MARTHA VALLES
Raleigh,NC
Summary
Motivated Program Supervisor adept at accomplishing program objectives through effective staff training and supervision. Prepared to apply 5 years of experience in program operations.
Overview
27
27
years of professional experience
Work History
Program Supervisor Offshore
Mercalis
Morrisville, NC
06.2022 - Current
- Provided leadership, guidance and supervision to staff members.
- Developed, implemented and evaluated program policies and procedures.
- Coordinated training sessions for staff members.
- Ensured compliance with all applicable laws, regulations, standards and codes of practice.
- Maintained accurate records of program activities and results.
- Facilitated team meetings to discuss progress on projects and initiatives.
- Developed strategies for improving program efficiency and effectiveness.
- Collaborated with other departments within the organization to ensure successful project completion.
- Served as liaison between the organization and external partners.
- Coached staff members on how best to use available resources effectively.
- Helped team members improve productivity and performance through hands-on coaching in order to achieve company objectives.
- Partnered with program management on recommendations, process improvements and corrective action plans.
- Fostered relationships to define programming needs and strengthen organizational standing.
- Delegated tasks to staff and volunteers during daily activities and organized events.
- Developed and implemented new program features to address needs.
- Consulted with staff on resolution of complex service issues.
- Established and maintained relationships to meet community needs and avoid service duplication.
- Implemented and evaluated staff, volunteer or training programs.
Program Supervisor
Trial Card/Mercalis
Morrisville, NC
01.2019 - 06.2022
- Provided training for agents to perform benefit investigations.
- Reviewed and ensured the accuracy of completed benefit verifications.
- Ensured the completion of daily goals by effectively managing assigned tasks.
- Maintained high level of ethical conduct in protecting patient health information.
- Provided assistance to agents in accurately completing benefit investigations by addressing reimbursement inquiries
- Provided guidance and assistance to agents in enhancing productivity and performance
- Verified and authorized agents' time sheets.
- Provided guidance and support to agents in enhancing performance
- Facilitated effective communication between team members and program manager
- Regularly implemented quality assurance measures through reviews, meetings, and reports
- Provided weekly updates on team productivity statistics to program manager.
- Provided leadership, guidance and supervision to staff members.
- Developed, implemented and assessed program policies and procedures
- Conducted annual performance reviews of staff members.
- Coordinated training sessions for staff members.
- Ensured compliance with all applicable laws, regulations, standards and codes of practice.
- Facilitated team meetings to discuss progress on projects and initiatives.
- Developed strategies for improving program efficiency and effectiveness.
- Collaborated with other departments within the organization to ensure successful project completion.
- Coached staff members on how best to use available resources effectively.
- Helped team members improve productivity and performance through hands-on coaching in order to achieve company objectives.
- Partnered with program management on recommendations, process improvements and corrective action plans.
- Analyzed program effectiveness to optimize workflows.
- Fostered relationships to define programming needs and strengthen organizational standing.
- Established and maintained operations of Reimbursement program.
- Delegated tasks to staff and volunteers during daily activities and organized events.
- Explained program offerings and requirements to participants and answered related questions.
- Facilitated program development and launch via strategic resources allocation.
- Recruited, interviewed and hired volunteers and staff.
Reimbursement Specialist – Team Lead
Aerotek / Trial Card
Morrisville, NC
07.2018 - 01.2019
- Performed thorough investigations of Medical and Pharmacy coverage
- Ensured accurate review of accounts for insurance and patient follow-up
- Facilitated contact with insurance providers to ascertain insurance benefits, as well as persistently followed up on Prior Authorizations and Appeals.
- Work closely with Patient Care Coordinators to serve as an advocate to patients and health care professionals re: coverage, medical billing, and the reimbursement process
- Maintained high level of ethical conduct regarding confidentiality and privacy of patient health information
- Provide assistance to agents in accurately completing benefit investigations by addressing reimbursement inquiries
- Assigned and ensured completion of daily tasks to meet goals.
- Participated in and conducted team meetings when required
- Verified accuracy of completed benefit verifications.
- Analyzed patient data to ensure reimbursement information is accurate.
- Ensured alignment of provider documentation with insurance plan requirements.
- Identified potential areas of cost savings through proactive analysis of billing practices.
