Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Maria Angeles

San Antonio,TX

Summary

Proficient and caring nursing team member offering outstanding patient-facing experience. Adept at addressing patient and family needs with compassionate care and attention to detail. Diligent about maximizing satisfaction, safety and wellness while serving patients of all backgrounds.

Overview

14
14
years of professional experience
1
1
Certification

Work History

UM Quality Review Nurse

Gonzaba Medical Group
05.2023 - Current
  • Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
  • Performed prior authorization review of services requiring notification.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
  • Supported revenue cycle management through diligent monitoring of claims submissions, denials, and appeals.
  • Provided support during external audits conducted by governmental agencies or third-party payers, ensuring timely completion and submission of required documentation.
  • Prepared detailed reports outlining audit findings; communicated results to stakeholders promptly for prompt resolution of issues identified during audits.
  • Prepared working papers, reports and supporting documentation for audit findings.
  • Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
  • Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
  • Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
  • Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
  • Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.

Health Center Manager

Cano Health Group
02.2023 - 05.2023
  • Directed internal practice operations; created benchmarks, tracked and reported progress, researched process improvements/efficiencies, and recommended and implemented changes.
  • Worked with the Medical Director, practice supervisors, and the Regional Director, to ensure that associates were of the appropriate number and mix of competencies, skill levels, educational and experiential backgrounds, and other qualifications.
  • Worked with staff supervisors, Medical Director, and HR to address personnel issues.
  • Worked respectfully and cooperatively with management, 3staff, patients, and vendors; handling escalated patient and staff issues as needed.
  • Attended Divisional Operating Team and Practice Manager meetings, and others as required.
  • Monitored monthly statistical reports and practice trends and developed action plans accordingly.
  • Maintained complete office services knowledge and used all relevant office equipment, computer, and manual systems.
  • Maintained strict patient and associate confidentiality in compliance with HIPAA guidelines.
  • Reviewed practice risk assessment regularly reported any issues and ensured the clinic’s practice's compliance with federal, state, and safety regulations.
  • Accountable for ensuring compliance with patient and staff safety regulations.
  • Was responsible for ongoing professional development – maintaining appropriate licensure/certification and continuing education credentials and participating in available learning opportunities.
  • Maintained knowledge of and complies with standards, policies, and procedures, including the Associate Handbook.
  • Met regularly with practice providers to review material from Operating Team meetings, and financials including provider productivity, and to review progress on goals and work plans.
  • Managed practice staff - hiring, training, supervising, evaluating, disciplining, and terminating.
  • Organized and implemented orientation and training programs for all new staff and providers under the guidance of the Medical Director.
  • Promoted educational opportunities for staff and providers.
  • Ensured the patient satisfaction scores related to the office demonstrated continuous improvement.
  • Reviewed annual staff and provider satisfaction reports with the Medical Director, office leadership, providers, and staff; Developed, implemented, and monitored ongoing improvement plans.
  • Collaborated with multi-disciplinary staff to improve overall patient care and response times.
  • Communicated with patients with compassion while keeping medical information private.
  • Built work schedules and staff assignments, taking workload, space, and equipment availability into consideration.
  • Maintained records management system to process personnel information and produce reports.
  • Recruited, hired, and trained new medical and facility staff.
  • Established solid relations with leadership and staff by attending board meetings and coordinating interdepartmental information exchanges.
  • Maintained awareness of government regulations, health insurance changes, and financing options.
  • Directed, supervised, and evaluated medical, clerical, or maintenance personnel.
  • Coordinated work activities and scheduling of medical, nursing, and physical staff.
  • Assessed the need for additional staff, equipment, and services based on historical data and seasonal trends.
  • Administered fiscal operations for accounting, budget planning, authorizing expenditures, and coordinating reporting.

Referrals Manager

Cano Health Group
04.2022 - 12.2022
  • Care coordination
  • Oversaw and managed the referral and medical records department in the Texas region
  • Responsible for the accuracy, completeness, confidentiality, and security of all healthcare information
  • Understanding of HIPAA guidelines and the Health Information Management process
  • Managed and motivated employees to be productive and engaged in work.
  • As Manager I oversaw activities related to staffing, hiring, orientating, evaluating, coaching, training continuing education, and disciplinary actions with associates, providers, and clinic staff.
  • Monitored staff performance and addressed issues.
  • Enforced customer service standards and resolved customer problems to uphold quality service.
  • Trained employees on additional job positions to maintain coverage of roles.
  • Exercised good judgment and decision-making in escalating concerns and resolving issues.
  • Assigned tasks to associates to fit skill levels and maximize team performance.
  • Recruited and hired qualified candidates to fill open positions.
  • Enhanced team member performance through use of strategic and tactical approaches, motivational coaching and training.
  • Led team meetings and one-on-one coaching sessions to continuously improve performance.
  • Entered time and attendance logs in preparation for payroll.
  • Leveraged leadership skills to identify deficiencies and opportunities to improve policies, procedures and controls.
  • Conducted quality, timely performance feedback and performance appraisals.
  • Maintained adequate staffing to meet objectives within budget.
  • Minimized staff turnover through appropriate selection, orientation and training.

