Summary
Overview
Work History
Education
Skills
Timeline
Generic

Monica Palacios

Phoenix,Arizona

Summary

Accomplished professional with multifaceted expertise in all aspects of Managed Care Insurance including Customer Service, Case Management, and Subject Matter Expertise with over 25 years experience. Able to communicate effectively in great detail with individuals at all levels of management, both internally and externally within client companies. Demonstrates effective time management skills to plan, organize effectively, set priorities, meet deadlines, and handle multiple work assignments and projects while working closely with the team or on individually to meet the end goals. Solid performance in taking ownership of full lifecycle project execution with strong analytical abilities. Highly experience with acting as a Liaison between business. Areas of Excellence: Admin Coordinating

Overview

2
2
years of professional experience

Work History

Credit Analysis

American Express
Phoenix, AZ
10.1995 - 03.1998
  • Able to utilize and navigate the systems applicable to the product
  • Proven problem-solving, analytical, and decision-making skills
  • Experienced in customer inquiries on company products, services, and policies and procedures
  • Provided prompt, efficient
  • And exceptional customer service to American Express potential card customers/card members.
  • Performed credit analysis on financial statements of potential borrowers to determine their creditworthiness.
  • Conducted credit analysis and risk assessment of potential borrowers.

Sr Clinical Admin Coordinator

United Health/Optum Health
02.1999
  • Excellent relationships with providers, vendors, and members
  • Act as a Subject Matter Expert for other team members
  • Pod liaison between UHC and Optum health
  • Work closely with hospital and the clinical team
  • Manage incoming calls, request for services and program information from CMO’s and other clinical staff
  • Manages the referral process, processes incoming and outgoing referrals, and prior authorizations
  • Highly experience in intake, notification, and census roles
  • Acts as a technical resource to other in own functions
  • Responsible for triage of members, administrative intake of members or managing the admission/discharge information post notification.
  • Created and maintained accurate records of departmental activities, including budgets, personnel documents and project timelines.
  • Analyzed data to identify trends in customer behavior and preferences.
  • Developed strategies to improve operational procedures and reduce costs.
  • Drafted reports summarizing progress on various projects for upper-level management review.
  • Developed policies and procedures related to departmental operations ensuring compliance with applicable laws and regulations.
  • Maintained records of customer needs and preferences.
  • Implemented departmental policies and standards in conjunction with management to streamline internal processes.

Project Coordinator

PacifiCare
Phoenix, AZ
  • Responsible for various projects for Medical Directors, Concurrent Review Nurses, and Management
  • Such as facilitation various data management from databases and converting to distribution to other network management teams
  • Collect and analyze all data requested from providers from Medical directors as required for regulatory reporting Knowledge in managed care contracting including boh commercial/E&I & Medicare/Medicaid
  • HIPPA, NCQA, provider data management
  • Updating OOA daily reports and daily bed day census reports Data Entry and verifying precertification/authorizations
  • Obtaining referrals, medical records request, and prognosis notes
  • Updating Physicians' reports
  • Demonstrates problem solving, analytical and communication skills.
  • Monitored performance metrics such as cost, timeline, quality control and customer satisfaction levels.
  • Performed regular reviews of project documentation and communicated results with relevant personnel.
  • Collaborated with senior leadership on strategic planning initiatives related to future projects.
  • Facilitated meetings between stakeholders to discuss project requirements, objectives or outcomes.
  • Generated weekly, monthly, quarterly reports summarizing key performance indicators.
  • Developed and implemented project plans, established timelines, tracked progress and ensured deadlines were met.

Member & Provider Services Lead

PacifiCare
Phoenix, AZ
  • Handling large volume of incoming calls in a call center setting
  • Assisting members inquires, problem solving issues and concerns in medical benefirs, eligibility, and claims research, analysis, and reporting
  • Build strong teamwork, manages change, ensure clear communication, business Partner relationships/resolution
  • Excel in listening to customer needs and creating solutions
  • Provide coaching and feedback to team members and report to management.

Education

Associates in Applied Science -

Phoenix College

Certified Admin Coord -

North American College

Skills

  • Admin Coordinating
  • Project Coordinator
  • Document Management
  • Lead Services Provider
  • Prior Authorization
  • Communications
  • Quality Assurance
  • Organization & Time Management
  • Proficiency in Microsoft Office
  • Knowledge of Medical & Pharmacy Terminology
  • Experience with Medical Records (EMR) & UMR
  • Knowledge of ICD-10 CPT coding

Timeline

Sr Clinical Admin Coordinator

United Health/Optum Health
02.1999

Credit Analysis

American Express
10.1995 - 03.1998

Project Coordinator

PacifiCare

Member & Provider Services Lead

PacifiCare

Associates in Applied Science -

Phoenix College

Certified Admin Coord -

North American College

Similar Profiles

CREATE PROFILE
Monica Palacios