La Nacia Vargas
Katy
Summary
Dynamic medical management professional specializing in patient care coordination and utilization management. Proven ability to streamline processes, enhance productivity, and maintain compliance with regulatory standards. Recognized for strong leadership and rapid skill acquisition, with expertise in ICD 10, HCPCS, and healthcare billing/coding. Committed to supporting mission-driven organizations dedicated to delivering quality healthcare services to diverse populations.
Professional with focus on claims evaluation and resolution. Adept at analyzing complex information, negotiating settlements, and ensuring compliance with regulations. Known for strong teamwork and adaptability, driving results in fast-paced environments. Skilled in customer communication, conflict resolution, and decision-making.
Overview
9
9
years of professional experience
Work History
Claims Adjuster
Catalyst Solutions Blue Cross Blue Shield
06.2024 - Current
- Investigated discrepancies in claims and gathered necessary documentation.
- Reviewed claims submissions for accuracy and completeness.
- Communicated with clients to clarify information and resolve issues.
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
Patient Review Coordinator /Grievance Appeals Specialist
Molina Healthcare
06.2023 - 10.2024
- Medical management, billing, coding, and admissions approval.
- Improved patient satisfaction scores by 15% through streamlined patient review processes.
- Researched case files to ensure accuracy of information prior to making decisions on appeals or grievances.
- Coordinated review by internal teams of submitted appeals or grievances.
Utilization Management Coordinator/Medical Claims Processor
River City Medical
05.2022 - 01.2023
- Assessed healthcare data and collaborated with providers to optimize resource utilization, ensuring cost-effective, high-quality care delivery.
- Conducted utilization reviews, obtained treatment authorizations, and monitored outcomes, contributing to efficient healthcare delivery while adhering to regulatory standards.
- Processed 500 Medi-Cal/Medicare claims monthly, with accuracy and compliance.
- Reviewed medical claims for accuracy and completeness, verifying patient eligibility and coding.
- Ensured compliance with insurance company policies and procedures related to the processing of claims.
Supervisor of Operations (Seasonal)
Health Sherpa
07.2021 - 01.2022
- Leading the Affordable Care Act – ACA enrollment process, you'll oversee operations to ensure seamless functionality and adherence to regulatory standards
- Your role involves supervising a team of enrollment specialists, offering direction, training, and assistance to guarantee precise and streamlined enrollment for individuals accessing health insurance coverage via the ACA marketplace
- Increased productivity by over 300% with automation of tedious processes and improved
Patient Service Representative Supervisor
Triwest Health Care Alliance
10.2015 - 08.2020
- Lead a team coordinating healthcare services, ensuring timely access to quality care for veterans and their families
- Oversee daily operations, manage inquiries, resolve escalated issues, maintain compliance with policies and regulatory requirements
- Consistently recognized for patient service throughout 5 year career
Education
Business Management -
University of Phoenix
11.2024
Skills
- ICD-10 Coding Expertise
- HCPCS Compliance Understanding
- Appeals and Grievance
- Medicaid Expertise
- Medicare Expertise
- Medical Billing
- Technical Proficiency
- Healthcare Coding
- Facets
- Epic
- FEP Claims Processing (5 Years)
Accomplishments
Promoted to management role in six months, showcasing dedication and leadership potential.
Timeline
Claims Adjuster
Catalyst Solutions Blue Cross Blue Shield
06.2024 - Current
Patient Review Coordinator /Grievance Appeals Specialist
Molina Healthcare
06.2023 - 10.2024
Utilization Management Coordinator/Medical Claims Processor
River City Medical
05.2022 - 01.2023
Supervisor of Operations (Seasonal)
Health Sherpa
07.2021 - 01.2022
Patient Service Representative Supervisor
Triwest Health Care Alliance
10.2015 - 08.2020
Business Management -
University of Phoenix
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