Nely Argueta-Hernandez
Hyattsville,MD
Summary
Bilingual healthcare professional with a strong focus on eligibility analysis and quality improvement. Excels in managing confidential records, conducting detailed reviews, and facilitating educational sessions for clients. Leverages data-driven insights to enhance program compliance and support patient advocacy efforts.
Overview
1
1
Certification
13
13
years of professional experience
Work History
Eligibility Specialist
Catholic Charities, DC
Washington, D.C
01.2022 - Current
- Serve as primary point of contact for eligibility determinations, reviewing applications for completeness, accuracy, and compliance with program requirements
- Reviewed applications for eligibility and determined whether applicants met the criteria to receive benefits.
- Communicate with applicants to obtain supporting documentation and resolve discrepancies within deadlines
- Conduct intake interviews and guide patients through eligibility processes
- Conducted detailed reviews of patient documentation, identifying discrepancies and resolving missing information to ensure compliance
- Analyze program data and generate monthly reports on eligibility outcomes
- Collaborate with program leadership and clinical staff to resolve issues
- Participate in quality improvement initiatives and implement process enhancements
- Facilitate educational sessions on program services and eligibility guidelines
- Advocated for patients by connecting them to essential resources and support services, enhancing their access to needed care
- Provided guidance and support to clients navigating complex systems and resources.
- Educated clients on available services and programs tailored to their specific needs, facilitating informed decision-making
- Maintain and safeguard confidential patient records
- Explained reasons behind application denials and recommended further action.
Lead Medical Assistant / Program Support
Catholic Charities, DC
Silver Spring, MD
01.2018 - 01.2022
- Collaborated with teams to resolve documentation issues, enhancing accuracy and compliance
- Streamlined workflow by identifying bottlenecks and recommending quality improvements
- Reviewed patient records for accuracy and compliance
- Maintained detailed records of patient interactions and treatment plans, ensuring compliance and facilitating reporting
- Verified insurance and eligibility information
Medical Assistant
Child and Adolescent Health Center
Silver Spring, MD
01.2016 - 01.2018
- Conducted patient intake, screenings, and data collection to enhance patient care delivery
- Assisted providers by coordinating referrals to community resources for improved patient access
- Maintained accurate documentation and streamlined administrative functions to support operational efficiency
Medical Assistant
Center Park Place Pediatrics
Takoma Park, MD
01.2014 - 01.2016
- Coordinated clinic operations, managing patient intake, scheduling, and documentation
- Executed billing processes, ensuring accurate coding and verification of insurance information
- Assisted healthcare providers with patient examinations and procedures.
- Managed patient records and ensured accuracy of medical information.
- Coordinated appointments and maintained scheduling for medical staff.
Education
Associates of Science Degree - General Studies
Prince George’s Community College
01-2021
Medical Assistant Certificate -
TESST College
Beltsville, MD08-2014
High School Diploma -
Northwestern High School
Hyattsville, MD08-2013
Skills
- Eligibility determination
- Compliance analysis
- Healthcare Program Compliance
- Discrepancy identification
- Case documentation
- Documentation review
- Documentation reporting
- Data Collection & Reporting
- Data Analysis & Reporting
- Data analysis
- Process evaluation
- Program Evaluation
- Quality improvement
- Patient advocacy
- Referral coordination
- Information gathering
- Issue resolution
- Partnership Development
- Bilingual Communication (Spanish/English)
- Microsoft office
- Problem-solving
- Microsoft office
- Documentation review
Certification
- CPR Certification
- Crisis Prevention Intervention (CPI) Certification
- American Medical Association (AMA) Certifications (2)
- First Aid Certified
Timeline
Eligibility Specialist
Catholic Charities, DC
01.2022 - Current
Lead Medical Assistant / Program Support
Catholic Charities, DC
01.2018 - 01.2022
Medical Assistant
Child and Adolescent Health Center
01.2016 - 01.2018
Medical Assistant
Center Park Place Pediatrics
01.2014 - 01.2016
Associates of Science Degree - General Studies
Prince George’s Community College
Medical Assistant Certificate -
TESST College
High School Diploma -
Northwestern High School