Dana Minor
Summary
Seasoned IEHP team member with knowledge and expertise in various areas and departments, my goals are to continuously learn and grow within IEHP, and to incorporate LEAN standards in all areas of my work, and ensure that our members have the highest quality of care, and are treated with the dignity and respect that they all deserve.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Medi-Cal Member Services Representative
Inland Empire Health Plan
11.2022 - Current
- Assist Member with provider changes, filing grievances or appeals, demographic updates, answer questions about benefits, referrals, claims, external resources, I am also cross-trained and work in the grievance & appeal call center and assist with disposition of case status notification to members that call in, adding additional information, advising members of legal rights when needed, act as a liaison between the member and the SCO/appeals nurse, etc.
Network Contract Specialist
Inland Empire Health Plan
04.2022 - 10.2022
- Contact prospective and current providers to obtain documents required to prepare for a new contract or contract renewal
- Delegate emails that came into the Contracts email to the correct contract manager for review and response, make corrections for NDDB
Coordination of Benefit Specialist
Inland Empire Health Plan
07.2020 - 07.2022
- After my previous position was dissolved I helped other departments until I found a position in the CBS Dept/COB unit.
- I began working as a COB Specialist, verifying if members had other health coverage.
- Researching to find other possible health coverage, working in MediTrac to manually update the term date on urgent requests that affect member access to care.
- Verifying eligibility of other health coverage, and then submitting to the state to add, remove or correct OHC to reflect in AEVS.
- Working in events to address OHC/COB/Research sent to us by other departments.
- Working in both Access on HMS discrepancies, and Excel on the HIS Error report Monthly to research claims sent from finance where there was possible OHC in order to locate the insurance information, verify eligibility, submit to the state when necessary, and document my findings.
- Running Audits for MediTrac errors.
- Working reconciliation reports, making calls to other Health Plans.
- Checking MARx for Medicare part C&D coverage info.
- Working COB urgent emails.
- Prior to our transition of our Medi-Cal pharmacy benefit which ended 12/31/2021, I would work in RX Nova to make necessary updates in the COB information details to ensure pharmacy claims were paid correctly according to the effective and term dates of OHC which was considered primary while active, I also verified MSP to obtain the ID, BIN, PCN, effective and or term dates.
- I would submit to ECRS when necessary
- I submitted various JDI's and Experiments, participated with joy in creating cards for our SNF, LTC, BH, and anywhere that our members could use some form of encouragement.
Claims Configuration Specialist
Inland Empire Health Plan
11.2016 - 07.2020
- Before moving to Core I worked in the Claims Department Configuration Unit as a Configuration Specialist.
- I was responsible for adding all Non Par Providers.
- Verification of Tax ID from the IRS website.
- Verification of specialty type from NPI website, NPPES.
- Checking SAM for prior to Sanction before processed through the batch load.
- I manually checked the Medi-cal website, OIG, and other resources to ensure that the non contracted provider was not sanctioned, as well as the completeness of submission.
- I used Access to upload the pricing and QA when complete, to speed up the process.
- I was also responsible for running Claims inventory pended to configuration unit report on a daily basis.
- After the move to Core and going live with MediTrac, I worked perfect claim to fix vendor and provider issues, and added all Non Par providers, vendors, Offices, and attached contracts in MediTrac.
- I was responsible for all pre check run activities in Diamond including running batch upload, interest, ensuring all duplicate ACPAYs had been deleted, running DAYCK to catch all current day claim errors and put claims on hold to avoid check run, and then running check run.
- I also assisted with adding some Contracted providers I knew how to add basic Specialist, Behavioral Health, Vision, LOA's and Member LOA's.
Claims Configuration Processor
Inland Empire Health Plan
04.2012 - 11.2016
- Worked in the Claims Department Configuration Unit , In November of 2012, I became part of the Claims Lean Kaizen event
- My responsibilities include running APUPD, 1, 3, FINAL, and TOASC for Check Run
- I was responsible for research and correction of all returned Checks and addresses in Diamond
- I was part of the ERRVU team for both IEHP and RCHC, Sending check box letters, Submitting P55's for providers to be added or updated in Diamond, Worked various Reports and databases including Access, and Scheduled items
- I trained with Confidata for both the beginner and intermediate sessions of Diamond training.
- I was the back up for the Provider Build adds
- I was responsible for adding RCHC that failed to register as a Vendor and Non Par providers for almost two years.
- I suggested the DNR process to build those providers to just deny so that some of the Check box letters would be eliminated, and this process worked quite well.
- I tested for the new Error Queues and worked to identify errors, modifications, and add or delete features.
