Summary
Overview
Work History
Education
Skills
Accomplishments
Languages
Affiliations
Certification
Timeline
Receptionist
Lisa Franqui

Lisa Franqui

Long Beach,CA

Summary

• 30+ years in management with emphasis on Risk Adjustment Education, Hierarchal Condition Codes, Revenue Cycle and Patient Access Managed Care Compliance, Risk adjustment and HCC Coding Education for Clinical Champions

• 30+ years’ experience working in a hospital, urgent care, outpatient, medical group, and public health settings. Health Equity Population Health SDOH subject matter expert bi-lingual consultant

• Over 10 Years in project management; Teamwork, Critical Thinking, Rapid Problem Solving, planning, procurement and execution of a projects assigned, maintained responsibility for management of quality assurance data and reports including audits, rounding tool, benchmarking and reporting, projects range from quality, quantitative analysis and actively participate in quality improvement , chart reviews, and process improvement programs both system wide and department specific, track and manage ongoing performance metrics, reports, create and maintain effective interpersonal relationships with all stakeholders, communicate effectively with all levels of staff throughout organization by consistently utilizing and facilitating effective strategies to encourage collaborative problem solving and decision making. • Specialties included but were not limited to Primary healthcare, Radiology, Cardiology, Emergency, and Cath Lab, surgery, inpatient, short stay patients, cardiac rehab, physical therapy, Sub Acute, Mental Behavioral health, hospice, and internal medicine.

• Direct oversight of all Patient Access staff which includes functions in patient registration, Pre-Admitting, Insurance verification and benefits, Bed Control, and multiple census reporting.

• Extensive experience in centralized scheduling, LOA’s, Workers’ compensation, TARS, mental behavioral health level of care tiers, financial counseling, revenue integrity, cash collections, cashiering, patient authorization and payment compliance.

• Strong understanding of HMO’s, PPO’s, Medicare, POS and Medi-Cal plans. Experience introducing and implementing EPIC and Passport One source EMR systems and surveyed ancillary departments to ensure compliance with JACHO, DNV, CAHPS/ HEDIS, NCQA requirements.

• Software: ORCHID, Power Chart, ELM Analytics, NextGen, Passport One Source, Allscripts SFM, MS4, SCM

• 3 M HDM , HPF, Meditech, AS400, PAI, AHIQA, Clearance, and EPIC/OCHIN

• Managed the day-to-day operations and provided technical & administrative leadership of the front-end revenue cycle.

• Reviewed work schedules and assigned duties to ensure optimal patient flow & production goals.

• Supports the policies, procedures, & standards of care, risk adjustment.

• Ensures compliance with protocols & procedures.

• Plan and prioritizes work assignments Supervises various personnel functions including recruitment, schedules, payroll evaluations coaching & discipline.

Overview

16
16
years of professional experience
1
1
Certification

Work History

Managed Services Manager

Altera Digital Health
09.2023 - 04.2024
  • Lead the planning and coordination of healthcare IT programs including gathering requirements ad planning for systems selection, system design, testing implementation, systems integration, training, and system maintenance for client hospitals
  • P&L responsibility for one or more cost centers at an outsourcing account with revenues of 3-5 million.

Director Population Health Managed Care/ DEI Consultant Services

EKSITUS
04.2017 - Current
  • Responsible for leading population health, and social determinants of health data and metrics to measure and monitor and inform clients diversity, and equity inclusion compliance for Acute Care/Urgent Care Facility and Behavioral Health facilities in LA County.

Director Payor Contracts

Up Medical Urgent Pointe
11.2022 - 06.2023
  • Responsible for the initiation, development, negotiation, and monitoring of contracts on behalf of UP Medical Urgent Pointe Health
  • Negotiates with external parties whose financial objectives may be in direct opposition to those of UP Medical, convincing them to include UP Health in their provider network and to pay rates that adequately meet UP Health's financial needs.

Contractor HAI Heluna Health Program Manager

California Department of Public Health
10.2020 - 11.2022
  • Responsible overseeing So California Skilled Nursing facilities infection prevention education in Health Associated Infections CDC CDPH Project Firstline
  • Leads the coordination, monitoring, and implementing of Project Firstline Online Education SNF acute inpatient, and outpatient public health facilities.

