Sujata Anaya
Gilroy,CA
Summary
Highly knowledgeable Sr. Program Administrator with a wealth of healthcare experience and expertise in problem-solving. Talented in maintaining complex and comprehensive databases covering patient information. Dedicated to proactive monitoring and thorough reporting using top-notch technical abilities.
Overview
25
25
years of professional experience
Work History
Senior Health Care Program Analyst
Santa Clara Valley Medical Center
San Jose, CA
09.2019 - Current
- Implementing and providing support of new credentialing system for Enterprise Medical Staff Office- MD Staff
- Assigns, directs, and monitors MD staff provider credentialing database and provides system analysis
- Performs software updates, upgrades and data backups.
- Completes other credentialing projects/reports as assigned by Manager or Medical Director from inception through delivery
- Conducts quality improvement and customer satisfaction surveys to evaluate patient care.
- Demonstrates strong organizational and time management skills while managing multiple projects
Senior Regulatory Affairs Analyst
Valley Health Plan
San Jose, CA
03.2014 - 09.2019
- Active collaborator with people who are responsible for internal business projects and programs involving department or cross-functional teams of the health plan
- Focused on process improvement, organizational change management, program management and other processes relative to the health plan
- Performed quality control departmental audits on internal processes in compliance with state and federal regulations
- Reviewed claims data to assess compliance with DMHC regulations.
- Built effective plans to mitigate risk by analyzing data trends within the health plan
- Prepared and submitted regulatory file applications and supporting documentation.
- Leadership to design, implement, and communicate strategic action plans
- Developed methods and formats for planning, preparing, and compiling reports for Federal, State, and other regulatory agencies
- Developed strong communication and organizational skills through working on group projects
- Collaborated with clinical and administrative staff to develop methods to monitor compliance and methods to format presentation of performance data concerning consumers, hospital services, service providers, and Valley Health Plan
Assistant Claims Manager
Valley Health Plan
San Jose, CA
10.2005 - 03.2014
- Managed up to 20 Claims examiners.
- Established internal audit procedures to validate and improve accuracy of financial reporting
- Developed and implemented claims management strategies aimed to cost-effectively resolve claims and streamline investigations in accordance with company policies and procedures
- Developed team members to ensure accountability for achievement of departmental goals and objectives
- Utilized claims management systems to provide reports and analysis to management on a regular basis
- Updated and facilitated implementation of process and workflow modifications to improve operational efficiency
- Created financial dashboards to provide insights into key performance indicators.
- Developed strategic plans for day-to-day financial operations
- Championed insurance claims process by providing expert knowledge and building positive, trusting relationship to support clients during challenging times
Registration Supervisor
Watsonville Community Hospital
Watsonville, CA
03.2004 - 10.2005
- Supervised 40+ registrars in multiple ancillary departments
- Oversees the day-to-day operations and activities performed by registration staff
- Collaborates with staff and leadership within the organization to drive standard processes and ensure consistency of practices as well as continuous process improvement within the Patient Access department
- Completed bi-weekly payroll for 40+ employees.
- Implemented project management techniques to overcome obstacles and increase team productivity.
- Makes decisions in fast-paced, fluid environment; actively collaborates with leadership and staff within defined service level agreements
- Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews and administered salaries for staff.
Patient Medical Billing Representative
Stanford University
Stanford, CA
03.2002 - 03.2004
- Accurately completes, keys and batches charge documents in a timely manner
- Applies predefined ICD-9-CM, and modifiers following coding guidelines and biller functions
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
- Ensure coded services, provider charges and medical record documentation meet appropriate guidelines or standards
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Keeps abreast of billing guidelines and reimbursement reporting requirements
- Performs or updates required billing information for claim edits, denials, documentation requests
- Utilize appropriate methods to ensure all documented professional services are submitted timely
Education
MBA -
Saint Mary's College of California
Moraga, CABachelor of Science - Health Science, Healthcare Management
SAN JOSE STATE UNIVERSITY
San Jose, CASkills
- MS Office computer proficiency
- Regulatory websites
- Health Information
- Leadership experience
- Strong communication skills
- Problem-solving abilities
- Claims Reporting
- Knowledge of regulatory practices
- Knowledge of healthcare computer systems and databases
- Technical Requirements Understanding
- Network Analysis
Timeline
Senior Health Care Program Analyst
Santa Clara Valley Medical Center
09.2019 - Current
Senior Regulatory Affairs Analyst
Valley Health Plan
03.2014 - 09.2019
Assistant Claims Manager
Valley Health Plan
10.2005 - 03.2014
Registration Supervisor
Watsonville Community Hospital
03.2004 - 10.2005
Patient Medical Billing Representative
Stanford University
03.2002 - 03.2004
Bachelor of Science - Health Science, Healthcare Management
SAN JOSE STATE UNIVERSITY
MBA -
Saint Mary's College of California