Hi, I’m
Maria Rodriguez
Winter Haven ,FL
Summary
Healthcare management professional with comprehensive experience in overseeing healthcare operations and driving quality patient care. Strong focus on fostering team collaboration and achieving optimal results. Known for adaptability, reliability, and strategic leadership. Skilled in healthcare administration, process improvement, and regulatory compliance, with commitment to enhancing both patient and staff satisfaction.
Overview
16
years of professional experience
Work History
Devoted
Transitions of Care Guide
03.2024 - Current
Job overview
- Participating in and assisting with pilot programs
- Coordinating with medical providers and facilities to access necessary discharge records
- Following escalation processes to clinical team to ensure members get needed evaluation and care
- Trained new guides on company policies, procedures, and best practices, leading to consistently high-quality across the team.
- Utilized effective communication and problem-solving skills to quickly resolve customer issues.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Enhanced customer satisfaction by addressing and resolving complex inquiries in both English and Spanish languages.
- Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
- Managed difficult conversations with compassion and professionalism, helping deescalate tense situations while maintaining a focus on finding resolutions.
- Maintained accurate records of customer interactions, ensuring proper documentation within the company's database.
- Developed strong relationships with clients by providing empathetic support and understanding during challenging health situations.
- Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures.
- Promoted a positive work environment through active participation in team meetings and contributing ideas for organizational success.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Investigated and resolved accounting, service and delivery concerns.
- Cross-trained and provided backup support for organizational leadership.
- Identified and resolved discrepancies and errors in customer accounts.
- Guided groups of up to 30 people
Devoted Health
Agent Support Associate
05.2023 - 03.2024
Job overview
- Company Overview: (Supporting the core values of the Devoted health plan by treating the agent and members like family)
- Team player assisting in closing out cases
- Assisting agents in the process of submitting their enrollment applications managing about 40 to 70 calls and cases a day
- Assist during high call volumes during annual enrollment period and open enrollment period
- Used resources and slack channel to support the agents with accurate information
- Checking eligibility for Medicaid and Medicare
- Assist agents in both English and Spanish language
- Warm transfer calls to member services team
- Assist utilizing tools guiding the agents to learn how to navigate plans and other valuable information
- Licensing and preparation for certifications
- Updating emails and resetting passwords
- Troubleshooting technical issues
- Agent portal navigation
- Commissions inquiries
- Outreach cases following up pending incomplete applications
- Formulary dental, medical, Durable medical equipment, over the counter, provider search and many other inquiries
- (Supporting the core values of the Devoted health plan by treating the agent and members like family)
- Informed clients of policies and procedures.
- Maintained accurate records of client communications, transactions, policies, and other relevant documentation for seamless operations within the agency.
- Delivered exceptional customer service by proactively addressing concerns and fostering a positive experience throughout all interactions.
- Facilitated training sessions for new agents, elevating overall team performance.
- Consistently met or exceeded performance metrics, showcasing dedication to providing exceptional support services.
- Consistently received positive feedback from both patients and colleagues alike due to strong work ethic, professionalism, and commitment to quality care.
- Educated clients about health insurance coverage options, benefits and costs.
Devoted Health
Member Service Guide
06.2022 - 05.2023
Job overview
- Company Overview: (Supporting the core values of the Devoted health plan by treating the members like family)
- Team player assisting in closing out cases
- Completed outreach calls to complete surveys, continuity of care, transitions, health risk assessments
- Assisted DMG routing the calls to the appropriate lines or team members
- Created necessary cases to build the trust of the members as a problem solver with the help of a team
- Obtaining prior authorization, referrals, orders from primary care doctors
- Scheduled appointments for the members when necessary to fit their needs
- Worked open cases to help ease the members concerns by providing accurate information
- Translated all benefit inquiries or concerns to the member following EOC
- Ordered or checked the status of Durable Medical Equipment when necessary for the member or representatives
- Accepted warm transfers up-tiered calls from Tier 1 guides or any other team with complex calls
- Treated irate members with professionalism
- Deescalating the members throughout the call with success while finding the best solution
- Assisted with copays, premiums, late enrollment penalties
- Educated the members in understanding their evidence of coverage to better explain any bill inquiries
- Emailed necessary documents to the member to assist the member of representative
- Paid attention to detail while keeping accurate documentation in cooperation with CMS guidelines
- Showing to work timely, reliably, trustworthy following all metrics to meet all expectations
- Assisting members with balance billing issues and providers by submitting the claim with proper coding
- Provided information on denied claims for post appeal instructions
- Followed Org D instructions to file on behalf of the member
- Filed grievances when necessary and closed as FCR as first goal
- Constructive feedback helped achieve smart goals rapidly which I adjusted quickly to those changes
- Answered 30 to 40 calls a day
- (Supporting the core values of the Devoted health plan by treating the members like family)
- Built personal relationships with guests to promote positive experiences.
- Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
- Increased first-call resolution rates by carefully listening to customers'' needs and providing accurate information based on their inquiries.
- Developed strong relationships with clients by providing empathetic support and understanding during challenging health situations.
- Delivered exceptional support during high call volume periods by maintaining composure and professionalism under pressure.
- Investigated and resolved customer inquiries and complaints quickly.
- Exhibited high energy and professionalism when dealing with clients and staff.
- Investigated and resolved accounting, service and delivery concerns.
- Implemented and developed customer service training processes.
- Increased efficiency and team productivity by promoting operational best practices.
Righteous Clinic
Medical Records and Health Information Technician
06.2021 - 06.2022
Job overview
- Downloading all medical records and uploading to the patients charts
- Managed an average load of 100 to 300 records a day
- Sending out records ROI to designated providers and patients that are requesting records
- Reviewed Medical records to correct errors
- Requesting outside records for new and established patients
- Attaching and assigning Diagnosis, lab, test results, procedures, progress notes
- Utilized E-clinical medical software
- Team player
- Handling records in a timely manner by prioritizing and organizing
- Acted as a liaison between departments, coordinating efforts to achieve efficient interdepartmental communication concerning health information management.
- Trained fellow technicians on best practices for managing health information, fostering a high-performance team environment.
- Managed the release of information process, safeguarding sensitive patient data while adhering to legal requirements.
- Implemented quality control measures within the department, resulting in improved accuracy rates in medical record keeping.
- Assisted healthcare providers with timely access to accurate medical records, contributing to better patient outcomes.
- Ensured compliance with HIPAA regulations through diligent management of confidential patient data.
- Reduced errors in coding diagnoses and procedures by meticulously reviewing medical records for accuracy.
- Conducted regular audits of medical records to identify discrepancies and areas for improvement in documentation practices.
- Established and maintained strong relationships with external vendors, ensuring smooth operations within the department.
- Maintained confidentiality of all medical records and sensitive information to comply with HIPAA regulations.
- Reviewed charts and flagged incomplete or inaccurate information.
- Maintained patient records systems by archiving, scanning and indexing important documents and files.
- Assisted in preparation of medical records to release to other medical facilities requesting for patient history and information.
- Assisted in training new staff on medical record processing and filing procedures.
- Enhanced patient care by accurately organizing and maintaining medical records and health information.
Gessler Clinic P.A
Medical Secretary
05.2018 - 06.2018
Job overview
- Schedule appointments, Schedule tests, Order labs, Sent in electronic prescriptions managing 100 calls a day in between tasks
- Printed controlled substances while verifying on Eforce
- Referral, paperwork, respond to urgent tasks, request authorizations for prescriptions
- Excellent customer service to patients in person and handling high call volume
- Deliver tape to the transcriptionist and request Jury duty letters to excuse patients
- Verify patient charts, updating information and making sound decisions with minimal supervision
- Distributing correspondence through interoffice mail
- Screened emergency calls to advise patients how to proceed further with health needs
- Trained new employees
- Billing
- Medical collection
- Assisted medical assistants with home tests
- Lab orders, medical equipment orders, home health, scheduling specialist appointments and all types of tests
- Contributed to smooth daily clinic operations by managing telephone lines, directing calls appropriately and taking detailed messages when needed.
- Supported overall patient care by maintaining a clean and organized office environment, prioritizing safety and infection control measures.
- Organized diagnostic test results for easy access by healthcare providers during patient consultations or rounds.
- Managed sensitive patient data securely, maintaining strict compliance with HIPAA regulations.
- Served as liaison between healthcare providers and patients'' families, ensuring clear communication regarding treatment plans and progress updates.
- Trained new administrative staff members in proper procedures and protocols, ensuring consistent quality of service for patients.
- Processed prescription refill requests efficiently, verifying accuracy of information before forwarding to the appropriate physician for approval.
- Maintained current and accurate medical records for patients.
