Franjeska Caimares
GLENDALE,New York
Summary
Experienced strategic planner and operational leader adept at enhancing performance, productivity, efficiency, and profitability of departmental and organizational operations. Skilled in providing comprehensive support and resources to diverse teams for success.
Overview
10
10
years of professional experience
Work History
VFCA Liaison
Cayuga Centers
09.2018 - Current
- Main point of contact for the agency to convey crucial information to diverse levels of audiences
- Conduct revenue cycle meetings as needed and follow up with vendors regarding deliverables
- Coordinated benefits, contracted and credentialed the agency, and individual providers with all needed insurance companies; Medicaid to ensure adequate billing revenue
- Ensures that cross-training of departmental employees occurs for developmental purposes and to ensure continuity of management
- Schedule and conduct interviews, assist candidates with any onboarding requirements once hired
- Obtain access and assist employees on different insurance portals and clearing house companies online
- Implement, monitor, and coordinate programs policy and procedure and ensure success
- Initiate request and collect complex data and provide guidance to subcontractors, and third parties
- Create revenue cycle training manuals for appointment scheduling, registration, billing policies and procedures complied with HIPAA laws regarding electronic health records and patient information by collaborating with our compliance team.
Hospital Care Investigator
Elmhurst Hospital/ Lincoln Hospital
06.2014 - 08.2018
- Ensure timely follow-up with patient and various third party insurance companies i.e
- Medicaid Managed Care, Medicare, Blue Cross, Commercial, Workers Compensation, and No-Fault
- Informs patient of hospital rates; performs in-depth interviews with patients, families, relatives and friends in an office setting or the hospital, during field investigations, and/or by telephone to determine patients’ and/or legally responsible relatives’ ability to pay for services rendered
- Knowledgeable on EMR, and clearing house systems
- EPIC, Navinet, Availity, and eMedny, for billing and eligibility purposes
- Verify insurance eligibility and benefits to ensure hospital payment and avoid insurance denials
- Reviews and abstracts Medical charts to obtain pertinent information for accurately coding and completing third party billing forms, indicating treatment given, discharge diagnoses and overall patient information for computerization purposes
- Established discharged office at Elmhurst Hospital, while introducing new policy, and procedures to new HCI’s.
Education
BA -
Queens College City University of New York
Queens, NYAA -
LaGuardia Community College
Queens, NYSkills
- Bi-lingual (Spanish, English)
- Communications & Critical thinking Skills
- Strong Organization and Time-Management Skills
- Billing, Credentialing & Contracting
- ICD-10
- Multidisciplinary Collaboration
- Project Planning
- Policies and procedures implementation
Pronouns
She/Her/Hers
Languages
Spanish
Native/ Bilingual
References
References available upon request.
Timeline
VFCA Liaison
Cayuga Centers
09.2018 - Current
Hospital Care Investigator
Elmhurst Hospital/ Lincoln Hospital
06.2014 - 08.2018
BA -
Queens College City University of New York
AA -
LaGuardia Community College
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