Adept at managing regulatory documents from start to finish, including assessing audits, evaluating technical data and checking information accuracy. Well-spoken and friendly with top-notch abilities in information verification, report preparation and records management. Systematic and practical with sound judgment, and analytical mindset and good problem-solving skills. Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand. Skillful front desk medical assistant with background in patient scheduling, insurance verification and processing, as well as handling patient inquiries. Strong administrative skills enable smooth clinic operations. Familiarity with electronic health records and medical terminology enhances communication with healthcare professionals. In previous roles, contributed to improved efficiency and patient satisfaction through organized system management.
Overview
18
18
years of professional experience
Work History
Regulatory Compliance Specialist
Sierra Health + Wellness Centers
Sacramento
06.2022 - 01.2025
Submitted initial applications, renewals, and amendments to regulatory agencies, such as the Department of Human Services (DHCS website), to obtain state licenses and Clinical Laboratory Improvement Amendments (CLIA website) to obtain state and federal licenses.
Manage and maintain the business license for all residential and outpatient facilities.
Collaborated with other department heads to develop strategies and provide updates on safety concerns and improvements in the departments.
Prepare, assist in annual and monthly facility inspections, and walk-throughs.
Conducted internal audits of processes and procedures to assess compliance with relevant regulations
Contributed innovative ideas and solutions to enhance team performance and outcomes.
Utilized various software to verify physician, nurse, counselor, and therapist credentials, such as the Office of Inspector General (OIG), National Practitioner Data Bank (NPDB), California Consortium of Addiction Programs and Professionals (CCAPP), CADTP, and the Department of Consumer Affairs (DCA). Board of behavioral Sciences (BBS)
Assisted the Chief Executive in updating corporate policies to ensure compliance with applicable laws and regulations.
Investigated and analyzed incoming incident reports to determine the level of urgency to report to the state agency.
Managed upkeep of regulatory electronic and hard copy filing systems and archives.
Determined requirements apply to the treatment, storage, and disposal of hazardous production-related waste.
Prepared reports for management on the status of current compliance activities.
Medical Records Coordinator
Collected, sorted, and distributed incoming correspondence and reports related to medical records.
Tracked and processed release of information requests.
Processed and invoiced records requests from patients, providers and third parties.
Created new patient charts, including entering data into electronic health record system.
Performed daily audits to ensure accuracy and completeness of medical records.
Participated in quality assurance activities to enhance the accuracy and privacy of patient records.
Scanned incoming documentation.
Determined and implemented techniques to improve medical records retrieval process.
Streamlined day-to-day office processes to meet long-term goals.
Responded to inquiries regarding status of requests for release of confidential information from patients' files.
Conducted regular quality assurance reviews on medical records for completeness, accuracy and compliance with applicable laws and regulations.
Answered questions and fulfilled requests with friendly and knowledgeable service.
Sent out reminders to providers regarding overdue documentation or incomplete charts.
Claim Analyst -OPS
HealthNET
Sacramento, CA
01.2015 - 02.2020
Create an Excel spreadsheet to add necessary formats to report productivity, to show a reduction in claims inventory.
Conducted investigations to gather evidence in support of claims resolution.
Utilized claims processing software to update and maintain accurate claim files.
Process Autism, MHN, toxicology,115 claims a day, 15 claims per hour
Correspond with the work assignment via email.
Ability to navigate through the billing system, insurance website, and patient accounts.
Performed insurance verification, pre-certification and pre-authorization.
Answered customer questions to maintain high satisfaction levels.
Developed financial reports detailing accounts receivable aging status.
Knowledge in HMO, PPO, Medi-Cal, fee-for-service, OON, and behavioral health benefits.
Experience in EDI, National Plan, and Provider Enumeration (NPPES)
Process and enter ICD9/10 codes, CPT codes on to CMS 1500 and UB04's .
Phone Representative
SAC E.N.T
Sacramento, CA
04.2012 - 05.2015
Provided customer service by answering incoming calls and responding to inquiries in a timely manner.
Entered insurance, demographics and health history into patient database.
Answered phones promptly and directed calls appropriately.
Managed office phone lines by checking voicemail, returning calls and directing messages to team members.
Took messages from patients and promptly relayed to appropriate staff.
Compiled and coded patient information or data in appropriate computer system.
Maintained confidentiality of patient information according to HIPAA regulations.
Verified insurance coverage for appointments, collected co-payments as required, and scanned insurance cards.
Biling and Coding
Utilized ICD-10, CPT, and HCPCS coding systems to process claims and billing.
Managed coding for multiple specialties, ensuring specific codes are accurately applied.
Verified patient information, including medical history and insurance coverage, to ensure accuracy of coding and billing.
Participated in coding team meetings to discuss challenges and best practices.
Maintained high accuracy rate on daily production of completed reviews.
Monitored regulatory updates from Medicare and Medicaid programs as well as private insurers.
Provided customer service support via phone or email regarding account balances or other inquiries related to billing issues.
Translate and abstract surgery reports, trauma reports, into ICD-9/10 and CPT codes for inpatient and outpatient surgeries. Apply appropriate modifiers into the billing system and account management.
Medical Assistant
River Bend Medical Association
Sacramento , CA
05.2007 - 11.2009
Positioned patients properly during examination or treatment for comfort and safety.
Organized patient charts according to policies set by the practice administrator.
Handled general office duties to support administrative staff during peak hours.
Cleaned and maintained medical equipment following procedures and standards.
Documented notes during patient visits.
Verified appointment times with patients, preparing charts, pre-admission and consent forms.
Oversaw patient registration, insurance verification, form completion and appointment scheduling to maintain operational efficiency.
Provided instructions to patients regarding medication use and lifestyle modifications needed for improved health outcomes.
Answered phones, scheduled appointments, greeted patients and ordered supplies.
Recorded patient vital signs, medical history, medications, allergies, immunization dates, test results, and other relevant information into EHR system.
Collected, labeled and stored laboratory specimens properly prior to testing.
Education
High School Diploma -
River City High Schoo
West Sacramento, CA
06-2000
Some College (No Degree) - Medical Assistant
MTI College
Sacramento, CA
Some College (No Degree) - Medical Billing and Coding
Carrington College
Sacramento, CA
Skills
Investigation techniques
Auditing processes
Healthcare coding
Payment collection and processing
HIPAA compliance
Patient registration
Insurance billing
Industry software applications
Insurance verification
Patient referrals
Insurance authorizations
Medical terminology
Multi-line telephone management
Timeline
Regulatory Compliance Specialist
Sierra Health + Wellness Centers
06.2022 - 01.2025
Claim Analyst -OPS
HealthNET
01.2015 - 02.2020
Phone Representative
SAC E.N.T
04.2012 - 05.2015
Medical Assistant
River Bend Medical Association
05.2007 - 11.2009
High School Diploma -
River City High Schoo
Some College (No Degree) - Medical Assistant
MTI College
Some College (No Degree) - Medical Billing and Coding
Carrington College
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