Jacqueline Garcia
Rancho Cucamonga,CA
Summary
Organized and dependable. Successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
31
31
years of professional experience
Work History
Senior Provider Services Representative
Optum, UnitedHealth Group
12.2016 - 08.2024
- Accountable for all contracted Medical Providers inquiries.
- Provider update contract amendments
- Delivered exceptional customer service to every Medical Provider, staff members, and Health Plans, creating welcoming, positive experiences.
- Resolve and investigate unpaid Medical Claims (Capitation and Fee for Service)
- Initiate credentialing process for new on-boarding providers
- Identify medical screening gaps in provider's senior and commercial practice.
- Provide monthly Ad Hoc reports, statistical and analytical reports for all Health Plans to corporate.
- Implemented custom up-to-date knowledge of training processes to Providers and staff members for Portal access.
- Coordinate all Senior Wellness programs, for Annual Health Assessments.
- Develop new Provider relationships with Network Marketing.
- Responded to all Providers and staff requests, offering excellent support and tailored recommendations to address needs.
Customer Service Representative
Pacific Pulmonary Services
11.2006 - 06.2016
- Process Oxygen and CPAP prescription orders, verifying Medicare and various insurance guidelines.
- Interpret english to spanish for non-english speaking patients.
- Coordinate travel and hospital discharges arrangements for incoming/outgoing Oxygen/CPAP patients.
- Order all office and medical supplies.
- Download testing of overnight oximeters, to determine patient's meet insurance guideline qualifications.
- Create billing packets for Revenue department
- Medical coding of diagnosis and medical equipment
- Conduct monthly audit for State and Federal Regulations.
- Obtain insurance authorizations, TARS and various health plans.
- Answered constant flow of customer calls with minimal on-hold wait times.
Admissions Coordinator
Waterman Acute Care
11.2004 - 10.2006
- Confirmed all insurance benefits met standards of admissions, as dictated by policy.
- Managed admissions processes for incoming, skilled and custodial patients based on federal and state laws.
- Collaborated with admissions team to develop and implement strategies to improve admissions process.
- Completed preliminary paperwork for incoming and outgoing patients.
- Coordinate communication between patient, family members, medical and administration staff.
- Report daily census to Director of Nursing.
Accounts Receivable/Medical Biller and Coder
Desert Hematology Oncology
03.2002 - 04.2004
- Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Respond to all correspondence, pertaining to appeals and interpretation of explanation of benefits.
- Audit, analyzed and managed coding fo diagnostic and treatment procedures contained in outpatient medical records.
- Assist front office with coverage and preparation of charts for patient chemotherapy sessions.
Referral Coordinator
Santa Monica Bay Physicians
09.1993 - 05.2001
- Processed referral requests from patients, doctors and other health care professionals.
- Responded to patient inquiries to offer timely updates regarding referral status.
- Called insurance companies to get precertification and other benefits information on behalf of patients.
- Monitored referrals to foster timely completion and followed up with physicians to facilitate.
- On-going contact with Health Plans and Utilization Review department,
- Assist with scheduling in/outpatient procedures
- Attend weekly Utilization Review meetings, present a number of denied cases, previously appealed.
Education
ICD9/CPT Coding - Healthcare Administration
Los Angeles Valley College
Van Nuys, CA09.2000
Medical Terminology - Healthcare Administration
Los Angeles Valley College
Van Nuys, CA03.1996
Skills
- Medical Terminology
- Certified in CPT/ICD-9 coding
- Accounts Receivable/Capitation and Fee for Service Claim process
- Bilingual English/Spanish (speaking, writing and reading)
- Healthcare Insurance policy and benefit
- DOFR & Contract/Amendment language
- Initialing Provider Credentialing process
- Cozeva, Microsoft, Office, Excel, Power Point, office tools, storage drives and locations
- Staff Education and Training
- Appeals and Grievances process
Timeline
Senior Provider Services Representative
Optum, UnitedHealth Group
12.2016 - 08.2024
Customer Service Representative
Pacific Pulmonary Services
11.2006 - 06.2016
Admissions Coordinator
Waterman Acute Care
11.2004 - 10.2006
Accounts Receivable/Medical Biller and Coder
Desert Hematology Oncology
03.2002 - 04.2004
Referral Coordinator
Santa Monica Bay Physicians
09.1993 - 05.2001
ICD9/CPT Coding - Healthcare Administration
Los Angeles Valley College
Medical Terminology - Healthcare Administration
Los Angeles Valley College
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