Overview
Work History
Education
Additional Information
Languages
Timeline
Generic

Natali Sanchez Pichardo

Union City,CA

Overview

9
9
years of professional experience

Work History

Referral Coordinator

Axis Community Health
01.2024 - Current
  • Demonstrated strong attention to detail and organizational skills in managing a high volume of referrals while maintaining exceptional levels of patient care.
  • Scheduled appointments for patents with our internal specialist
  • Maintained a high level of accuracy in referral documentation, ensuring smooth transitions between healthcare providers.
  • Participated in weekly meetings to discuss operational improvements and share best practices among the team members.
  • Maintained up-to-date knowledge of insurance requirements.
  • Submit prior authorization to insurance companies to get Authorizations.
  • Managed electronic health records efficiently, safeguarding sensitive patient information while expediting the referral process.
  • Established strong relationships with external providers, facilitating seamless communication and collaboration in patient care.
  • Provided exceptional customer service to patients, addressing concerns promptly and professionally.
  • Work closely with insurance AAH CHCN, Medical, Medicare, CCHP and PPO.

QA/QC Case Reviewer & Third Tier

Horne/State of California Rent Relief Program
05.2023 - 09.2023
  • Analyze cases base on program policy, protocol's and guidelines
  • Examine each claim to determine if any further investigation is required. Update Audit note with fact-finding information.
  • Review Applicant and Landlord documents to determine claim status.
  • Identify fraud or irregular cases, proceed with the Denial Notification process, route cases to the correct status
  • Analyze claim information to determine the cause of outstanding issues and determine the following steps to resolve these issues
  • Cross reference information if outreach was not completed, conducted outreach if necessary
  • Track claims via Pivot Table throughout the day and make changes as needed before the end of the day
  • Third Tier Review, revise previous QA/QC work.
  • Use software's provided such as PowerBi and Jurisdiction for fact-finding. Ensuring no duplicates are found while case is being review
  • Conduct final decision including supporting documents, ensuring outreach was conducted and update correct status.
  • Ensured equitable treatment of all parties involved in case reviews by adhering to established ethical guidelines and maintaining a neutral perspective throughout the review process.

Claims Auditor

Maximus/ State of California EDD
01.2022 - 01.2023
  • Identified fraudulent activities by conducting detailed audits on suspicious claims, protecting company resources.
  • Participated in ongoing professional development opportunities to stay current on industry trends, enhancing personal skill set and benefitting the organization.
  • Reduced claim overpayments with comprehensive analysis of billing discrepancies
  • Evaluate unemployment insurance claims data for potential eligibility issues.
  • Conduct outbound calls as needed to interview employers, claimants, and/or third-party administrators for information verification
  • Review unemployment insurance claims for weekly benefit amounts and payment
  • Process claims with confirmed eligibility issues for potential adjudication and determination by the California Employment Development Department
  • Analyze claim information to determine the cause of outstanding issues and determine next steps to resolve these issues
  • Recommend eligibility determination based on code, policy, procedures, and complex financial information by evaluating wages and earnings
  • Conduct outbound calls as needed to interview employers for information verification to resolve any noted issues and discrepancies
  • Recommend eligibility determination based on code, policy, procedures, and complex financial information by evaluating wages and earning
  • Document employer interactions, along with actions taken to supplement case notes.
  • Collaborate with subject matter experts to address unique issues

Patient Service Representative

Stanford Medicine Partner's
11.2018 - 01.2022
  • Participated in ongoing training programs related to HIPAA compliance, maintaining up-to-date knowledge on regulatory requirements.
  • Verified insurance eligibility and coverage for patients.
  • Handled sensitive patient concerns with professionalism and empathy, fostering an atmosphere of trust within the clinic.
  • Filed and maintained patient records in accordance with HIPAA regulations.
  • Provided exceptional customer service to patients, answering questions and addressing concerns.
  • Managed patient registration process, confirming data accuracy and completeness.
  • Used EPIC to schedule appointments.
  • Assisted patients in filling out check-in and payment paperwork.
  • Processed medical records requests efficiently, safeguarding patient privacy while ensuring timely information access for healthcare providers.
  • Coordinated referrals efficiently between primary care providers and specialists, ensuring a seamless patient experience.
  • Reduced no-show rates through consistent appointment reminder calls, leading to improved clinic productivity.
  • Communicated with physicians regarding disability and FMLA forms, complete them in a timely matter for physician to review and sign
  • Responsible to complete California Disability forms online/DE2501 forms/FMLA forms.

