MAGDA MENDOZA
Asheville,NC
Summary
Highly motivated candidate with significant background in public assistance programs, Social Security programs, and advocating for public over 30-year career. Excited to learn and grow in full-time position that offers challenges utilizing interpersonal skills, decades of experience ,and problem-solving skills. Excellent reputation for resolving problems and improving customer satisfaction. Eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Clear understanding of NC Medicaid programs and Medicare. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
24
24
years of professional experience
Work History
Patient Benefits Advisor - Bilingual
HCA Healthcare Mission Health
Asheville , NC
2020.11 - Current
- Interview, support, and serve as advocate for patients in application process for various federal, state, and county programs such as Medicaid, Social Security, Veterans benefits, Victims of Crime, and Workers Compensation.
- Collaborate with local agencies in obtaining necessary documentation, medical records, and verification s required by respective programs.
- Act as Authorized Representative for patients and file applications on their behalf.
- Assist patients in obtaining necessary records and verifications required by agencies.
- Document all interactions with patients and collect all paperwork using computerized record keeping such as Electronic Medical Records, Cerner, OneSource, and DHHS website.
- Proficient in multiple applications used in medical billing, including EMF, Cerner, and ICD 10 coding.
- Recommend successful approaches to help resolve assignment and coverage issues.
- Serve as subject matter expert in answering questions from colleagues regarding NC Medicaid Emergency Services program.
- Work with leadership to support organization's business objectives.
- Function as main point of contact for NC Medicaid EMS program for facility Social Workers and Case Managers.
- Conduct research, gathered information from multiple sources and presented results.
- Deliver exceptional level of service to each customer by listening to concerns and answering questions.
Caretaker
Family Member With Progressive Disease
Chapel Hill , NC
2020.10 - 2021.01
- Leave of Absence: became full-time caretaker when partner received kidney transplant on 10/08/20.
- Scheduled and accompanied spouse to medical appointments.
- Administered IV medications to spouse and documented changes in condition.
- Performed basic wound care and other medical aid.
- Determined specific needs and provided most appropriate level of assistance .
- Documented residents' mental status, sleep and eating patterns.
- Recognized and reported abnormalities or changes in patients' health status to Transplant Coordinator.
- Recorded temperature, blood pressure, pulse, or respiration rate as directed by Transplant Coordinator.
- Restocked supplies and rotated items to prevent expiration of prescription medication.
- Remained alert to problems or health issues.
- Monitored and maintained cleanliness, sanitation, and organization of IV medication materials at home.
- Ran errands, did shopping, and picked up other necessities.
- Planned, prepared and served meals and snacks according to prescribed diets.
Housing Case Manager - SSVF Specialist, Case Manager /Advocate
Veterans Services of the Carolinas
Asheville , NC
2020.07 - 2020.10
- Collaborated with Veterans from initial contact to move into permanent housing.
- Assisted Veterans in obtaining household goods, food, and utility services for their permanent housing.
- Collaborated with VSQ, Pisgah Legal, County DSS, Veterans Affairs, Law enforcement, AB Tech, employers, HUD, and property management companies in securing housing.
- Served as case coordinator, assuming responsibility for assignments and guiding participants to successful completion.
- Identified care needs of individual clients and coordinated responses based on VA physician advice, insurance limitations.
- Participated in professional growth program at A-B Tech to support special education access to Veterans.
- Increased referral rates by providing excellent service and building meaningful relationships with patients and local resources.
- Managed support services and fostered communication among VA social workers, VA hospital staff and patients.
- Provided service and supportive counseling in client's native language as needed, translating and interpreting between client, and third-party entities as needed.
- Developed and implemented transition services plan to facilitate movement from homelessness to temporary/permanent housing.
- Communicated with Assistant Manager regarding issues related to case management, resourcing, service collaboration and development of new resources.
- Helped patients receive appropriate, high-quality care at VA.
- Assisted and accompanied clients and families to court, legal appointments, health care, public benefits and social or community agencies relative to client short- and long-term stabilization goals.
- Collaborated with local employers to provide jobs to Veterans.
Eligibility Advocate - Bilingual
Kemberton Healthcare Services
Hendersonville , NC
2019.10 - 2020.03
- Assisted patients in obtaining health coverage for their medical expenses.
- Interviewed patients while inpatient, outpatient, and via phone.
- Assisted patients by acting as their authorized representative and filing applications on their behalf with various government agencies.
- Completed all phases of applications for patients.
- Provided follow-up and ensured that applicants provide all necessary information to government agencies, insurance companies, or any other party with potential liability for medical expenses.
- Documented all interactions with patients and collected all paperwork using computerized record keeping.
- Identified issues with then-current financial assistance program in relation to Spanish-speaking patients.
- Worked with management in creating responsive, inclusive, diversity training for patient access staff.
Intake Specialist -Bilingual
Helpmate
Asheville , NC
2019.07 - 2019.09
- Explained eligibility requirements to County programs, application details, and applicants' legal rights during intake assessment.
- Initial point of contact for survivors of intimate partner violence seeking support from Buncombe County Family Justice Center (FJC).
- Offered compassionate and attentive guidance to patients during moments of crisis and trauma.
- Completed intake assessment forms and filed clients' charts.
- Collected, verified, recorded and processed client demographics, and referral information.
- Entered referrals into appropriate system based on type of referral obtained.
- Answered phone calls and provided new clients with required information to initiate service.
- Determined eligibility for counseling and referral for all Spanish-speaking clients.
- Determined needed and relevant interventions based on each client's cognitive abilities and current needs.
- Compiled socioeconomic data for specific program eligibility determinations.
