Karla Ramos
Orange,CA
Summary
Motivated Patient Account Representative offering 25 years of healthcare and customer service experience. Highly effective time management, conflict resolution, and communication skills.
Overview
1
1
Certificate
16
16
years of professional experience
Education
Bachelor of Science - Business/Healthcare Management
DeVry University
Long Beach, CA02.2024
High School Diploma -
Saddleback High School
Santa Ana, CA06.2001
Skills
- Administrative and Office Support
- Database Search and Data Entry Skills
- Verbal and Written Communication
- Organized and Efficient
- Insurance Authorizations
- Reliability and Dedication
- Attention to Detail
- Medical Terminology
- Records Management
- Computer Proficiency
- Performance monitoring
- Team leadership
- Expert problem-solving
- Attention to detail
- Conflict resolution
- Process improvement
Certification
CMA - Certified Medical Assistant
Timeline
Revenue Cycle / Operations Specialist
Kaiser Permanente
04.2023 - Current
Financial Counselor
Kaiser Permanente
04.2018 - 04.2023
Admitting Clerk
Kaiser Permanente
04.2008 - 04.2018
Bachelor of Science - Business/Healthcare Management
DeVry University
High School Diploma -
Saddleback High School
Work History
Revenue Cycle / Operations Specialist
Kaiser Permanente
04.2023 - Current
- Uphold KP's Policies & Procedures, Principles of Responsibilities & applicable state, federal & local laws
- Tracks and analyzes monthly reports such as budget, operation activity, and department metrics; consolidates and analyzes trends and variances.
- Assess claims for various lines of business, including, but not limited to, Medicare, MediCal USDOL, State Workers Compensation, third-party lien, self-pay, and DHMO.
- Identifies effectiveness and improvement opportunities on various revenue cycle functions and processes
- Maintain timely capture and completion of audit data collection
- Partner with crucial stakeholder departments to meet annual goals and objectives
- Supervisory Responsibilities
- Participates in various special projects
- Coordinates project work schedules to meet client expectations and raises conflicting deadlines to management’s attention
- Performs auditing functions within Revenue Cycle Operations, Patient Access, and CSS Departments
- Provide complex administrative and project support to a department head and senior management using advanced MS Office skills (Word, Excel, MS Project, Visio, Access, and/or PowerPoint)
- Proofread content for accuracy and KP-established formatting
- Ability to acquire and use advanced knowledge of KP and its customers
- Strong quantitative and analytical skills
- Ability to use research and auditing principles and methods
- Ability to manage multiple priorities, work in a complex, fast-paced work environment, be self-directed, detail-oriented, deadline-focused, flexible, and communicate effectively at all organizational levels
- Collaborate with cross-functional teams to achieve project goals on time and within budget.
- Implement new training programs for staff, leading to higher employee retention rates and better overall performance.
- Enhance team productivity by streamlining processes and implementing time-saving strategies.
- Develop strong client relationships through consistent communication and attentive service.
- Oversee daily operations of a busy office environment, ensuring tasks are completed efficiently and accurately.
- Assists with staff training to enforce quality, safety and sanitation guidelines.
- Improve operational efficiency by streamlining processes and implementing new systems.
- Manage inventory control, ensuring optimal levels of stock while minimizing waste and costs.
Financial Counselor
Kaiser Permanente
04.2018 - 04.2023
- Upheld KP's Policies & Procedures, Principles of Responsibilities & applicable state, federal & local laws
- Trained and mentored new Financial Counselors and Admitting Clerks
- Confidentially obtained reviews & records patient financial & demographic information
- Coordinate with/ inpatient/outpatient admission & registration to identify potential alternate payor sources
- Completed Medical Financial Assistance applications based on analysis of patient financial information
- Provided functional guidance to support staff & informed support staff & physicians on new and revised processes
- Retrospectively reviewed diagnosis & treatment records to identify potential Third-Party Liability & Worker's Compensation cases
- Screened for potential eligibility for KP Membership through government programs
- (Medi-Cal, Medicare, transition plan, etc.) Checks patient information against updated eligibility using online systems
- Placed telephone calls to appropriate departments (CSC, Sales & Marketing, etc.) in cases where group eligibility is not updated
- Contacted insurance providers to obtain critical information regarding patient benefits and submit account documentation
- Identified healthcare resources and programs for patients unable to meet financial obligations
- Conducted interviews with patients and family members and answered questions regarding insurance benefits
- Documented details regarding contact with patients, providers, and other individuals in HealthConnect
- Worked flexible hours, night, weekend, and holiday shifts
- Performed other related duties as required.
- Verified insurance information, collected payment or co-payment for services and created record of visit for future billing.
Admitting Clerk
Kaiser Permanente
04.2008 - 04.2018
- Obtained required information and made referrals to Financial Counseling as needed
- Reviewed reports for coordination of benefits
- Performed pre-admissions functions for surgery and labor & delivery cases
- Secured and released patient valuables
- Verified patient details and insurance coverage and collected co-pays
- Handled admission processes and discharge procedures to transfer patients from hospital to home care, extended facility, and self-care plans
- Arranged forms and charts for each patient
- Calculated collectible amount due for procedures
- Reviewed hospital schedule and confirmed arrival times
- Registered patients for labs, surgeries, and radiology
- Answered telephone calls to offer office information, answered questions, and made direct calls to staff
- Accurately completed insurance and Medicaid billing and OASIS documentation for patient visits
- Obtained payments from patients and scanned identification and insurance cards
- Worked flexible hours, night, weekend, and holiday shifts.
- Streamlined patient admissions process by implementing efficient data entry and record-keeping procedures.
- Enhanced patient satisfaction with timely and accurate registration of personal information and insurance details.
- Reduced wait times for patients by efficiently managing high-volume admission periods during peak hours.
- Collaborated with medical staff to ensure seamless communication regarding patient status and bed availability.
- Provided exceptional customer service, addressing patient concerns promptly and professionally.
- Maintained strict confidentiality of sensitive patient information in accordance with HIPAA regulations.
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