Client services
- Authorization requests
Additional Information - Bilingual
English/Spanish
Timeline
Care Review Processor
Molina Healthcare
12.2023 - Current
Health Plan Specialist II
Medica
12.2022 - 01.2023
Case Management Support
The CSI Companies
12.2021 - 06.2022
Non-Medical Case Manager
Access to Healthcare Network
01.2020 - 01.2022
Medical Case Manager
Community Outreach Medical Center
01.2019 - 10.2019
Certificate - Long Term Social Services
Social Services Consultant
Diploma - Education
California High School