Keila Hernandez
Ontario,United States
Summary
Experienced Office Administrator with over 10 years of experience in a managed care setting and have been in leadership and supervising roles. Seeking a full time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
12
12
years of professional experience
Work History
Customer Support Representative I
AltaMed
05.2023 - Current
- CSR-I providing exceptional customer service to members and providers.
- Receiving inbound calls and making outbound calls.
- Eligibility verification.
- Authorizations status: retro authorizations, redirections and providing denial/ cancellation outcomes.
- PCP Changes.
- Appeals and Grievances.
- Claim Status.
- Documenting incidents in a clear and concise manner to ensure patient care.
Office Administrator
Pacific Coast Dermatology
05.2016 - 02.2023
- Claims submissions and disputes.
- Receiving and submitting medical records.
- Knowledge in IPA Networks
- Referral Coordinator for IEHP, HMO and PPO plans.
- Knowledge of Medicare and Medi-cal plans.
- Utilization Management.
- Prior-authorization submission and appealing prior-authorization denials.
- Eligibility and benefits coordinator for PPO and HMO plans.
- Supervising and training of office staff in managed care setting to ensure productivity and to follow HIPAA regulations.
Lead Surgical Technologist
Pacific Coast Dermatology
03.2012 - 05.2016
- Delivered exemplary assistance and support to Board Certified Dermatologist during general surgery and MOHS for over 8 years.
- Educated patients on expected side effects and discomfort levels post-surgery.
- Skilled in complex wound care to properly keep excision sites free of debris and to prevent infections.
- Wound care instructions given to patients for pre-op and post-op surgeries.
- Maintained high infection control standards.
- Sterilized instruments and disposed of medical supplies and waste following OSHA guidelines.
- Maintained records to document patient medical history and surgical procedure notes.
Education
Certification - Real Estate
Mt San Antonio College
Walnut, CA05.2020
Medical Assistant - Healthcare
UEI
Ontario04.2012
High School Diploma -
Montclair High School
Montclair, CA08.2008
Skills
- Bilingual in Spanish
- Advanced skills in Microsoft Suite
- Interpersonal Skills
- Communication Skills
- Knowledgeable in ICD-10 and CPT Coding
- Medical Terminology
- Referral Processing
- Claims review and processing
- Utilization Management
- Management Skills
- Data Entry
- 75 WPM
Timeline
Customer Support Representative I
AltaMed
05.2023 - Current
Office Administrator
Pacific Coast Dermatology
05.2016 - 02.2023
Lead Surgical Technologist
Pacific Coast Dermatology
03.2012 - 05.2016
Certification - Real Estate
Mt San Antonio College
Medical Assistant - Healthcare
UEI
High School Diploma -
Montclair High School
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