Clinic LVN

Wellmed Medical Group At SW Military
01.2017 - 04.2022
  • Performed all nursing duties within the scope of an LVN as determined by the TX BON
  • Enhanced clinic efficiency by assisting in the coordination of patient appointments and scheduling.
  • Assisted physician in taking patient health histories, taking vitals, and aided in procedures
  • Performed medication reconciliations and notified providers of changes in a patient’s health condition
  • Collected data as part of nursing assessment, coordinated patient care with providers, generated referrals, and reviewed patient charts
  • Maintained strict member and company confidentiality
  • Had a leadership role as a team lead
  • Assisted in STAR ratings and HEDIS measures with prevention and screening of chronic care conditions such as medication adherence, BMI, cholesterol, and colorectal screening.
  • Charted changes in patient conditions and discussed concerns with the supervising healthcare provider.
  • Addressed patient care needs, collected vitals, dressed wounds, and managed catheters.
  • Observed strict confidentiality and safeguarded all patient-related information.
  • Answered patient calls, identified issues, and determined how best to assist within parameters established by the facility and supervisor.
  • Administered prescribed medications and started intravenous fluids to address patient symptoms and underlying etiologies.
  • Directed implementation of improved patient care and documentation methods and procedures to achieve quality objectives.
  • Collected biological samples for routine laboratory testing to assist diagnostic processes.
  • Kept EHR updated with patients' vital statistics, tracking metrics,, and observations about behaviors or responses.
  • Coordinated with doctors and registered nurses to develop care plans for patients.
  • Monitored patient's respiration activity, blood pressure,, and blood glucose levels in response to medical administration.
  • Answered patient and family questions to educate them on optimal treatment procedures.
  • Communicated concerns regarding patients' status, and care to nursing supervisors, clinical care supervisors, and case managers.
  • Looked for physical, emotional and symptomatic changes in patient condition and obtained necessary care for medical concerns.
  • Collected and documented vital signs to track current patient conditions.
  • Administered prescribed medications or started intravenous fluids, noting times and amounts on patient charts.
  • Prevented drug interactions and contributed to correct diagnosis by recording patient health information, monitoring vitals and updating patient files.
  • Interviewed patients to obtain medical history.
  • Promoted culture of safety for patients and employees through proper identification, reporting documentation and prevention.
  • Used sterile techniques to prepare patients for procedures.

Outpatient Case Manager

Gonzaba Medical Group
09.2015 - 01.2017
  • Maintained an accurate database of complex care patients
  • Reviewed high-risk census weekly to ensure it reflected appropriate high-risk patients
  • Enhanced patient care by developing and implementing individualized treatment plans in collaboration with healthcare professionals.
  • Arranged appropriate acute care and follow-up care with PCP, Intake, and other GMG Providers or Preferred Providers
  • Kept PCP, clinical, and complex care team members informed of pertinent findings/issues.
  • Looked for physical, emotional and symptomatic changes in patient condition and obtained necessary care for medical concerns.
  • Coordinated with doctors and registered nurses to develop care plans for patients.
  • Communicated concerns regarding patients' status, care and environment to nursing supervisors, clinical care supervisors and case managers.
  • Answered patient and family questions to educate on optimal treatment procedures.
  • Interviewed patients to obtain medical history.
  • Promoted culture of safety for patients and employees through proper identification, reporting documentation and prevention.
  • Charted changes in patient conditions and discussed concerns with supervising healthcare provider.
  • Documented patient medical histories, current symptoms and vitals.
  • Observed strict confidentiality and safeguarded all patient-related information.
  • Answered patient calls, identified issues and determined how best to provide assistance within parameters established by facility and supervisor.
  • Communicated with patients with compassion while keeping medical information private.
  • Worked with social workers, physical therapists and speech therapists to assess patient needs, plan and adjust plans of care and actualize nursing interventions to promote and restore patient health.
  • Communicated effectively with patients and loved ones to explain diagnoses, treatment options and procedures.
  • Answered patients' calls to determine how to assist.
  • Evaluated nursing intervention outcomes by conferring with other healthcare team members.
  • Collaborated with multi-disciplinary staff to improve overall patient care and response times.
  • Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
  • Counseled clients, patients and families and provided emotional and psychosocial support.

