Kristina Chacon

• Develop and support provider contract strategies to ensure Medicare and Medicaid network adequacy compliance.
• Interpret and apply CMS regulations, HIPAA privacy standards, and fraud and abuse laws in provider agreements and daily operations.
• Manage end-to-end authorization processes for medical procedures and services.
• Review complex medical claims, resolve billing discrepancies, and support appeals processing.
• Provide regulatory guidance and benefit education to commercial and Medicaid-contracted providers.
• Assess provider documentation to identify patient-specific risk indicators, including nutritional and pregnancy-related risks.
• Maintain strict confidentiality and secure handling of protected health information (PHI).

Key Contribution: Strengthened compliance oversight and reduced authorization delays through detailed regulatory review and proactive issue resolution.

• Interpreted ophthalmologic and optometric prescriptions to ensure precise lens fabrication.
• Collected ocular measurements including corneal width and thickness.
• Managed billing processes, insurance coordination, and inventory tracking.
• Created detailed lab work orders to ensure accurate and timely lens production.
• Adjusted eyewear, performed frame repairs, and educated patients on lens care and treatment options.
• Maintained HIPAA-compliant patient records and documentation systems.

Key Contribution: Improved workflow efficiency and minimized order discrepancies through accurate documentation and provider coordination.

• Managed high-volume financial transactions averaging $30,000 weekly with full reconciliation accuracy.
• Processed liens, title releases, loan documentation, and bankruptcy case files in compliance with regulatory policies.
• Maintained database accuracy while safeguarding confidential financial information.
• Generated required accountability and audit reports.
• Ensured adherence to institutional procedures and risk mitigation standards.

Key Contribution: Maintained operational integrity and financial accuracy while handling sensitive documentation and regulatory processes.

• Assisted physicians and physician assistants during examinations and clinical procedures.
• Collected and documented vital signs and patient histories within EMR systems.
• Managed patient triage communications and coordinated with pharmacies and providers.
• Maintained compliance logs including medication expiration tracking, sterilization processes, and equipment checks.
• Ensured exam rooms were fully prepared and compliant with infection control standards.

Key Contribution: Enhanced clinical workflow efficiency and compliance through meticulous documentation and patient coordination.