Clinical QI Program Manager

Clinica Msr. Oscar Romero FQHC
02.2020 - 06.2020
  • Responsible for leading and serving as point person for HEDIS/ Risk Adjustment quality measure adherence.

Senior Consultant Managed Care, QI Health Hubert H, Humphrey ACN Primary Care TCPI

Department Health Services LA County
04.2017 - 08.2019
  • Supported several federal funding projects: Transforming Clinical Practice Initiative 'TCPI', Public Hospital Redesign and Incentives in Medi-Cal Program measures 'PRIME', Quality Incentive Program 'QIP', COVID-19 vaccine and activity data.

Program Manager Risk Adjustment QI

Molina Healthcare Incorporated
06.2015 - 03.2017
  • Under the direction of the Sr
  • Manager or Consultant-Risk Adjustment, and in collaboration with others on the RPM team, perform value-stream research, measurement, and model-building; develop strategies for, and calculations in support of RPM operations; and review the work of peers.

Director Palliative Education and Community Outreach

Creekside Hospice Skilled Health LLC
06.2010 - 05.2015
  • Identified outreach and educated on End-of-Life Care Hospice awareness and bereavement support.

Bereavement Coordinator /Grief Recovery Method

Nathan Adelson Hospice Center for Compassionate
09.2008 - 06.2010
  • Client centered anticipatory Identified outreach and educated on End-of-Life Care Hospice awareness and bereavement support.

Education

MAT - Thanatology Theology

Fuller Theological Seminary
Pasadena, CA
09.2002

Skills

  • Staff Development
  • Service Delivery
  • Technical knowledge
  • Operations Management

Accomplishments


Health Equity Management

Pioneers in Quality Health Care Equity Certification Standards

June 26, 2023, July 31, 2023, The Joint Commission Certification# ACCME /ANCC/ACHE/ 3.0 CME Category

Health Equity Management

Advancing Health Equity Skills for Healthcare Providers

January 25-27, 2022, Harvard Medical School Certification# 900 AMA PRA Category

Hospice Levels of Care

Palliative Care

February 15, 2019, Hygeia Hospice

Certification# CEP17020

NASW Suicide Prevention

As One Nevada State of Nevada

Board of Examiners for Social Workers

October 21- 22, 2019 NASW Certification# CEP 12-0817

Palliative Care Hospice

End of Life Education

Grief Recovery Method (GRM)

September 30, 2009, Grief Recovery Institute Certification# 2N1058180107

Fuller Theological Seminary

Master of Arts Theology/ Thanatology September 20, 2002

Press Ministries Incorporated

Ordination PCF

March 31, 1996, Certification#1957872

Languages

Spanish
Native or Bilingual

Affiliations

Zeta Phi Beta Sorority Inc

Gamma Lambda Chapter USC 1987

Certification

Grief Recovery Institute

Sept 2009

2N1058180107

Bend,OR

Timeline

Managed Services Manager

Altera Digital Health
09.2023 - 04.2024

Director Payor Contracts

Up Medical Urgent Pointe
11.2022 - 06.2023

Contractor HAI Heluna Health Program Manager

California Department of Public Health
10.2020 - 11.2022

Clinical QI Program Manager

Clinica Msr. Oscar Romero FQHC
02.2020 - 06.2020

Director Population Health Managed Care/ DEI Consultant Services

EKSITUS
04.2017 - Current

Senior Consultant Managed Care, QI Health Hubert H, Humphrey ACN Primary Care TCPI

Department Health Services LA County
04.2017 - 08.2019

Program Manager Risk Adjustment QI

Molina Healthcare Incorporated
06.2015 - 03.2017

Director Palliative Education and Community Outreach

Creekside Hospice Skilled Health LLC
06.2010 - 05.2015

Bereavement Coordinator /Grief Recovery Method

Nathan Adelson Hospice Center for Compassionate
09.2008 - 06.2010

MAT - Thanatology Theology

Fuller Theological Seminary
Lisa Franqui