Leticia ARellano
Highland
Summary
Adept Quality Assurance Specialist with a proven track record at San Bernardino County Preschool Services Department and ARMC, enhancing workflow efficiency and ensuring compliance with federal and state regulations. Skilled in analytical thinking and problem-solving, I significantly improved program effectiveness and customer satisfaction. Expertise in HIPAA compliance and EPIC systems software underscores my commitment to quality improvements and meticulous documentation.
Overview
23
23
years of professional experience
Work History
Quality Assurance Specialist II
San Bernardino County Preschool Services Department
02.2022 - Current
- Provide regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
- Ensure product compliance with industry regulations by staying up-to-date on relevant standards and guidelines, implementing necessary changes to maintain conformance.
- Enhance customer satisfaction by addressing reported issues promptly and providing effective solutions.
- Optimize workflow efficiency by introducing automation tools into the QA process where appropriate.
- Evaluate program operations and ensure that necessary steps are taken to meet mandated federal and state regulations, program goals and objectives and ensure that appropriate corrective actions are taken in a timely manner.
- Gather, analyze and interpret federal, state, and licensing regulations in order to assess program compliance and effectiveness.
- Conduct on-site monitoring, staff interviews, child and staff file monitoring, and child health and safety observations.
- Evaluate multiple levels of performance, including program strengths, concerns, areas of non-compliance and deficiencies.
- Create and maintain contract monitoring reports and trend reports of deficiencies.
- Support with special projects.
Supervising Office Assistant
San Bernardino County ARMC- Patient Reception
10.2017 - 02.2022
- Supervise the work of assigned staff.
- Evaluate work performance, prepare and sign performance evaluations.
- Participate in personnel decisions including hiring and disciplinary actions and assist in resolving employee grievances, approve leave requests.
- Plan, organize, schedule and assign the day to day clerical support operations of the office; establish work sequence, priorities, deadlines, and work standards; estimate supply, staff and equipment requirements.
- Identify training needs and plan training programs; may develop training curricula and prepare training.
- Review work products prepared and processed by department for accuracy and compliance with County policy.
- Maintain records of workload and personnel information; prepare operational, narrative and statistical reports.
- Research data, laws, regulations and policies, and explain and interpret same to the public, employees, supervisors and others.
- Obtain and verify insurance using multiple insurance portals including MCR, MCL, IEHP and Molina and all Manage Care.
- Obtain insurance authorization for admission.
- Submit insurance claims
- Assist finance department with special projects- Audit outstanding insurance claims and process new claims.
Office Assistant
San Bernardino County ARMC- Patient Reception
05.2002 - 10.2017
- Plan, organize, schedule and assign the day to day clerical support operations of the office; establish work sequence, priorities, deadlines, and work standards.
- Monitor and order supplies. Maintain records of workload and personnel information.
- Check in/Pre register patients via walk in and or ambulatory. Obtain patient demographics.
- Obtain and verify insurance using multiple insurance portals including MCR, MCL, IEHP and Molina.
- Obtain insurance authorization for admission. Audit signatures for consents for treatment and MCR rights.
- Collect copayments and issue receipts
- Use of office equipment including fax, copy machine, scanner, multi line phones and tube system. Heavy data entry and phone calls. Microsoft Word, Excel, Outlook.
- Managed receptionist area, including greeting visitors and responding to telephone and in-person requests for information.
- Maintained utmost professionalism when interacting with customers by telephone or in-person to answer questions, provide general information or direct to appropriate personnel.
Education
Associate of Arts - Liberal Arts- Social & Behavioral Science
San Bernardino Valley College
San Bernardino, CA05-2017
Skills
- Quality assurance
- Claims audit
- Analytical thinking
- Problem-solving skills
- Detail-oriented
- Quality improvements
- Trend data analysis
- Documentation and reporting
- HIPAA Compliance
- EPIC systems software
- Internal audits
- Contract writing
- Strong problem solver
Timeline
Quality Assurance Specialist II
San Bernardino County Preschool Services Department
02.2022 - Current
Supervising Office Assistant
San Bernardino County ARMC- Patient Reception
10.2017 - 02.2022
Office Assistant
San Bernardino County ARMC- Patient Reception
05.2002 - 10.2017
Associate of Arts - Liberal Arts- Social & Behavioral Science
San Bernardino Valley College
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