Housekeeping Team Leader

Lucile Packard Children's Hospital
11.2017 - 10.2018
  • Managed linen inventory effectively by tracking usage trends and collaborating with laundry staff to maintain optimal stock levels at all times.
  • Enhanced guest satisfaction by ensuring timely and thorough housekeeping services in all rooms and common areas.
  • Trained new team members in proper cleaning techniques and safety protocols, ensuring consistent service quality across the board.
  • Reduced guest complaints with proactive communication and addressing issues promptly.
  • Coordinated household cleaning service operations and managed client relations.
  • Established clear communication lines between housekeeping, front desk, and maintenance departments, resulting in faster resolution of guest concerns.
  • Assigned housekeeping staff to specific shifts and room blocks based on abilities and daily requirements.
  • Conducted regular room inspections to ensure adherence to brand standards and address any potential issues before they escalated.
  • Maintained high standards of cleanliness, contributing to improved hotel ratings on various review platforms.

Front Desk Receptionist

Ergo Rehab
02.2017 - 11.2017
  • Verified insurance eligibility and coverage for patients.
  • Participated in ongoing training programs related to HIPAA compliance, maintaining up-to-date knowledge on regulatory requirements.
  • Handled sensitive patient concerns with professionalism and empathy, fostering an atmosphere of trust within the clinic.
  • Provided exceptional customer service to patients, answering questions and addressing concerns.
  • Facilitated patient registration by accurately entering demographic and insurance information into electronic health record systems.
  • Processed medical records requests efficiently, safeguarding patient privacy while ensuring timely information access for healthcare providers.
  • Assisted with insurance verification tasks, ensuring accurate billing and timely reimbursement for services rendered.
  • Took copayments and compiled daily financial records.
  • Balanced deposits and credit card payments each day.
  • Handled complex insurance pre-authorization processes accurately, enabling timely delivery of necessary medical services.
  • Reduced no-show rates through consistent appointment reminder calls, leading to improved clinic productivity.

Fraud Specialist

Zazzle
10.2015 - 01.2017
  • Improved customer trust by promptly addressing and resolving reported instances of fraud.
  • Conducted thorough investigations into suspected fraudulent activities, resulting in timely resolution of cases.
  • Reduced instances of fraud by implementing comprehensive detection and prevention strategies
  • Conduct reviews of flagged transactions and reports that showed potential suspicious activity.
  • Identified fraud patterns and anomalies through analysis of large quantities of data
  • Input information regarding fraud investigations into detailed reports for submission to clients
  • Participate in group discussion with team members to develop new ways to combat fraud
  • Determine existing fraud trends by analyzing accounts and transaction patterns

Education

High School Diploma -

Robertson High School
Fremont, CA
06.2010

Additional Information

SharePoint, EDD Portal, Otech, NICE, AWS, Infoimage, Outlook, Office 365, Microsoft Teams, NICE/IEX, In Contact Virtual Contact Center, Fieldglass, multiple systems logins utilizing different multi-factor authentication applications, Microsoft word, EPIC, ADP, Fluent Spanish, Neighborly Software, Sharefile, PowerBi, DataTree and Jurisdiction Software.

Languages

Spanish
Native or Bilingual

Timeline

Referral Coordinator

Axis Community Health
01.2024 - Current

QA/QC Case Reviewer & Third Tier

Horne/State of California Rent Relief Program
05.2023 - 09.2023

Claims Auditor

Maximus/ State of California EDD
01.2022 - 01.2023

Patient Service Representative

Stanford Medicine Partner's
11.2018 - 01.2022

Housekeeping Team Leader

Lucile Packard Children's Hospital
11.2017 - 10.2018

Front Desk Receptionist

Ergo Rehab
02.2017 - 11.2017

Fraud Specialist

Zazzle
10.2015 - 01.2017

High School Diploma -

Robertson High School

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Natali Sanchez Pichardo