QuickCap
Mikaela Vitug
Rowland Heights
Summary
Professional Utilization Management expert prepared to excel in data coordination roles. Extensive background in managing data integrity and optimizing data workflows. Recognized for collaborative team efforts and strong commitment to achieving results. Proficient in data analysis and process improvement.
Overview
4
4
years of professional experience
Work History
UM Data Management Coordinator
Innovative Management Systems MSO
07.2024 - Current
- Enhanced data accessibility for team members through the creation of custom reports, ie. identifying Part B authorizations, urgent, and expedited referrals.
- Conducted complex data management with multiple SQL servers to track UM data.
- Ensured authorizations and UM processes are within compliance.
- Assisted in CAPs and resolutions for respective health plans and medical groups.
- Completed quality reports such as ODAGs and CMS Part C reporting.
- Submits monthly, quarterly, bi-weekly reports to medical groups and health plans.
- Trained staff, providing direct supervision, ongoing staff development and continuing education to employees regarding UM processes.
UM Coordinator
Innovative Management Systems, MSO
03.2023 - 07.2024
- Entered authorizations received via fax and email to EMR system.
- Enhanced member and provider satisfaction by responding promptly to inquiries and addressing concerns professionally.
- Played key role in ensuring authorizations are within compliance and meets CMS standards.
- Collaborated with Medical Directors and Case Managers with inpatient admissions and discharge planning.
- Reviews patient cases to determine the medical necessity of services and procedures.
Unit Secretary, Tele/Med-Surg
Garfield Medical Center
06.2022 - 09.2022
- Managed incoming calls and directed to appropriate personnel.
- Managed inventory levels of office supplies, ensuring adequate stock was available at all times for efficient unit operations.
- Supported office staff and operational requirements with administrative tasks.
- Scheduled consultations with specialists for patients needing higher level of care.
- Facilitated with charge nurse in assigning new admissions to nurses.
- Answered call lights and ensured patients receive professional care.
- Replaced tele monitors and worked hand-in-hand with CCU team in cardiac monitoring.
Site Operator
Fulgent Therapeutics
08.2021 - 03.2022
- Ensured LA county employees and students test for COVID-19 on an as-needed basis.
- Aided over 500+ LA county residents a day in scheduling appointments and taking COVID-19 test appropriately.
- Delivered test specimens to appropriate lab couriers.
- Enhanced site safety by conducting regular inspections and addressing potential hazards promptly.
- Trained new team members on site policies and procedures.
- Collaborated with management and fellow supervisors to organize operations within LA county schools and kiosks.
Education
CCS Certification - Medical Coding
Hope of St. James
Chino, CA06-2025
High School Diploma -
Rowland High School
Rowland Heights, CA05-2019
Skills
- Data quality assurance
- Teamwork and collaboration
- Attention to detail
- Organizational skills
- Analytical thinking
- SQL programming
- Data analysis
Software
SQL Servers
Crystal Reports
Excel
Timeline
UM Data Management Coordinator
Innovative Management Systems MSO
07.2024 - Current
UM Coordinator
Innovative Management Systems, MSO
03.2023 - 07.2024
Unit Secretary, Tele/Med-Surg
Garfield Medical Center
06.2022 - 09.2022
Site Operator
Fulgent Therapeutics
08.2021 - 03.2022
CCS Certification - Medical Coding
Hope of St. James
High School Diploma -
Rowland High School
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