- Supported office staff and operational requirements with administrative tasks.
- Used knowledge of medical terminology to transcribe patient information from written copy, electronic equipment, or verbal direction.
- Prepared and processed patient referrals and transfer requests.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Conducted patient intake interviews, recording and documenting relevant information.
American Care Medical Center
Office Manager Assistant/Telemedicine
02.2016 - 04.2018
Job overview
- Answer phones, Patient Registration, Insurance verification using a wide variety of health plan carriers
- Prevented hospitalization, referral information, scheduled appointments, scheduled transportation, checked in/checked out patients, uploading medical records, collected payments, posted payments, requested medical records, entered charges, medical software IPHES, called in prescriptions and dispense from an in-house pharmacy
- Update Demographics, Update Insurance, Renew benefits through DCF
- Fixed employees time clock hours
- Assisted manager with projects and scheduling meetings
- Managed two offices with over 50 employees
- Uploaded medical records
- Audited charts for accuracy of information labeling and providers
- Medical collection
- Project management
- Participated in sales
- Case management
- Coordinating long term care
- Assisted RN with Telemedicine physicians with dispensing medications from the apothecary in house pharmacy
- Connected patient and doctor via telemedicine after taking vitals
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
- Scheduled surgeries, managed pre-certifications and verified insurance coverage.
- Developed policies and procedures aligned with organizational goals while prioritizing patient-centered care.
- Enhanced quality of care by establishing and monitoring performance metrics for staff members.
- Implemented successful healthcare program through professionalism, quality of care, medical teaching and patient satisfaction.
- Defined testing protocols, quality assurance initiatives and clinic policies and procedures.
- Designed and introduced leadership development, coaching and team management model, resulting in promotion of employees into increased levels of responsibility.
Medical Providers Network
Healthcare Manager
12.2008 - 01.2016
Job overview
- Skillfully developed departmental goals, objectives, standards of performance, policies, and procedures
- Worked with department heads, staff, and faculty to develop engaging curriculum and advance instruction for all nursing programs
- Provide excellent customer service to both providers and members constantly meet established productivity schedule adherence quality standards while maintaining good attendance
- Established for the position in the areas of efficiency, call quality, customer satisfaction, first call resolution and attendance
- Data collection
- Onboarding new hires
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to over 50 employees.
- Designed and introduced leadership development, coaching and team management model, resulting in promotion of employees into increased levels of responsibility.
- Oversaw regulatory compliance initiatives, maintaining a safe environment for patients and staff members alike.
- Championed initiatives focused on improving staff morale, resulting in enhanced productivity and job satisfaction among team members.
- Led successful accreditation efforts, ensuring adherence to industry best practices and regulatory requirements throughout the organization.
- Streamlined administrative tasks for increased efficiency in daily operations.
- Implemented innovative solutions for complex healthcare challenges, improving overall service delivery.
- Enhanced quality of care by establishing and monitoring performance metrics for staff members.
- Improved patient satisfaction by implementing efficient healthcare management processes and procedures.
- Communicated with patients, ensuring that medical information was kept private.
- Liaised with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care.
Education
Colorado Technical UniversityColorado Springs, CO
Bachelor of Science from Healthcare Management
01-2022
Southern Technical CollegeAuburndale FL
Associate of Science from Medical Office Administration
02-2016
Everest University Lakeland FL
Associate of Science from Billing And Coding
05-2009
Skills
- Route navigation
- Expert communication
- Social perceptiveness
- Strong leadership
- Cultural sensitivity
- Public speaking
- Presentation skills
- Team building
- Team rapport
- Time management
- Staff management
- Engaging personality
Languages
English
Spanish
Timeline
Transitions of Care Guide
Devoted
03.2024 - Current
Agent Support Associate
Devoted Health
05.2023 - 03.2024
Member Service Guide
Devoted Health
06.2022 - 05.2023
Medical Records and Health Information Technician
Righteous Clinic
06.2021 - 06.2022
Medical Secretary
Gessler Clinic P.A
05.2018 - 06.2018
Office Manager Assistant/Telemedicine
American Care Medical Center
02.2016 - 04.2018
Healthcare Manager
Medical Providers Network
12.2008 - 01.2016
Colorado Technical University
Bachelor of Science from Healthcare Management
Southern Technical College
Associate of Science from Medical Office Administration
Everest University
Associate of Science from Billing And Coding
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