Itzel Carter
Fredericksburg,VA
Summary
Goal-driven professional with extensive experience and particular emphasis on process improvement, well-versed in quality, analytics, recruiting, training and managing employees . A results-oriented professional with a demonstrated ability to manage complex projects requiring strong leadership, communications, flexibility, and significant problem-solving skills. Dedicated to implementing innovative solutions to address issues with extensive experience in quality, financial and billing, systems analysis, and team leadership with ability to interact on a professional and technical level with colleague, customers, technical teams, and management. Successful history identifying process breakdowns in hospital billing, collections and cash posting processes. and maintaining professional relationships.
Overview
13
13
years of professional experience
Work History
Quality Consultant/Value Based Care Consultant
INOVA Health System
01.2021 - Current
- Serve as a liaison, coach, or advisor between Inova Signature Partners and CIN practices
- Provide oversight and supports to ensure that network clinical programs are in full compliance with accrediting and regulatory standards
- Establishes and maintain effective and responsive relationships with leadership, Signature Partners Network providers and key internal and external stakeholders
- Serve as an educational resource on quality, population health management, and regulatory changes
- Subject matter expert in VBC contracts, payor contracts, CIN operations, population health and quality improvement
- Abstract, analyze, interpret, VBC data
- Recruit, lead and perform required reporting for the ACO
- Lead, plan, evaluate and the implement quality and performance improvement plan and Total Cost of Care reduction related projects (including regulatory activities related to provider coding and documentation and ACO quality reporting etc.)
- Provide project management leadership for multiple projects as evidence by project planning, problem resolution, process improvement, change control and quality assurance activities
- Assists physicians, leaders, and others in studying and understanding the effects of variations within clinical processes.
- Led company-wide initiatives aimed at improving overall conformance rates with industry standards, resulting in enhanced competitive positioning within the marketplace.
Clinic Manager
Nextcare Urgent Care
01.2020 - 01.2021
- Assessed patient care procedural changes for effectiveness
- Analyzed business and operational processes, identified areas for potential enhancement and process improvements
- Produced detailed reports and presented to senior directors and recognized by directors for reducing expenses
- Analyzed clinical performance and healthcare quality performance by conducting assessments of clinical data
- Provide thorough supervision for day-to-day operations of facility in accordance with policies
- Recruit, screens, hire, orient, and train staff
- Evaluates employee performance and provides guidance and feedback to assigned staff
- Audit Charts and educated employees on standards of documentation and billing
- Actively maintain up-to-date knowledge of applicable state and Federal laws and regulations
- Responsible for posting job post, filtering candidates, conducting phone and in per-son interviews, calling references, negotiating pay according to company budget, completing I-9 and new hire paperwork, completing health screens, orientation, and training
- Regularly evaluate employee performance provide feedback and assist, coach, and discipline staff in accordance with HR procedures and policies
- Work closely and interactively with Marketing, Clinic Development, Medical Operations team, and other corporate functions to support clinic rollout and ongoing initiatives
- Develops and adheres to annual budget for the group practice; responsible for the efficient, accurate and prudent financial management of the group practice
- Predicted and analyzed financial impact of health plan initiatives.
Patient Financial Services Rep 4 Team Lead
INOVA Health Systems
05.2019 - 01.2020
- Provide support, education, and guidance to Team of 26 employees
- Responsible for filtering candidates, conducting phone and in person interviews, calling references, negotiating pay according to company budget and new hire experience, completing new hire paperwork, and training
- Perform duties, as assigned in the absence of the Supervisor or Manager
- Assist management in special projects including performance improvements and healthcare quality performance
- Assure all assigned claims PB and HB meet payer processing criteria
- Guarantee appropriate follow-up on assigned work lists
- Collect payment and set up payment plans
- Handled escalated patient concerns from customer service team and monitored workques
- Train and assist staff members and complete evaluations
- Host Job fairs and perform on spot interviews.
