Margaret Ventura
Tampa,FL
Overview
9
9
years of professional experience
Work History
Quality Documentation Specialist
Nuance Communications
08.2022 - Current
- Concurrently review and evaluate selected patient's medical records for overall quality and completeness
- Assisting in clarifying documentation regarding the patient's diagnoses and/or procedures, co-morbid conditions, complications, and other reportable data elements
- On-site support, education, and collaboration with physicians, non-physician clinicians, and coding professionals regarding documentation opportunities, and relevant quality and performance improvement opportunities.
- Reported problems and concerns to management.
- Collected and analyzed data to measure effectiveness of quality control processes.
- Developed and implemented procedures to meet product quality standards.
- Works nearly in real-time with a physician and their care team to complete documentation of clinic visits. Specialists support healthcare providers and their patients by using an emergency technology platform to complete confidential medical documentation summaries of patient encounters. Our team saves time for providers by delivering accurate documentation within hours of patient visits. Documentation includes patient histories, exams, radiographic findings, assessments, and treatment plans. Specialists make healthcare functional and efficient by allowing providers to keep their focus on their patients.
- Providing documentation coverage or a set of healthcare providers, which involves listening to audio recordings of patient clinic visits and leveraging technology to summarize medical facts in professional clinical reports (History of Present Illness, Physical Exam, Results Assessment & Plan).
Patient Care Coordinator
Sonas Home Health Care
11.2020 - 06.2022
- Using judgment and discretion, effectively schedule appropriate caregivers, based on competency, availability, and preferences, to meet home care needs for new and existing clients with minimal errors
- Maintain accurate and current client and caregiver calendars
- Assist team members in filling call-outs and last minute service requests
- Treat and communicate with clients, families, co-workers, referral sources and caregivers with courtesy, respect and consideration
- Document all pertinent interactions electronically
- Answer all client and caregiver questions and concerns in a timely and courteous manner
- Communicate schedule including openings to client, client's family and/or referral sources as soon as possible
- Follow up on all caregiver assignments immediately after services have begun, and on an ongoing basis, to ensure continuing satisfaction of clients, their families, and caregivers
- Carefully monitor client care to ensure reliability and continuity of care with minimal employee changes per client
- Provide the on-call team with all pertinent and current information
- Additionally, conducting on- call or backup to the On-Call Manager as necessary
- Review on-call report daily and follow-up as needed
- Develop long-term positive relationships with clients, caregivers and referral sources,to maintain and grow caseload
- Monitor unfilled hours, overtime, and gross margin to ensure adherence to company-wide standards
- Document missed visits weekly for any unfilled, authorized hours
- Fax to physician as applicable and processed payroll for Caregivers
- Accurately and timely process field employee payroll through daily management of EVV Exceptions
- Queue and weekly reports
- Communicate open needs to the Care Manager, Market Manager and/or recruiter and participate in recruitment planning to ensure minimal unfilled hours
- Participate in orientation of new employees
- Promptly schedule new hires with clients that fit their preferences, competency and availability
- Investigate, document and resolve all client and caregiver incidents and complaints in a timely manner in conjunction with Care Manager, Market Manager and/or Director of Nursing
- Ensure all caregivers maintain necessary credentials to remain active with the organization and scheduled with clients
- Make recommendations and provide feedback to caregivers related to recognition, pay rate changes, counseling and termination of employment within allowable parameters
- Complete caregiver performance evaluations, jointly with Care Manager, Market Manager and/or Director of Nursing
- Ensure all applicable verifications, evaluations, competences, and checks are completed timely
- Conduct administrative duties such as answering phones (preferably by the second ring), filing, ordering supplies, etc
- Assist with the implementation and execution of the emergency management plan to ensure client and caregiver safety during an emergency
- Support the office before, during and after the emergency situation as needed/instructed
- Submit all requested reports, action plans, etc
- Timely to management as requested.
- Maintained confidentiality of patient data and condition to safeguard health information.
- Acted as main point of contact for patients and nurses by closely reviewing medical charts and maintaining high levels of communication.
- Worked closely with patients to deliver excellent and direct individualized patient care.
- Upheld confidentiality requirements and regulatory compliance guidelines.