Triage Nurse

Methodist Healthcaere Ministries
04.2013 - 09.2015
  • Assess patient needs using established triage protocols
  • Maintained accurate patient records, ensuring thorough documentation of triage assessments and treatment plans.
  • Document all encounters in EMR
  • Maintain quality control standards
  • Perform all other related duties as assigned
  • Assisted physician in taking patient health histories, taking vitals, and aided in procedures
  • I performed medication reconciliations and notified providers of changes in a patient’s health condition
  • Collected data as part of nursing assessment, coordinated patient care with providers, generated referrals, and reviewed patient charts
  • Maintained strict member and company confidentiality
  • Had a leadership role as a team lead.
  • Answered incoming patient calls, gathering history and symptoms to determine scope of medical complaints.
  • Assessed patient needs, prioritized treatment, maintained patient flows and assisted physicians with non-invasive procedures.
  • Collected data to represent symptom onset, presenting problem and medical diagnoses.
  • Communicated triage information to primary care team to discuss disposition.
  • Maintained confidentiality in matters related to patient, family and client facility staff.
  • Documented services discussed and provided details in electronic medical records.
  • Reviewed medical chart and requested appointments, prescriptions and consultations for urgent needs.
  • Analyzed discussed symptoms with established protocols to determine patient acuity.
  • Educated patients relative to health care urgency and community resources available to meet needs.
  • Cultivated professional conduct operating under triage nursing care guidelines.
  • Administered oral, IV and intra-muscular medications and monitored patient reactions.
  • Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
  • Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
  • Observed strict safety measures, including checking medication dosages before administration to patients.
  • Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
  • Coordinated with healthcare team to establish, enact and evaluate patient care plans.
  • Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
  • Delivered information regarding care and medications to patients and caregivers in comprehendible terminology.
  • Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
  • Prepared medical equipment and tools to aid physician during examination and treatment of patients.
  • Stocked clinical workstations and procedure rooms with necessary supplies.
  • Referred patients to specialized health resources or community agencies to furnish additional assistance.
  • Collaborated with health groups to plan or implement programs designed to improve overall health of communities.
  • Conducted specified laboratory tests to help detect conditions and determine diagnosis.

Non-Clinical Case Manager

Patient Advocate Foundation
12.2011 - 02.2013
  • Assisted patients in securing funds for medications, chemotherapy treatments, outstanding medical bills, and/or household bills
  • Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
  • Researched insurance denials and initiated appeals on the patient’s behalf.
  • Provided case management services including intake, assessment, crisis intervention, advocacy, referral and monitoring of families.
  • Maintained up-to-date case records with case activity status.
  • Adhered to ethical principles and standards to protect clients' confidential information.
  • Maintained logs and electronic client records following department and agency policies for effective monitoring.
  • Linked clients with social services, health care providers and governmental agencies to help claim or reclaim individual autonomy.
  • Assisted individuals with eligibility for available benefits.
  • Participated in regular team meetings and in-house training sessions to boost group effectiveness.
  • Coordinated support services and optimized communication between healthcare workers and patients.
  • Educated clients on options to assist in making informed decisions.
  • Advocated for clients to resolve medical or personal crises.

Denial Specialist

Wellmed Medical Management
04.2010 - 12.2011
  • Adjudicated claims appropriately per contract or stand processing guidelines which include appropriate coding of CPT and ICD codes against charges that are being billed and entered
  • Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
  • Reviewed referrals to determine approval, modification, or denial of services
  • Assured that utilization of referrals was completed within proper timeframes
  • Consulted with the medical director for all possible denials of referrals within the required timeframe
  • Knowledge and understanding of CMS-Medicare guidelines.
  • Input claim information and payments into company database.
  • Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
  • Investigated potentially fraudulent claims with focus on thoroughness, quality and cost control.
  • Reduced loss ratios through fair and prompt processing of claims.

Education

Diploma - Vocational Nursing

Kaplan College
San Antonio, TX
04.2010

High School Diploma -

Oliver W. Holmes High School
San Antonio, TX
12.1994

Skills

  • HIPAA compliance
  • Electronic Medical Record software
  • Knowledgeable with CPT/ICD-10 coding
  • HEDIS measures; Star rating, CMS guidelines
  • Time Management
  • Process Implementation
  • Employee Performance Evaluations
  • Interdepartmental Functions Coordination
  • Employee Supervision, recruitment, and hiring
  • Problem Identification
  • Claims review & audits of authorizations
  • Direct Patient Care, and patient education
  • Managing deadlines

Certification

  • Licensed Vocational Nurse - 2010 to Current
  • CPR Certified, BLS - Current

Timeline

UM Quality Review Nurse

Gonzaba Medical Group
05.2023 - Current

Health Center Manager

Cano Health Group
02.2023 - 05.2023

Referrals Manager

Cano Health Group
04.2022 - 12.2022

Clinic LVN

Wellmed Medical Group At SW Military
01.2017 - 04.2022

Outpatient Case Manager

Gonzaba Medical Group
09.2015 - 01.2017

Triage Nurse

Methodist Healthcaere Ministries
04.2013 - 09.2015

Non-Clinical Case Manager

Patient Advocate Foundation
12.2011 - 02.2013

Denial Specialist

Wellmed Medical Management
04.2010 - 12.2011

Diploma - Vocational Nursing

Kaplan College

High School Diploma -

Oliver W. Holmes High School

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