Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

JANETH MAINERO

Kearny,New Jersey

Summary

A seasoned healthcare professional with over 15 years' experience managing various aspects of business operations including data analysis, claims processing, and audit management. Extensive experience with Commercial Insurance, as well as Government Programs (Medicare and Medicaid) . Over 10 years of proven success in Medical Office Management, Authorization Coordination, and Healthcare Analytics. Proficient in all Microsoft Applications, and various Claims engines, PBM and EMR systems (Epic, Athena) .

Overview

12
12
years of professional experience
1
1
Certification

Work History

Senior Clinical Administrative Coordinator

UnitedHealthcare
01.2023 - 09.2024
  • Generated detailed reports and facilitated care coordination by working in multiple systems such as; Salesforce, Outlook, Epic and Excel. Enhancing operational efficiency.
  • Educated and assisted members by serving as a subject matter expert, reducing care gaps by 18% and enhancing preventive care techniques
  • Adapted to rapidly changing work environment while multitasking and maintaining accuracy in data entry and reporting.
  • Liaison between business and IT teams for various initiatives including audits, IT releases, and claims monitoring

Office Supervisor

Optum
06.2021 - 01.2023
  • Managed operations in fast -paced environment, trained staff on EMR systems, and oversaw medical authorizations and claims for medications and procedures of office.
  • Established workflow processes, monitored daily productivity, and implemented modifications to improve overall performance of personnel.
  • Prepared and submitted weekly reports to C-suite, tracking supplies sales, inventory levels and authorizations.
  • Proficient in navigating commercial insurance, medicare, medicaid, D-SNP, including disability forms, appeal and grievances and other healthcare documentation processes

Clinical Coordinator

Summit Medical Group
06.2016 - 06.2021
  • Processed authorizations, streamlined processes, and resolved discrepancies
  • Monitored team productivity, handled escalated cases, and maintained metrics
  • Collaborated for EHR optimization and resolution of insurance-related issues
  • Coordinated, monitored, assigned, and documented patient and clinical care activities.
  • Utilized multiple web-based platforms to process insurance authorizations, documented all activities in Athena EMR
  • Maintained accurate records in excel and provided weekly reports to management

Assistant Office Manager

New Jersey Physicians LLC
06.2012 - 09.2016
  • Supervised teams, achieving a 30% increase in workflow efficiency and patient satisfaction
  • Managed billing, resolved patient concerns, and facilitated office improvements
  • Assisted in EHR management and analysis of office performance metrics
  • Conferred with insurance company representatives to expedite payments and resolve filing issues, keeping aging balances low and office finances strong.

Education

Bachelor of Science - Business Administration, Management and Operations

Capella University

Associates - Diagnostic Medical Sonography, Medical Assistant

Eastwick College

Skills

  • SalesForce
  • Team Leadership
  • Microsoft Suit
  • Project Coordination
  • Process Improvements
  • Organizational
  • Spanish: native
  • HIPAA compliant
  • Metrics tracking
  • Epic, Athena

Certification

RMA

Timeline

Senior Clinical Administrative Coordinator

UnitedHealthcare
01.2023 - 09.2024

Office Supervisor

Optum
06.2021 - 01.2023

Clinical Coordinator

Summit Medical Group
06.2016 - 06.2021

Assistant Office Manager

New Jersey Physicians LLC
06.2012 - 09.2016

Associates - Diagnostic Medical Sonography, Medical Assistant

Eastwick College

Bachelor of Science - Business Administration, Management and Operations

Capella University

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JANETH MAINERO