Patient Intake Specialist
CareCentrix
06.2018 - 11.2020
- The first point of contact for patients needing home healthcare services
- Responsible for receiving and responding to incoming calls from providers, referral sources and potential patients by collecting and entering clinical and demographic information into CareCentrix portal
- The intake coordinator is responsible for handling incoming calls and faxes from providers, hospital discharge planners, physicians, and patients
- Collects and enters clinical and demographic information to begin the referral process
- Gathers information using scripted clinical and non-clinical questions
- Also handles inquiry calls and questions from providers about how to use the CareCentrix provider portal Is able to provide appropriate issue resolution and/or escalation when needed
- Works under moderate supervision, with clinical oversight and input
- Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis
- Receives/responds to incoming calls from providers, referral sources, and potential patients
- Accurately enters information to begin the referral process
- Accurately records the outcome of calls in the proper screen
- Involved in the collection, verification and confirmation of non-clinical information
- Gathers structured clinical documentation
- Participates in and contributes to utilization management and performance improvement activities
- Is committed to quality and company standards
- Adheres to and participates in Company’s mandatory HIPAA privacy program / practices and Business
- Ethics and Compliance programs / practices
- Complies with Utilization Management and URAC standards
- Participates in implementing / maintaining operational processes to ensure compliance to Company policies, legal requirements and regulatory mandates
- Reviews and adheres to all Company policies and procedures and the Employee Handbook
- Participates in special projects and performs other duties as assigned
- Embraces the values of accountability, consistency, engagement, empowerment, respect and outstanding service
- This position requires excellent communication, customer service and problem solving skills, as well as, the ability to effectively interact with all levels of management and highly diverse customers
- Experience in a health care or durable medical equipment (DME) environment preferred.
Bilingual Authorization Specialist
Health Net Federal Services
01.2016 - 03.2018
- Validates Veteran and medical provider demographic information including correct selection of a medical provider by specialty for healthcare service
- Determines whether Veterans are eligible to receive health care benefits under the program by determining the patients status/eligibility, and the appropriate authorization path
- Contacts medical provider offices by telephone, schedules and cancels patient appointments, and notifies Veterans for all requests
- Follows step-by-step instructions, including redirecting Veterans to appropriate providers for care, as required by contractual standards
- Coordinates with providers new to the program to collect demographic information and establish an agreeable reimbursement rate
- Identifies, analyzes and resolves a variety of scheduling issues
- Documents transactions in authorization system and communicates via written correspondence to the Veterans Administration when needed
- Accounts accurately for personal production via a production report that
- Includes outcome data such as closed transactions, duplicative transactions and requests.
Scheduler
Eye Doctor's Optical Outlets
01.2014 - 01.2016
- Assist customers with appointing them to a provider and verifying insurances
- Attracts potential customers by answering product and service questions; suggesting information about other products and services
- Opens customer accounts by recording account information
- Maintains customer records by updating account information
- Resolves product or service problems by clarifying the customer's complaint; determining the cause of the problem; selecting and explaining the best solution to solve the problem; expediting correction or adjustment; following up to ensure resolution.
Education
Some College (No Degree) - Radiology
Hillsborough Community College
Tampa, FLDiploma -
Tampa Bay Tech High School
Tampa, FL2012
Skills
- Scheduling and verifying insurances (8 years)
- Call Center (10 years)
- Customer Service (10 years)
- Medical terminology knowledge
- Professional telephone demeanor
- Multi-line phone talent
- Decision-Making
- Excellent Communication
- MS Office
- Critical Thinking
- Dependable and Responsible
- Planning and Coordination
- Organization and Time Management
- Data Entry
- Multitasking Abilities
- First Aid/CPR
- Attention to Detail
- EHR/EMR Software Proficiency
- Employee Relations
- Timecard Management
- Meeting Deadlines
- PTO Accrual
- Daily Payroll Activities
- Payroll Processing
Languages
Spanish
Native or Bilingual
Timeline
Quality Documentation Specialist
Nuance Communications
08.2022 - Current
Patient Care Coordinator
Sonas Home Health Care
11.2020 - 06.2022
Patient Intake Specialist
CareCentrix
06.2018 - 11.2020
Bilingual Authorization Specialist
Health Net Federal Services
01.2016 - 03.2018
Scheduler
Eye Doctor's Optical Outlets
01.2014 - 01.2016
Some College (No Degree) - Radiology
Hillsborough Community College
Diploma -
Tampa Bay Tech High School