Patricia Fernández Mariani
Apopka,FL
Summary
Innovative employer with 5 years plus of experience in managing all aspects of office management, logistics and data entry in federal emergency management projects. Dedicated and effective leader who excels at using proven and cutting-edge methods while implementing technology to successfully streamline operations and increase productivity with focus on efficiency and quality. Energetic, full of commitment with high standards of service, performance, and integrity, ready to embrace a new professional challenge.
Overview
6
6
years of professional experience
Work History
UM Administration Coordinator II
CarePlus Health Plans
Apopka, FL
06.2023 - Current
- Attaching faxes for chart reviews for the nursing team
- Answering departmental phones as assigned
- Make outbound calls to engage providers to verify clinical information/discharge date and admission status
- Document calls and attach clinical information received
- Request clinical information from providers/facilities
- Create and send out written correspondence
- Ability to multitask and prioritize
- Creation and distribution of determination letters
- Collaborate with multiple roles/departments/providers/team members
Claims Review Representative
Humana/Care Plus Health
Remote
04.2022 - 02.2023
- Responsible of reviewing supportive documentation, contracts and supportive data related to claim; investigate thoroughly to ensure that an insurance claim is not fraudulent and may be required to contact relevant third parties including a doctor, employer, or health facility
- With the ultimate purpose of settling claim settlements, authorizing payments, and keep records.
Grievance Analyst
Convey Health Solutions
Remote
12.2021 - 03.2022
- Effectively managed a high-volume work queue of Cigna’s Medical Plan grievances
- Primary duties, but not limited to reviews, analyzes and processes complex and non-complex grievances in accordance with members Plan coverage, Extra Help Coverage and Medical Medicare Requirements
- Effectively communicated internal policies and claims events requiring written responses in clear, understandable language (English)
- Utilized guidelines and review tools such as Express Scripts, Avaya, Share Point, PDP, medical records and Cignature Rx to conduct extensive research and analyze the grievance issues and pertinent claims to compose a grievance resolution, for it to be used either verbal or written to communicate resolution to member dissatisfaction.
Disaster Recovery Support/Data Entry IT Consultant
MMM. Holdings
Remote
06.2021 - 12.2021
- Responsible for administering the business continuity program to include maintenance of IT recovery services contracts, facilitating annual rehearsal exercises, facilitating tabletop exercising of individual business unit recovery plan and facilitating the incident management team emergency operation center
- Support in the planning, development, and execution of disaster recovery tests for those systems that support critical processes necessary for the continuity of the Organization's operations
- Coordinate testing processes with third parties or external entities which use critical applications
- Participate as moderator, incident logger or test attendant during the execution of the disaster recovery tests
- Report results and submit documentation for audit purposes after DR exercises are completed.
Disaster Recovery Consultant - Manager Landlord Liaison
CVR Associates
Remote
08.2021 - 11.2021
- Demonstrated strong managerial skills in team development and team expectations
- Focus on implementing workflows that resulted in high, fastest, and accurate results from team members
- Showed a high level of customer service regarding emails, calls, text messages, etc
- Met daily and weekly goals with a high level of quality and accuracy
- Processed applications for eligibility and screening, requesting family and landlord documentation, reviewing, and verifying information
- Accurately and timely calculated annual income from documentation provided by the family, updating applicant records and tracking
- Reviewed documentation with attention to detail
- Utilized computer programs to prepare correspondence and reports, requesting verification documents from landlords
- Verified eligibility for rent assistance, reviewing leases, determining rent assistance portion, all in conformance with established rent assistance policy, and prescribed performance standards.
Disaster Recovery Data Analyst - Technician Monitor II
Tetra Tech
Remote
06.2020 - 06.2021
- Thorough and meticulous Data Analyst passionate about helping; experienced in project multitasking, fast paced productivity, and short deadlines
- Responsible for QA/QC reconciliation, and data entry of timesheets records, invoice records, material use records as well Coordinate, review, analyze, and summarize financial data for grant-funded programs
- Auditing and reconciliating force account documentation while QA/QC reviewing of financial documentation
- Reconcile federal and state grants, cost estimates, audits, and other initiatives that support disaster recovery efforts.
Administrative Assistant / Data Entry
Tetra Tech
Millennium Plaza, Guaynabo, Puerto Rico
07.2018 - 06.2020
- Dedicated and focused administrative assistant who exceeds at prioritizing, completing multiple tasks simultaneously and following through to achieve project goals
- Answer a high volume of incoming emails while handling in person inquiries from colleagues
- Responsible for providing technical and administrative support focusing on specifics task as providing technical support to staff on projects and proposals, coordinate inventory and record management
- Compiled, prioritized, sorted, and processed customer orders into local database
- Researched further information for incomplete documents and maintain hard copies backup of all sensitive information.
Eligibility Team Lead
Puerto Rico Federal Emergency Management Agency’s Sheltering and Temporary Essential Program
Puerto Rico Department of Housing/Adjusters International, Guaynabo, Puerto Rico
01.2018 - 07.2018
- Eligibility review leads for Adjusters International and Federal Emergency Management Agency (FEMA)
- Responsibilities including assisting with assignments and QA/QC of eligibility review team, providing support to up-site team to assure applications are eligible to proceed construction, being accountable for managerial and legal lead support, re-routing tickets for applicants, receiving inbound applicant documents, QA/QC documents, correcting mistakes and dividing attachments into accurate applications, resolving issues with documentation for team of reviewers, ultimate goal to approve eligible applicants and reconcile documents so inspections can begin, extracting eligible and completed registrations to begin inspection and construction scheduling
- The project involves delivering temporary repair assistance for those whose homes can be quickly repaired so that they can return home sooner.
Education
Bachelor’s Degree in criminal justice -
Inter-American University of Puerto Rico (Metro Campus)
05.2014
Certificate of Institute in Speed Reading, Study Method, and Memory -
Nilvem Institute
04.2011
High School Diploma -
Academia Bautista de Puerto Nuevo
05.2010
Skills
- Document Control
- Project Support
- Project Management
- Customer Database Systems
- Document Management
- Data Collection
- Report Analysis
- Data Entry
- Attention to Detail
Timeline
UM Administration Coordinator II
CarePlus Health Plans
06.2023 - Current
Claims Review Representative
Humana/Care Plus Health
04.2022 - 02.2023
Grievance Analyst
Convey Health Solutions
12.2021 - 03.2022
Disaster Recovery Consultant - Manager Landlord Liaison
CVR Associates
08.2021 - 11.2021
Disaster Recovery Support/Data Entry IT Consultant
MMM. Holdings
06.2021 - 12.2021
Disaster Recovery Data Analyst - Technician Monitor II
Tetra Tech
06.2020 - 06.2021
Administrative Assistant / Data Entry
Tetra Tech
07.2018 - 06.2020
Eligibility Team Lead
Puerto Rico Federal Emergency Management Agency’s Sheltering and Temporary Essential Program
01.2018 - 07.2018
Bachelor’s Degree in criminal justice -
Inter-American University of Puerto Rico (Metro Campus)
Certificate of Institute in Speed Reading, Study Method, and Memory -
Nilvem Institute
High School Diploma -
Academia Bautista de Puerto Nuevo
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