LUCIE M. SOLIS
Amarillo,TX
Summary
Dynamic Office Manager with a proven track record at High Plains Senior Care Hospice, excelling in leadership and technical support. Achievements include spearheading initiatives that enhanced business development and employee training, highlighting a dedication to operational excellence. Strong conflict management skills foster robust relationships among staff and clients alike. Career aspirations focus on further elevating organizational efficiency and team performance.
Overview
20
20
years of professional experience
Work History
OFFICE MANAGER/HR/MARKETING
HIGH PLAINS SENIOR CARE HOSPICE
AMARILLO, TX
10.2022 - Current
- Community liaison, networking, and getting leads for potential hospice patients.
- Meeting with families and facilities, and having the hard discussion of hospice.
- Building relationships in the community and generating new business.
- Managed office budget to handle inventory, postage and vendor services.
- Responded to customer inquiries via phone or email in a professional manner.
- Implemented quality control measures to uphold company standards.
- Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
- Assigned work and monitored performance of project personnel.
- Mediated conflicts between employees and facilitated effective resolutions to disputes.
- Used judgment and initiative in handling confidential matters and requests.
- Maintained filing system for records, correspondence and other documents.
- Provided training to new hires on office policies and procedures.
- Recruited and trained new employees to meet job requirements.
- Coordinated meetings, conferences, travel arrangements and department activities.
- Evaluated individual and team business performance and identified opportunities for improvement.
- Organized company events including holiday parties, team building activities .
- Created and managed budgets for travel, training, and team-building activities.
- Coordinated office activities and operations to secure efficiency and compliance with company policies.
- Interpreted and communicated work procedures and company policies to staff.
- Created spreadsheets in Excel to track data such as vacation requests, sick days .
- Answered phone calls, responded to emails, routed mail and coordinated courier services.
- Administered payroll and maintained proper documentation of employee personnel.
- Implemented and maintained company protocols to facilitate smooth daily activities.
- Assisted in recruiting, onboarding and training new employees.
- Provided administrative support to management team including preparing reports and presentations.
- Trained and mentored administrative staff members in company policies, daily task execution and industry best practices.
- Maintained confidential records relating to personnel matters.
- Ordered supplies and equipment to maintain adequate inventory levels.
- Resolved customer inquiries and complaints requiring management-level escalation.
- Planned and led team meetings to review business results and communicate new and ongoing priorities.
- Ensured compliance with applicable laws regarding employment practices.
- Processed payroll accurately ensuring all employees were paid on time.
- Developed and implemented office policies and procedures.
- Reviewed employee performance and provided ongoing feedback and coaching to drive performance improvement.
- Managed office inventory and placed new supply orders.
ESCALATION SPECIALIST
OCCUNET
01.2019 - 04.2022
- Diffusing escalated situations.
- Worked on appeals and disputes from providers and facilities that do not agree with the reimbursement from the carrier.
- Interpret contract language and reimbursement fee schedules, so the billers understand the way the claims are processed.
- Speaking to members who are receiving balance bills or have been sent to collections, and contacting the appropriate parties to have that resolved for them.
- Negotiating out-of-network claims with the CFO, CEO, or upper leadership for them to accept a discounted reimbursement.
- Working with legal departments regarding our contracts and types of reimbursement.
- Kept communication with our clients, keeping them up to date on accounts that are being disputed or appealed.
- Request claims and UBs for the claims to be processed from doctors and facilities.
- Worked with providers for refunds for our clients when an overpayment or patient payment is issued.
REGIONAL DIRECTOR OF CONTRACTING
OCCUNET
09.2015 - 01.2019
- I served as a liaison between the clients (payers) and the providers.
- I would follow up and keep providers updated on their payments, or if they were having issues contacting the payer.
- I would have conference calls with upper leadership from Managed Care Teams to explain what our company does and to get providers to join the network so we could direct care to them.
- I would get providers and facilities to contract and become a part of our sports provider network.
- Also, I would negotiate single-case contracts and different types of reimbursement.
- Developed and executed marketing campaigns tailored to regional preferences and opportunities.
- Participated in round table discussions to brainstorm business strategies.
- Revitalized business plans and realigned company objectives to increase overall profits.
- Resolved escalated customer complaints in a timely manner while maintaining high satisfaction ratings across all stores.
- Collaborated with team members in developing best practices to support company objectives.
- Facilitated communication between regional offices and corporate headquarters.
- Monitored compliance with all legal and regulatory requirements within the region.
LEAD MEDICAL INSURANCE SPECIALIST
MAXOR ADMINISTRATIVE SERVICES
09.2012 - 12.2015
- This was a new TPA starting out and they needed someone to put a training manual together and train new employees
- Once a team was built, I supervised the call center.
- Resolved complex insurance issues by communicating with providers, patients, and third-party payers.
- Developed strategies to improve customer service practices within the department.
- Developed relationships with key personnel at provider organizations for better coordination of services provided under contracts.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Sent clinical request and missing information letters to obtain incomplete information.
- Conducted audits of billing documents to identify discrepancies between billings and actual services rendered.
- Improved data collection accuracy by structuring systems for desktop spreadsheets.
- Collaborated with other departments within the organization such as finance or accounting when needed.
- Assisted in developing new procedures and policies related to medical insurance operations.
- Explained coverage options to potential policyholders, answering questions or concerns.
- Communicated regularly with physicians' offices regarding status updates on pending claims or reimbursements.
- Participated in training sessions regarding new policies or procedures related to medical insurance processing.
- Facilitated continuing service by processing changes in beneficiaries and analyzing policy loan applications.
- Reviewed administrative guidelines whenever questions arose during processing of claims.
- Used contract notes and processing manual to correctly apply group-specific classifications to claims.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Reviewed claims for accuracy before submitting for billing.
