MALEEN YANG
Elk Grove,USA
Summary
Solutions-oriented and dedicated healthcare professional with extensive experience in provider network coordination, medical billing, administrative assistant, and quality assurance. Impactful professional supporting organizational values with continuous learning and professional development. Known for a strong work ethic and ability to tackle challenges effectively while enhancing operational efficiency.
Overview
10
10
years of professional experience
Work History
Provider Network Coordinator
Health Net Federal Services
Sacramento, CA
07.2022 - 01.2025
- Performed quality checks to verify the professional history and background of healthcare providers, ensuring adherence to best practices and regulatory requirements.
- Conducted comprehensive credentialing for healthcare providers, including behavioral health, ensuring compliance with state and federal regulations as well as organizational policies.
- Managed provider data collection and verification processes to enhance the accuracy and timeliness of credentialing activities.
- Conducted analysis and research to identify and recruit qualified providers for contract opportunities, expanding the network to meet evolving patient needs.
- Collaborated with medical staff and management to facilitate efficient data sharing and improve provider network management.
- Processed and managed claims submissions and resolutions for timely and accurate reimbursement.
- Monitored incoming requests from providers, ensuring prompt handling and resolution to enhance customer satisfaction.
- Maintained effective communication with providers and stakeholders to improve customer service and address questions or concerns.
- Generated regular reports for management to support decision-making related to provider network improvement and compliance.
- Negotiated contract terms and reimbursement rates with payers.
- Followed up on the status of applications for providers and payers, tracking progress on all pending and completed work.
- Submitted EFT and ERA applications to ensure electronic payments are received from payers.
- Reviewed billing to ensure compliance with payer requirements and assisted in the quality assurance review process.
Provider Network Coordinator
Wollborg Michelson Recruiting: Health Net Federal Services
Sacramento, CA
01.2022 - 07.2022
- Conduct comprehensive credentialing for healthcare providers, including verification of license, certification and professional history to ensure compliance with regulatory standards.
- Collaborate with healthcare teams to facilitate onboarding processes and maintenance efficient provider records in accordance with internal policies and procedures.
- Manage the end-to-end credentialing process, including initial applications, re-credentialing and ongoing monitoring of providers qualifications.
- Prepared documentation and reports for internal audits and regulatory reviews, supporting organization compliance efforts.
Billing Assistant
Capital Medical Extended Care
Fair Oaks, CA
08.2021 - 12.2021
- Reviewed daily encounter records for accuracy of charges, ICD-10, and CPT codes, collaborating with clinic staff and physicians to address any discrepancies.
- Analyzed rejected claims, made necessary corrections, and resubmitted or appealed claims to optimize reimbursement.
- Verified patient eligibility using Medicaid and Medicare insurance portals to ensure accurate coverage information before billing.
- Processed initial billing of claims post-service delivery, meticulously reviewing claims prior to submission to insurance providers to minimize errors.
- Utilized the Athena EMR system to effectively manage patient records and billing information.
- Accurately inputted new and updated insurance information into the system, maintaining data integrity.
- Demonstrated knowledge of Medi-Cal, Medicare, commercial payor programs, and other third-party payor programs.
- Managed filing, sorting, and retrieval of documents, including patient records and correspondence.
- Handled customer service tasks by tracking, checking, processing delinquent invoices, and issuing customer refund checks.
- Performed daily payroll functions, including the closing and balancing of payments and receipts.
- Maintained and organized daily logs of transactions for clear record-keeping.
Cal Pers Large Group Processor
Aero Tek: Blue Shield of California
Lodi, CA
08.2019 - 01.2021
- Audited member-level processing activities for Calpers, including updating demographics, processing plan changes, adding new members, and handling terminations to ensure compliance with operational standards and regulatory guidelines.
- Reviewed the accuracy and completeness of member-related documentation, specifically focusing on Calpers-related benefits, identifying discrepancies in demographic updates and plan changes, and recommending corrective actions to improve processing efficiency.
