Diana Guerrero
Williams,AZ
Summary
Achievement oriented, knowledge of Microsoft word, excel, PeopleSoft and Equator Strong written and interpersonal skills. Bilingual and fluent in Spanish. Ability to work efficiently, independently, or as part of a cooperative team effort.
Overview
16
16
years of professional experience
Work History
Caregiver
Richard Lucero
Warner Springs, California
04.2023 - 12.2025
- Assisted clients with daily living activities and personal care needs.
- Managed medication schedules to ensure timely administration for clients.
- Coordinated transportation for clients to medical appointments and social events.
- Maintained clean and safe living environments through regular housekeeping tasks.
- Supported bathing, dressing and personal care needs.
- Prepared meals according to dietary requirements and assisted with feeding when necessary.
- Laundered clothing and bedding to prevent infection.
- Drove clients to shop for groceries, attend doctor appointments and run errands.
Patient care Senior Coordinator
Monarch Health Care
05.2017 - 04.2023
- Make patient follow up calls ( e.g. after procedures, admissions, or ER visits).
- Answer phones and access incoming faxes from right fax. Label faxes and distribute to hospital coordinators.
- Connect patients with outside resources (e.g., community resources, social services)
- Work directly with patients to identify specific needs and/or request adjustments to plan of care.
- Explain and ensure understanding of details related to patient care (e.g., , home health care transition procedures)
- Explain medical benefits/coverage specifics (e.g., procedures/amounts covered, denials of coverage, appeal rights)
- Access insurance plan systems to verify insurance eligibility/benefits for patients and seek additional information as necessary
- Input/update patient demographic data into computer system
- Update/upload patient care data (e.g., care plan data, inpatient data, patient program flags) in computer systems
- Document patient interactions in appropriate systems/logs (e.g., medication changes)
- Enter/process patient referral data (e.g., medical services, radiology, durable medical equipment)
- Optum Health
Utilization Review Coordinator
Pinnacle Claims -Temporary Agency
08.2016 - 04.2017
- Process Authorization requests from provider office.
- Customer Service: answer heavy phones.
- Verify Eligibility and benefits
- Process Letter of Agreements for non-contracting providers.
- Aerotek
Case Management/ Triage Coordinator
Primary Provider Management Company
05.2012 - 04.2016
- Process Hospital Facesheets verify members’ eligibility and run census reports.
- Customer service: answering of heavy telephone calls and directing to appropriate personnel/area.
- Claims Auditing Work directly with company liaisons and hospital case manager staff to establish appropriate care upon discharge.
- Interpretation of Physician orders for correct process of delegated specialty services.
- Liaison for Vantage medical group and IEHP the health plan.
- Assist member in navigation of health care and education with utilization of resources.
- Problem solve issues concerning contracting, claims issues, redirection to appropriate specialist, assist member in appointment scheduling and getting authorizations needed and approve services according to authorized coordinator level.
- Assess member needs and determine if ambulatory case management is needed.
- Set up of transportation services when requested by physician for member.
- Verify CCS eligibility and benefits via website or telephone upon request.
- Obtain, review and document medical information that supports medical eligibility for CCS bases on California Children’s Services program criteria.
Client Support
QBE First
Irvine, USA
12.2009 - 05.2012
- Homeowner, Flood & Fire Insurance Tracking for Clients
- Maintain 100% Production with 98% + Accuracy
- Liaison between Agents, Carriers & Our Client
- Inbound Customer Service Calls
- Outbound Research Calls to Carriers/ Agents
- Irvine, CA
Education
Skills
- Complex Problem-solving
- Multitasking and organization
- Organization skills
- Time management
- Customer service
- Documentation
Timeline
Caregiver
Richard Lucero
04.2023 - 12.2025
Patient care Senior Coordinator
Monarch Health Care
05.2017 - 04.2023
Utilization Review Coordinator
Pinnacle Claims -Temporary Agency
08.2016 - 04.2017
Case Management/ Triage Coordinator
Primary Provider Management Company
05.2012 - 04.2016
Client Support
QBE First
12.2009 - 05.2012