- Reviewed and processed medical insurance claims to ensure accuracy of information and compliance with established regulations.
- Performed administrative tasks such as filing paperwork, preparing reports, answering phones, scheduling appointments.
- Remained current on latest industry trends by gaining comprehensive knowledge of financial and insurance products, services, and best practices.
- Administered standard contract benefits to process pending claims for dental benefits.
- Ensured compliance with HIPAA regulations when handling sensitive patient information.
- Provided guidance on medical reimbursement issues such as coding, claim forms, and fee schedules.
- Counseled prospects and policyholders on coverage, limits and regulations.
- Researched medical codes used in billing processes to ensure accuracy of documentation.
- Maintained up-to-date understanding of insurance payment practices.
- Prepared detailed summaries of medical claims data for review by upper management.
- Investigated discrepancies between billed charges and approved payment amounts from third party payers.
- Greatly improved office operations by reducing backtracking of work through creation of material movement process.
- Advised clients on how to maximize their health care benefits while minimizing out-of-pocket expenses.
- Handled third-party insurance processing tasks to assist patients.
- Based payment or denials of medical claims upon well-established criteria for claims processing.
- Identified needs of customers promptly and efficiently.
- Assisted with customer requests and answered questions to improve satisfaction.
- Worked effectively in team environments to make the workplace more productive.
- Worked with cross-functional teams to achieve goals.
- Updated and maintained databases with current information.
- Provided support and guidance to colleagues to maintain a collaborative work environment.
- Completed day-to-day duties accurately and efficiently.
OFFICE MANAGER
BROOME OPTICAL
03.2012 - 12.2012
- Supervised the paraoptometric techs and call center, oversaw 21 employees.
- Evaluated and trained new employees.
- Responsible for keeping all training and certificates current.
- Verify and check eligibility for patients with insurance, handle patient complaints, and construct all employees' work schedules.
- Check patients in for appointments.
- Directed employee meetings twice a month to discuss all updates within the company, and to do team building.
- Mediator between employees and other management.
LEAD CUSTOMER SERVICE SPECIALIST
INSURANCE MANAGEMENT SERVICES
07.2008 - 03.2012
- Supervised the customer service team.
- Excelled in my role and my ability to handle a variety of customer service and administrative tasks, and to resolve customer issues with ease.
- Knowledgeable of Plan Documents for our numerous clients to best serve their needs and the needs of the company.
- Demonstrated proficiencies on the telephone and in person with our clients.
- I calmed the upset insureds and was able to research, take the time to listen to their issues and frustrations, and resolve the matter or walk them through the process.
- Performed the job interviews and new employee training.
- Offered superior customer service.
FRONT DESK/BILLING
DR. OKOGBO'S PEDIATRIC OFFICE
08.2004 - 06.2008
- I checked all patients in and out, answered multi-phone line systems, and oversaw making sure our medical records were compliant.
- I scheduled appointments and made referrals to other providers or hospitals.
- I did the insurance coding and billing, and I would reach out to insurance companies for benefits, authorizations, and approvals, as well as work on disputes for non-payments and denials with the insurance and Medicaid companies.
- I assisted patients with payment plans when needed, and went above and beyond to make sure the patients were always put first.
Education
HIPAA TRAINING CERTIFICATE -
Work training program
01-2019
SKILLED PATHWAYS INDISPENSABLE ADMINISTRATIVE ASSISTANT CERTIFICATE -
01.2012
SKILLED PATHWAYS MANAGEMENT CERTIFICATE -
01.2011
HIGH SCHOOL DIPLOMA -
CAPROCK HIGH SCHOOL
05.1999
Skills
- Office Management and leadership
- Conflict management
- Mail handling
- Employee supervision
- Policy development
- Technical support
- Information protection
- Business administration
- Office administration
- Meeting planning
- Clerical support
- Contract negotiations
- Proposal writing
- Employee training
- Staff training
- Payroll and budgeting
- Payroll processing
- Organizational skills
- Customer relations
- Training and coaching
- Clear oral/written communication
- Travel coordination
- Relationship building
- Data entry
- Policy implementation
- Policy and procedure modification
- Administrative support
- Event coordination
- Compliance monitoring
- Human resources
- Customer service
- Provider credentialing knowledge
- Direct provider contracting
- Knowledge of the appeals and dispute process
- TPA, Insurance, Billing, Reviewing records for medical necessity
- Insurance Terminology
- Insurance verification
- Authorizations
- Pre-certifications
- Bookkeeping
- Staff hiring
Timeline
OFFICE MANAGER/HR/MARKETING
HIGH PLAINS SENIOR CARE HOSPICE
10.2022 - Current
ESCALATION SPECIALIST
OCCUNET
01.2019 - 04.2022
REGIONAL DIRECTOR OF CONTRACTING
OCCUNET
09.2015 - 01.2019
LEAD MEDICAL INSURANCE SPECIALIST
MAXOR ADMINISTRATIVE SERVICES
09.2012 - 12.2015
OFFICE MANAGER
BROOME OPTICAL
03.2012 - 12.2012
LEAD CUSTOMER SERVICE SPECIALIST
INSURANCE MANAGEMENT SERVICES
07.2008 - 03.2012
FRONT DESK/BILLING
DR. OKOGBO'S PEDIATRIC OFFICE
08.2004 - 06.2008
HIPAA TRAINING CERTIFICATE -
Work training program
SKILLED PATHWAYS INDISPENSABLE ADMINISTRATIVE ASSISTANT CERTIFICATE -
SKILLED PATHWAYS MANAGEMENT CERTIFICATE -
HIGH SCHOOL DIPLOMA -
CAPROCK HIGH SCHOOL