- Conducted evaluations of generated letters and communications with Calpers members regarding their employment status and benefits, ensuring clarity and compliance with organizational policies.
- Collaborated with processing teams to investigate and resolve discrepancies in Calpers member records, leading to a 20% decrease in processing errors and improved member satisfaction.
- Developed and maintained audit checklists and reporting templates specifically for Calpers auditing processes to ensure consistency and streamline evaluations.
- Assisted in training staff on quality control measures, proper documentation practices, and the importance of accurate member data management, emphasizing Calpers procedures and guidelines.
Care Giver
IHSS
Sacramento, CA
10.2018 - 09.2019
- Assisted with personal care: bathing and grooming, dressing, toileting, and exercise.
- Basic food preparation: preparing meals, shopping, housekeeping, laundry, and other errands.
Referral Authorization Coordinator
Salem Solutions: Health Net Federal services
Rancho Cordova, CA
05.2016 - 08.2018
- Assisted the utilization management team by maintaining ongoing tracking and appropriate documentation of authorizations and referrals in accordance with established policies and guidelines.
- Supported the authorization referral process by researching and documenting necessary medical information, such as patient history, diagnosis, and prognosis, to provide to the clinical reviewer for determination.
- Verified member insurance coverage and/or service/benefit eligibility using system tools, ensuring that authorization requests aligned with the guidelines for timely payment adjudication.
- Performed data entry to maintain and update various authorization requests in the utilization management system, ensuring accuracy with ICD-10, ICD-9, CPT, and HCPCS codes.
- Processed authorization requests for services in accordance with the insurance prior authorization list and routed them to the appropriate clinical reviewer.
- Handled incoming and outgoing calls to communicate with patients and providers, addressing inquiries and providing exceptional customer service.
- Generated letters and emails to communicate authorization decisions and provide additional information to relevant parties.
- Stayed up to date on healthcare authorization processes, policies, and procedures.
- Performed other duties as assigned, complying with all policies and standards.
Member Level Processor Intermediate
Volt Services Group
Rancho Cordova, CA
07.2015 - 01.2016
- Processed member applications and updates, including demographic changes, plan selections, and terminations, ensuring timely and accurate processing in compliance with organizational policies.
- Generated and issued member ID cards, ensuring that all information was accurate and delivered promptly to enhance member experience.
- Managed incoming and outgoing emails related to member inquiries, requests, and updates, providing exceptional customer service and timely responses.
- Verified Electronic Data Interchange (EDI) transactions to ensure accurate processing of member data and compliance with industry standards.
- Facilitated onboarding for new members by providing detailed information about their plans and services, enhancing overall member satisfaction.
- Created and dispatched member communication letters, including welcome packets and termination notices, ensuring clarity and adherence to compliance standards.
- Collaborated with team members to resolve processing issues and address member inquiries, contributing to a seamless and efficient member experience.
- Participated in training sessions to stay updated on Blue Shield products, services, and processing guidelines, resulting in improved service delivery.
Education
High School Diploma -
Lindhurst High School
Olive Hurst, CASkills
- Electronic Medical Records (EMR)
- Data Analysis (Microsoft Excel)
- Microsoft Outlook
- Medical Terminology
- Medicare Claims
- Credentialing specialists
- Compliance
- Database management
Timeline
Provider Network Coordinator
Health Net Federal Services
07.2022 - 01.2025
Provider Network Coordinator
Wollborg Michelson Recruiting: Health Net Federal Services
01.2022 - 07.2022
Billing Assistant
Capital Medical Extended Care
08.2021 - 12.2021
Cal Pers Large Group Processor
Aero Tek: Blue Shield of California
08.2019 - 01.2021
Care Giver
IHSS
10.2018 - 09.2019
Referral Authorization Coordinator
Salem Solutions: Health Net Federal services
05.2016 - 08.2018
Member Level Processor Intermediate
Volt Services Group
07.2015 - 01.2016
High School Diploma -
Lindhurst High School
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