MISHA VELOZ

• Verified data accuracy by consistently reconciling work with scanned documentation
• Performed quality checks, data analysis, and generated reports
• Entered large volume of information daily with high degree of accuracy while exceeding daily production goals and reducing errors by 30%
• Provided status updates on current issues and proposed corrective actions.

• Managed approximately 30 incoming calls, emails, faxes, applications per day, coordinated all referrals and intakes with RCH&R Leadership Team, and managed admissions processes for incoming youth, promptly collecting and processing necessary documents.
• Demonstrated strong analytical skills by interpreting complex medical records, synthesizing relevant information for utilization review based on medical necessity, and maintaining strict deadlines for completion of reviews.
• Evaluated new protocols or interventions for cost-effectiveness and clinical utility, supporting evidence-based decision-making within organization.
• Confirmed all insurance benefits met standards of admissions as dictated by policy; along with obtaining prior authorizations.
• Improved interdepartmental communication by collaborating with medical professionals, case managers, and social workers to develop comprehensive care plans and improve admissions process.
• Collaborated with interdisciplinary teams to ensure adherence to treatment plans, evaluated medical guidelines and benefit coverage, helped create effective discharge plans that promoted optimal patient outcomes while minimizing hospital readmissions.
• Ensured compliance with federal regulations governing medical insurance reimbursements, implementing changes when necessary to safeguard against potential penalties or sanctions.
• Reduced healthcare costs for organization by identifying areas of improvement in clinical documentation and resource allocation.
• Enhanced staff/ team understanding and compliance with regulatory requirements through regular weekly meetings and updates.
• Increased admissions process transparency by streamlining application process, and creating informative materials for prospective youth and their families.
• Provided exceptional customer service during phone and email interactions with prospective youth and their families, addressing concerns promptly and professionally.

• Quoted pricing for nationwide emergency service requests; maintaining 30-40% margin
• Reevaluated procurement process and identified inefficiencies; helped develop and implement new vendor selection criteria which resulted in 10-20% reduction in vendor costs
• Assignment of KAM high dollar accounts; assuring client requests were expedited/addressed within 10 minutes
• Communicated client's needs and demands to internal stakeholders, and other key decision makers
• Handled on call/ emergency situations and fast-tracked problem solutions
• Trained, mentored, created job aids, and supported new team members
• Coordinated and assisted Procurement, Customer Service and Accounting departments to ensure accuracy and order lifecycle completion
• Salesforce data entry, audit of orders, and assisted on all product recall projects.

• Provided ongoing support to individuals with mental health and emotional challenges during the COVID-19 pandemic by offering telephonic coaching sessions, fostering resilience and adaptability in both personal and emotional growth.
• Enhanced client self-awareness by conducting personalized assessments and providing insightful feedback.
• Used cognitive behavior therapy to assist clients in recognizing and redirecting poor habits.
• Offered spiritual counseling and coordinated community service referrals for church members.

• Maintained client schedules for multiple providers
• Processed all mental health phone intakes/ prescreening for potential new clients, and first point of contact for client emergencies/ crisis after hours
• Supported provider's credentialing needs, including re-certification
• Updated fee schedules with contracted insurance companies
• Set-up virtual telehealth platform for owner/ providers when Covid-19 started to ensure continuation of provider counseling sessions with clients during pandemic.

• Obtained approximately 20 daily Advanced Diagnostic scan pre-authorizations for Oncology patients via record/clinical review with insurance company Oncology nurses
• Assisted patients with reviewing medical benefits and completed all financial clearance activities for maximum provider/hospital reimbursement
• Coded and processed medical claims
• Researched claim rejections and took corrective actions to ensure timely claim resolutions
• Managed medical denials by conducting comprehensive review of clinical documentation, consulted with physicians and initiated appeals for medical policy denials by writing arguments based on NCCN guidelines
• Maintained a working knowledge of applicable Federal, State, and local laws and regulations.

Cross-country move.

• Office management, coordinated staff scheduling, trained staff on new software and policies implemented in office
• Prepared bi-weekly payroll and generated payroll reports
• Processed A/R, A/P, including invoicing, researching chargebacks, discrepancies, and reconciliations
• Liaised with vendors to order and maintain inventory of office supplies
• Ran monthly production reports and maintained consistent collection rate of 96%
• Insurance claims submission and assisted both patients and insurance companies with billing issues.
• Managed scheduling and coordination of all office meetings to ensure smooth operations and minimal conflicts.
• Increased customer satisfaction by developing effective client feedback system that led to service improvements.