Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Nick Agustin Barajas

Sacramento,California

Summary

High-performing Manager with 20 years of healthcare experience in hospital and medical office environments. Highly analytical healthcare management professional combining more than number years of work in long term care with proficiency in financial management, leadership and positive clinical outcomes. HR executive adept at building consensus amongst staff and creating an involved workforce. Fosters an environment of teamwork and continued growth and development across all functions.

Overview

23
23
years of professional experience

Work History

Director

Ministry of Defense
Madrid, Spain
09.2001 - 06.2013

  • Composed and drafted all outgoing correspondence and reports for managers.
  • Trained new employees on multiple medical billing programs and data entry software.
  • Created company’s first employee manual including training and development.
  • Improved timely paying of bills by developing flexible payment plans for patients.
  • Researched questions and concerns from providers and provided detailed responses.
  • Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
  • Maintained strict patient and physician confidentiality.
  • Described product to customers and accurately explained details and care of merchandise.
  • Skillfully developed departmental goals, objectives, standards of performance, policies and procedures.

Provider Relations Manager

Baycare Medical Group
San Francisco, CA
09.1995 - 06.1999
    Educated network providers and office staff on established BayCare Medical Group policies and procedures. Responded to telephone, verbal and/or written inquires regarding medical claims and other offered plans and procedures. Idenified, researched and resolved daily and outgoing operational reimbursements for PCP (primary care physician) and specialists. Established and maintained effective communication and excellent rapport with providers, physicians, and all departments of Baycare to inprove and resolve operational issues. Attended health plan and physician meetings on a monthly basis. Analyzed and reconciled financial data for physicians regarding reimbursement, capitation and fee for service.
  • Negotiated new and renewal production goals with business development manager.
  • Conducted annual reviews of existing policies to update information.
  • Implemented improvements in manual and electronic billing procedures.
  • Designed and implemented strategic business plan objectives.
  • Managed all internal, external and crisis communications.
  • Supplied marketing expertise to all company departments.
  • Planned and organized seminars, meetings and retreats.

Member Service Trainer

Aetna Health Plans
San Francisco, CA
09.1990 - 09.1995
  • Investigated and resolved customer inquiries and complaints in an empathetic manner.
  • Cross-trained and backed up other customer service managers.
  • Adhered to all confidentiality requirements at all times.
  • Met all customer call guidelines including service levels, handle time and productivity.
  • Solved unresolved customer issues.
  • Promptly responded to inquiries and requests from prospective customers.
  • Strong leader of customer support staff.
  • Scheduled staff shifts to cover peaks and lulls in customer inquiries.
  • Managed work flow to exceed quality service goals.

Education

High School Diploma - undefined

C.K. McClatchy
Sacramento, CA
1984

Skills

  • Strong collaborator
  • Experience with instructional design
  • Technological instruction
  • Critical thinking
  • Interpersonal skills
  • Outstanding social skills
  • Positive reinforcement
  • Effective time management
  • Positive learning environment
  • Creative questioning
  • Creative imagination stimulation
  • Attention to detail
  • Physician billing
  • Team building
  • Filing and data archiving

Accomplishments

  • Management Support
    • Ensured smooth operations by supporting executive team.
    • Training
      • Responsible for training all new employees to ensure continued quality of customer service.
      • Billing -
        Cooperated with Medicare, Medicaid and private insurance providers to establish relationships and resolve billing issues.
    • Scheduling
      • Communicated with patients through phone, fax, email and in person to schedule appointments and answer inquiries.
  • Contract Negotiation -
    • Signed and negotiated the contract for two major clients.

Timeline

Director

Ministry of Defense
09.2001 - 06.2013

Provider Relations Manager

Baycare Medical Group
09.1995 - 06.1999

Member Service Trainer

Aetna Health Plans
09.1990 - 09.1995

High School Diploma - undefined

C.K. McClatchy

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