- Coordinated referrals and direct support for survivors of intimate partner violence.
- Spoke with Spanish-speaking groups to expand community engagement and program outreach.
- Accompanied clients to law enforcement interviews, court proceedings, and to law enforcement interviews, forensic nurse visits, Magistrate's office, and court hearings.
- Assisted survivors in obtaining resources available through partner agencies at FJC: TANF, SNAP, Section 8, Public Housing, YWCA child care, etc.
- Translated and completed all court documents such as 50Bs and 50Cs for clients.
Claims Adjuster - Bilingual
State Compensation Insurance Fund, SCIF
Eureka , CA
2015.04 - 2019.02
- Processed Workers’ Compensation claims for all 19 California Department of Corrections and Rehabilitation State Prisons for both Corrections staff and inmates, CAL Fire, CA Conservation Corps, and CA Highway Patrol.
- Examined claims forms and other records to determine insurance coverage.
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Testified on behalf of agency as part of civic proceedings.
- Evaluated all evidence with ultimate goal of creating positive outcomes for client's claims.
- Established productive working relationships with public officials and law enforcement officers, corrections officers, and wardens.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Coordinated various investigations conducted by field investigation team.
- Answered questions posed by insured and attorneys.
- Compared data from surveillance footage to data on medical reports.
- Reviewed police reports, medical treatment records to determine extent of liability.
- Prepared summaries of injuries, payments and policy coverage.
- Organized, planned, and documented materials for CDCR Inmate, Corrections, and CA State Employee claims.
- Handled calls from customers and employers about claim processes.
- Followed up on potentially fraudulent claims with Legal Dept.
- Negotiated Compromise and Release settlement agreements.
- Substantiated legitimate claims and denied unjustified claims.
- Collected information from customers to complete claims and legal files.
- Maintained claims data in multiple systems.
- Examined claims forms and other records to determine insurance coverage
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims
- Reviewed police reports, medical treatment records and physical property damage to determine extent of liability
Claims Representative - Bilingual
Social Security Administration, SSA
Auburn , WA
1999.06 - 2014.10
- Interviewed clients to verify information and obtain additional details.
- Examined medical reports, billing accounts and evidence to determine integrity and accuracy of information.
- Followed up with clients on unresolved issues.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Modeled exceptional customer service skills.
- Proposed settlements for uncomplicated issues to resolve claims.
- Checked level and type of coverage for Medicare purposes.
- Modified, updated and processed existing policies.
- Acted as Medicare/End-Stage Renal Disease subject matter expert, answering internal and external questions and inquiries.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Calculated adjustments, premiums, and refunds for Medicare.
- Verified client information by analyzing existing evidence on file.
- Assured timely verification of Medicare benefits prior to patient procedures or appointments.
- Maintained confidentiality of patient finances, records and health statuses.
- Checked documentation for accuracy and validity on updated systems.
Education
No Degree - General Studies
Central Texas College
Killeen, TX07.1986
Skills
- Teambuilding
- Clerical
- Good listening skills
- Interpersonal Communication
- Critical thinking
- MS Office
- Reading comprehension
- Written Communication
- Compassion
- Organization and Time management
- Responsible
- Collaboration
- Good telephone etiquette
- Teamwork
Accomplishments
- SA Retirement, Disability, Supplemental Security Insurance, and Medicare programs.
- Certified Medical Translator 1996 - 1998: State of Texas Eligibility Specialist - Bilingual Proficient in TANF, SNAP, Homeless Assistance, General Relief, and Medicaid programs.
- Liaison between the Department of Social Services Domestic Violence Prevention Unit and Ft Hood Family Support Services.
- 1989 - 1996: County of San Diego Eligibility Specialist - Bilingual Prenatal Outreach Unit Long Term Care Specialist Hospice Specialist Homeless Assistance Program Specialist General Relief, Food Stamps Adelante Mujer Hispana SSA Certified Translator.
- I received all my training through different County, State, and Federal agencies, as part of the Spouses Employment Program that assisted military spouses in retaining employment while transferring to new duty stations with their spouses.
- I received training from the following agencies, in the following locations: Central TX College, 6200 W Central Texas Expy, Killeen, TX 76549 Copperas Cove Satellite San Diego County Training and Development: 3754 Clairemont Dr, San Diego, CA 92117 State of Texas Workforce CommissionTraining and Development, 101 East 15th St.
- Rm.
- 274 Austin, Texas 78778-0001 Social Security Administration Training and Development, 1901, C St SW, Auburn, WA 98001 State of California State Compensation Insurance Fund, 900 Corporate Center Dr, Monterey Park, CA 91754.
- Before working for the County of San Diego, I lived in Aschaffenburg Germany, where I worked for American Express Bank, AAFES, and for Stars and Stripes newspaper.
Languages
Spanish
Native or Bilingual
Timeline
Patient Benefits Advisor - Bilingual
HCA Healthcare Mission Health
2020.11 - Current
Caretaker
Family Member With Progressive Disease
2020.10 - 2021.01
Housing Case Manager - SSVF Specialist, Case Manager /Advocate
Veterans Services of the Carolinas
2020.07 - 2020.10
Eligibility Advocate - Bilingual
Kemberton Healthcare Services
2019.10 - 2020.03
Intake Specialist -Bilingual
Helpmate
2019.07 - 2019.09
Claims Adjuster - Bilingual
State Compensation Insurance Fund, SCIF
2015.04 - 2019.02
Claims Representative - Bilingual
Social Security Administration, SSA
1999.06 - 2014.10
No Degree - General Studies
Central Texas College
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