Milagro Ramirez Cruz
Sacramento,CA
Summary
Experienced Patient Care Coordinator proficient in directing patient care programs that are both high-quality and efficient.
Accomplished and self-motivated Call Center Representative versed in customer support in a fast-paced, team-based healthcare environment. Superior computer skills and telephone etiquette. Successful at building long term relationships with customers and delivering positive experiences through high-quality customer care. Seeking an opportunity that will allow my excellent analytical ability, effective communication and collaborative leadership skills to benefit the organization
Overview
6
6
years of professional experience
Work History
Associate Patient Care Coordinator
SCA
Sacramento, California
09.2024 - Current
- Take inbound calls from patients and make outbound calls to patients
- Provide one call resolution to patient inquires whenever possible and perform timely follow up
- on inquiries requiring escalation or additional research
- Follow up on all patient voicemails within 24 hours
- Provide patient education regarding how to understand their Explanation of Benefits (EOB)
- Take payments from patients
- Provide requested documentation and records
- Consistently achieve defined metrics
- Read and understand contracts with Insurance companies
- Review and determine if an adjustment is required on an account
- Review and determine if a refund is required on an account
- Verify insurance
- Provide patient estimates
- Verify and update demographic information
- Research and locate missing payments
- Review clinical information to determine if a coding review is required
Patient Advocate
Centen
Sacramento, California
11.2021 - 01.2024
- Review, investigate and track all Medicare grievances, appeals, and provider claims disputes submitted, and pursue formal resolution for members and providers within required guidelines
- Screen all incoming grievances, appeals and provider claim dispute to ensure they are in compliance with CMS guidelines and the corporation’s policies
- Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
- Prepare response letters for member and provider complaints, grievances and appeals
- Conduct grievance and appeal investigations and provider claim dispute investigations through internal and external interviews, chart and contract audits, inspection, and interpretations of appropriate CMS guidance and policies
- Maintain files on individual appeals and grievance cases
- Manage the corporation’s grievance and appeals database
- Coordinate with all relevant departments to streamline the appeals and grievance processes
- Help prepare cases for Medicare Appeals Committee (MAC) review
- Identify training, process improvement and other ways to maximize team performance and recommend action plans to management
Patient Care Coordinator
Stanton Optical
Fair Oaks, California
01.2019 - 03.2020
- Fosters a strong partnership between the retail environment and professional services.
- Maintain a professional and supportive relationship with every associate and doctor.
- Answer phones; direct calls to appropriate individual/department.
- Solutions, contact lenses, leader's specials, etc.
- Schedule appointments, confirm all patient appointments, and greet patients
- Maintain quality control standards; ensure total patient satisfaction.
- Assist Management Team with patient complaint resolution and inform the status of all jobs; ensure all patient expectations are met
- Pre test patients
- File and scan papers in the patients profile
- Run different insurance including VSP, Eyemed Etc
Education
Associate of Arts - Business Administration
University of Phoenix
Tempe, AZ06-2021
High School Diploma -
Paseo Grande High School
Sacramento, CA05-2016
Skills
- Strong empathy
- Medical billing
- Workflow optimization
- Healthcare software proficiency
- Insurance verification
- Office administration
- HIPAA compliance
- Policy adherence
- Healthcare documentation
- Billing statement processing
- Administrative supervision
- Organizational standards
- Attention to detail
- Critical thinking skills
- Patient relations
- Customer service
Languages
Spanish
Professional
Timeline
Associate Patient Care Coordinator
SCA
09.2024 - Current
Patient Advocate
Centen
11.2021 - 01.2024
Patient Care Coordinator
Stanton Optical
01.2019 - 03.2020
Associate of Arts - Business Administration
University of Phoenix
High School Diploma -
Paseo Grande High School