Grace Mandujano
Los Angeles,CA
Summary
Years of Patient Care Management with experience in conflict-management skills Vast knowledge in medical terminology, insurance verification, and experienced with 3rd party communication Bilingual English and Spanish and an effective communicator with clients and insurance companies and providers Overall experience includes: Case Management, Appeals & Grievance Coordinator, Outpatient Coordinator, Customer Care Representative, Data Entry Clerk, Receptionist, Able to work under strict deadlines and under high pressure situations Handle billing discrepancies, working under strict confidentiality and QC experience Proficient in Microsoft Office and experienced operating under HIPAA regulations
Overview
24
24
years of professional experience
Work History
Case Manager
Via Care Community Health Center
Los Angeles, CA
04.2023 - Current
- Patient consultations via telephone and in-person
- Create Care plans with clinician and patient
- Arrange referrals or follow-up appointments
- Perform as a patient advocate and liaison for specialty providers and social service referrals
- Arrange patients’ appointments for continuity of care and other referrals
- Provide Health education to patient per provider request
- Assure timeliness if services rendered to patients
- Assist with transportation
- Maintain data/logs for mammograms, pap smears, vaccines, HEDIS
- Monthly case conference
- Schedule ER follow up visits with primary provider.
- Participated in daily huddles with team members in order to discuss common goals and objectives.
Call Center Representative
Via Care Community Health Center
Los Angeles, CA
09.2021 - 04.2023
- Responsible for scheduling appointments for patients with their primary care provider
- IHA (Initial Health Assessments) for Medicare and Medicare-Medi-Cal patients within 120 days of assignment
- Assist with the referral process
- Patients who have been in the ER within 3 days from the discharge from the ER
- Update patient information and patient registration
- Consistently demonstrate and uphold VCCHC's principle of providing quality health and human services to the medically under-served and low-income populations in a culturally sensitive manner.
- Collaborated with department manager to determine appropriate changes or additions to existing training curriculum.
- Provided support for manager when dealing with difficult patient or resolving escalated issues.
- Monitored calls in real-time to evaluate effectiveness of training programs.
- Trained new employees on company policies, job duties, and performance expectations.
Patient Care Specialist
Allied Pacific
Monterey Park, CA
11.2017 - 09.2021
- Worked directly with nurse practitioner
- Daily rounds in the hospital with nurse practitioner and hospitalist to discuss patients progress and discharge plan
- Case manage patients upon discharge
- Create authorizations for any follow up with specialist or DME if needed
- Establish relationship with patient and family
- Conduct weekly follow up visits, and calls
- Assist patient with appointment and transportation needs.
Appeals & Grievance Coordinator
Synermed
Monterey Park, CA
11.2016 - 08.2017
- Handled assigned grievances, obtained needed medical records, resolved issues while complying to company policies and tracked grievances through in-house databases
- Processed, researched and responded to members, providers and external agencies while working closely with internal departments towards investigating claims and billing discrepancies
- Answered telephones and worked with the CMO and medical directors to resolve and evaluate clinical issues.
Outpatient Coordinator
Synermed
Monterey Park, CA
08.2015 - 11.2016
- Worked in all aspects of referral processing and referral management
- Processed authorization requests in contingency with Health plans division of financial responsibility and contractual relationships with the provider and hospital networks.
Customer Care Representative
Synermed
Monterey Park, CA
05.2013 - 08.2015
- Handled all inbound customer calls within the department while answering all client inquiries including status of authorization, payment questions and directed calls to appropriate departments
- Assisted clients with Health plan issues related documentation of activities
- Worked Web Portal inquiry responses as needed and assigned by medical management.
Patient Care Coordinator
AppleCare Medical Group
Downey, CA
10.2006 - 10.2013
- Filled and input customer data while remaining in compliance with HIPAA and company procedural standards
- Answered customer inquiries in a call center setting regarding insurance policies and logged all call information into internal databases
- Communicated and worked as a liaison verbally and in writing between patients and insurance companies.
Receptionist/Data Entry Clerk
Bright Medical Group
Whittier, CA
09.2000 - 10.2006
- Greeted patients and offered hospitable services to ensure a welcoming environment for patients
- Handled multi-line phones, processed patients, collected information and scheduled appointments
- Ordered office supplies and assisted with office management responsibilities.
Education
Medical Assisting / Medical Administration -
East San Gabriel Valley ROP
High School Diploma -
Garfield High School
Skills
- Patient Care Management
- Conflict-management skills
- Medical terminology
- Insurance verification
- 3rd party communication
- Bilingual English and Spanish
- Effective communication
- Case Management
- Appeals & Grievance Coordinator
- Outpatient Coordinator
- Customer Care Representative
- Data Entry Clerk
- Receptionist
- Working under strict deadlines
- Working under high pressure situations
- Billing discrepancies handling
- Confidentiality
- QC experience
- Proficient in Microsoft Office
- Operating under HIPAA regulations
- Referral Coordination
- Chronic Disease Management
- Discharge Planning
- Patient support
- Utilization review
- Patient Management
- Case Needs Assessment
- Email and Telephone Etiquette
- Conflict Resolution
- Quality Assurance
- Coaching and Mentoring
- Problem-solving aptitude
Timeline
Case Manager
Via Care Community Health Center
04.2023 - Current
Call Center Representative
Via Care Community Health Center
09.2021 - 04.2023
Patient Care Specialist
Allied Pacific
11.2017 - 09.2021
Appeals & Grievance Coordinator
Synermed
11.2016 - 08.2017
Outpatient Coordinator
Synermed
08.2015 - 11.2016
Customer Care Representative
Synermed
05.2013 - 08.2015
Patient Care Coordinator
AppleCare Medical Group
10.2006 - 10.2013
Receptionist/Data Entry Clerk
Bright Medical Group
09.2000 - 10.2006
Medical Assisting / Medical Administration -
East San Gabriel Valley ROP
High School Diploma -
Garfield High School
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