Patient Access Team Lead, Emergency Department
INOVA Health Systems
03.2016 - 05.2019
- Guided a team of 16 employees to promote effective and efficient department operations and achieve revenue cycle goals by serving as a leader to front line staff and implementing process and performance improvements
- Responsible for filtering candidates, conducting phone and in person interviews, negotiating pay according to company budget and new hire experience, and trained new hires
- Audit Charts for healthcare quality and educated employees on standards of documentation and billing through data analysis
- Performed assigned duties related to customer accounts for outpatient and ER patients
- Assisted with team scheduling, managed completion of work assignments, effectively solved patient concerns etc
- Verified insurance information, obtained authorization/referral requirements, pro-vided financial counseling, and monitored workques
- Assisted with interview process as well as training staff
- Worked alongside with management and HR in assisting with recruiting, disciplinary actions, and PIP plans.
Mental Health Nurse (STAR Program)/ Technician
Dominion Hospital HCA
07.2018 - 11.2018
- Responsible for contributing to the maintenance of a safe and therapeutic milieu to provide quality healthcare, through prompt reporting of observed behavior, milieu processes and other pertinent information
- Responsible for 1:1 supervisory care of patients
- Worked within my scope and hospital regulations
- Responsible for medication administration, care plans, and patient education.
Medical Assistant/ Medical Records
Washington Radiology Associates
10.2014 - 03.2016
- Prescreened patients for procedures and obtained medical history
- Assisted clinical staff while monitoring front desk duties
- Other duties include obtaining pre authorizations, scheduling, payment collection, securing medical records, maintaining medical supplies inventory, and performing preventive maintenance to keep equipment operating to uphold healthcare quality.
Receptionist/ Technician
Dr. Gedamu & Associates
03.2013 - 10.2015
- Performed scheduling duties and customer reminder calls
- Assisted in testing for depth perception near and far acuity, color perception, macula integrity, and visual field
- Instructed patients on corrective care after eye surgery and wearing lenses properly.
Receptionist
Fairfax OBGYN
08.2011 - 03.2013
- Processed over twenty appointments per day
- Documented success in answering and screening telephone calls on multi-line system, taking messages, and providing appropriate information
- Proficient in verifying and updating necessary information in the medical database.
Education
Bachelors in Science of Nursing -
Stratford University
10.2017
Associates of Science and General Studies -
NVCC
08.2014
Diploma -
Chantilly Highschool
05.2010
Skills
- Demonstrated understanding and knowledge of quality control and quality assurance practices
- Ability to lead/manage others
- Proficient in Identifying and implementing process improvement plans
- Proven success at client relationship building
- Dedicated and self-motivated learner with excellent critical thinking and problem-solving skills
- Proficient in quality process assessments
- Bilingual-Spanish
- BLS in Healthcare
- Reporting capabilities
- Operational Excellence
- Documentation Review
- Certificates in Data analysis include Data cleaning in Python, Power BI, Analytics foundations, SQL, and Tableau
- Proficient in HR policies, hiring, interviewing, training, and new hire paperwork
- Skilled in MS Word, Excel PowerPoint and Outlook
- EHR, EMR (EPIC, Nextgen, Practice Fusion, ECW)
- Knowledge in the following:
-Billing and revenue cycle (ICD-10, CPT)
-Medicare and other payor programs and MCO contracts
-CMS, ACO Credentialing
-Insurance benefits and collections, ICD, CPT, and medical records
-Data analysis in Koan, Tableau, and Sharepoint
Activities
- Regularly volunteer my time at least twice a year at shelters.
- Routinely read business and healthcare articles to stay informed of trends and changes.
- Frequuently search for any opportunity to take courses and educate myself to improve my work.
Languages
Spanish
Native or Bilingual
Timeline
Quality Consultant/Value Based Care Consultant
INOVA Health System
01.2021 - Current
Clinic Manager
Nextcare Urgent Care
01.2020 - 01.2021
Patient Financial Services Rep 4 Team Lead
INOVA Health Systems
05.2019 - 01.2020
Mental Health Nurse (STAR Program)/ Technician
Dominion Hospital HCA
07.2018 - 11.2018
Patient Access Team Lead, Emergency Department
INOVA Health Systems
03.2016 - 05.2019
Medical Assistant/ Medical Records
Washington Radiology Associates
10.2014 - 03.2016
Receptionist/ Technician
Dr. Gedamu & Associates
03.2013 - 10.2015
Receptionist
Fairfax OBGYN
08.2011 - 03.2013
Bachelors in Science of Nursing -
Stratford University
Associates of Science and General Studies -
NVCC
Diploma -
Chantilly Highschool