Level 1 Claims Processor
T&T Staffing
08.2011 - 04.2012
- Worked as a temporary employee at IEHP in the Claims Department
- My responsibilities included, Entering missing member or provider information through ERRVU.
- Processing vision labs claims.
- Sending check box letters for various reasons to the provider.
- Sending P55's for providers to be added or updated in Diamond.
- Manually entered claims into Diamond,
- Correcting DC claims and batching them to processors for processing, and worked other daily or weekly reports.
Front Office Medical Assistant
Tsu Lai M.D., Inc.
03.2008 - 03.2009
- Worked in a specialty setting with a Cardiologist.
- Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.
- Facilitated patient flow by notifying provider of patients' arrival, being aware of delays and communicating with patients and clinical staff.
- Prepared and processed patient referrals and transfer requests.
- Handled sensitive information with discretion, adhering to HIPAA guidelines at all times.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Performed medical records management, including filing, organizing and scanning documents.
- Collected and documented patient medical information such as blood pressure and weight.
- Provided accurate documentation of patient interactions in electronic health record system.
- Verified patient insurance coverage and collected required co-payments.
- Prepared lab specimens for diagnostic evaluation.
- Performed phlebotomy tasks efficiently while ensuring minimal discomfort for patients during blood collection procedures.
- Completed EKGs and other tests based on patient presentation in office.
Patient Account Representative/Contract Biller
Pomona Valley Hospital Medical Center
01.2003 - 09.2005
- Worked in a Hospital setting, in the Contract Billing Department of the business office
- My most valuable attributes included, being extremely accurate with financial accounts, I verified everything before billing, during follow up, and at the closing of an account.
- The ability to write appeals that generated quick response and the remainder of the balance paid
- I was put in my position with no formal training and quickly became acquainted with procedures of two positions rolled into one as a guinea pig for the process.
- I worked with United Healthcare, Blue Shield, Blue Cross, Blue Card, and Kaiser insurances, using online claims follow up, Electronic billing of UB92 and HCFA 1500, knowledge in programs such as Excel, Office, Siemens, etc.
File Support- Pomona Valley Hospital
On Assignment
01.2002 - 01.2003
- Worked in a Hospital setting, in the Contract Billing Department for Pomona Valley Hospital as temporary employee, pulling EOB's (Explanation of Benefits) for an imaging, and legal project.
- I performed my duties above and beyond expectation, and began cross training for patient account representative.
- I was the first file support to move money and trained other file support to do the same duties.
- I created spreadsheets to track all incoming correspondence from insurance providers and compile a list of trends for the types of requests they were asking for.
- I was hired at PVHMC and promoted early.
Education
Coding Specialist Program -
Loma Linda University
Loma Linda, CA12.2014
Prerequisites for the Coding Specialist Program -
Chaffey College
Fontana, CA12.2011
Medical Assistant Program -
Concorde Career Institute
San Bernardino, CA12.2001
Skills
- Auditing to locate and correct various discrepancies
- Certified Coding Specialist through AHIMA
- Training and mentoring
- Research abilities
Accomplishments
- Collaborated with claims and computer programming experts in the development of the first Kaizen event, which is now known today as the LEAN process.
- Successfully being the first combined billing/follow-up representative in the contract billing department of PVHMC having no formal training and getting claims billed & paid with high accuracy.
- Going to school at LLU while working fulltime, and being a fulltime soccer/ softball mom.
Affiliations
- Active member of AHIMA
Certification
- Certified Coding Specialist, AHIMA - 12/28/2013- Current
- National Certified Medical Assistant - National Center for Competency Testing - 2001-2006
Hobbies
I love attending Concerts and Festivals, Singing, Rock hounding, Hiking, Camping, Off Roading, Water Sports, Exploring.
Timeline
Medi-Cal Member Services Representative
Inland Empire Health Plan
11.2022 - Current
Network Contract Specialist
Inland Empire Health Plan
04.2022 - 10.2022
Coordination of Benefit Specialist
Inland Empire Health Plan
07.2020 - 07.2022
Claims Configuration Specialist
Inland Empire Health Plan
11.2016 - 07.2020
Claims Configuration Processor
Inland Empire Health Plan
04.2012 - 11.2016
Level 1 Claims Processor
T&T Staffing
08.2011 - 04.2012
Front Office Medical Assistant
Tsu Lai M.D., Inc.
03.2008 - 03.2009
Patient Account Representative/Contract Biller
Pomona Valley Hospital Medical Center
01.2003 - 09.2005
File Support- Pomona Valley Hospital
On Assignment
01.2002 - 01.2003
Coding Specialist Program -
Loma Linda University
Prerequisites for the Coding Specialist Program -
Chaffey College
Medical Assistant Program -
Concorde Career Institute