- Provided training to new staff on the proper submission process for reimbursement requests.
- Investigated complex cases involving multiple providers or incorrect coding issues.
- Collaborated with other departments within the organization to coordinate activities related to reimbursements.
Compliance Administrator
Legacy Healthcare Services
Raleigh, NC
11.2013 - 07.2018
- Coordinated organization of medical records for Medicare appeals
- Streamlined administrative processes through effective handling of faxing, scanning, and copying duties for medical claims
- Contacted insurance companies regarding appeal statuses
- Created and compiled appeal packets for mailing.
- Prepared detailed reports outlining findings from internal audits of compliance programs.
- Ensured that all necessary forms are completed accurately prior to submission.
Assistant Office Manager/Medical Assistant/Extern
Dr. Ricardo Matienzo, General Family Practitioner
Hoboken, NJ
03.2003 - 08.2013
- Monitored and recorded patients’ vital signs
- Performed EKG's
- Successfully processed insurance claims
- Provided efficient telephone response, answering calls within a short timeframe.
- Supported Physician in providing quality patient care
- Maintained efficient system for managing patient records
- Performed injection administration
- Coordinated and organized appointment schedules
- Successfully completed new patient registrations
- Ensured accuracy of insurance benefit verification
- Maintained accurate and up-to-date filing system for medical documents
- Facilitate the acquisition of pre-certification requests for medical tests and medications
- Managed financial transactions involving co-payments, deductibles, co-insurances and patient debts
- Consistently keeping up with the necessary updates to ensure Doctor certifications are current
- Maintained a calendar of events, meetings, conferences, appointments.
- Assisted in the preparation of presentations and other documents as needed.
- Processed invoices from vendors in an accurate and timely manner.
- Tracked employee attendance records and vacation requests.
- Ensured compliance with company policies and procedures regarding security, confidentiality and data protection measures.
- Monitored inventory levels of office supplies; placed orders when necessary.
- Prepared payroll information for submission to external payroll services provider.
- Scheduled job interviews with potential candidates upon request.
- Provided technical assistance related to computer applications used by the organization.
- Managed office operations and procedures to ensure organizational effectiveness, efficiency and safety.
- Developed, implemented and maintained systems for the filing of records, reports and documents.
- Organized travel arrangements for staff members as requested.
- Responded promptly to customer inquiries via phone or email.
- Coordinated with vendors for office supplies and equipment maintenance.
Public Health Assistant
NYC Department of Health
Brooklyn, NY
06.1997 - 03.2003
- Maintained all student’s medical records
- Planned and scheduled physical examinations
- Assisted Doctors with physical examinations
- Administered first aid as necessary
- Contacted parents to discuss child’s needs.
Education
Bachelor’s Degree in Health Administration -
Phoenix University
02.2021
Obtained credits towards an Associates in Science Cooperative Nursing Degree -
Hudson County Community College
12.2012
Associates Degree in Health Administration -
Western International University
03.2007
Medical Assistant Diploma -
The Cittone Institute
05.2004
Skills
- Bilingual (Spanish/English)
- Proficient in Microsoft Office
- Knowledgeable in Salesforce
- Staff training experience
- Staff Development
- Team Oversight
Certifications Affiliations
- ECG Certification
- Registered Medical Assistant
- Nurse Technician Certificate
- Affiliated with the American Medical Technologists Association
- CPR and First Aid Certified
Languages
English
Native/ Bilingual
Spanish
Native/ Bilingual
References
References available upon request.
Timeline
Program Supervisor Offshore
Mercalis
06.2022 - Current
Program Supervisor
Trial Card/Mercalis
01.2019 - 06.2022
Reimbursement Specialist – Team Lead
Aerotek / Trial Card
07.2018 - 01.2019
Compliance Administrator
Legacy Healthcare Services
11.2013 - 07.2018
Assistant Office Manager/Medical Assistant/Extern
Dr. Ricardo Matienzo, General Family Practitioner
03.2003 - 08.2013
Public Health Assistant
NYC Department of Health
06.1997 - 03.2003
Bachelor’s Degree in Health Administration -
Phoenix University
Obtained credits towards an Associates in Science Cooperative Nursing Degree -
Hudson County Community College
Associates Degree in Health Administration -
Western International University
Medical Assistant Diploma -
The Cittone Institute