Norma Villarreal
Grand Prairie,TX
Summary
Hardworking employee enthusiastic about learning the Medicaid/Medicare Managed Care field inside and out. Pursues opportunities to learn new skills and contribute to the Companies success. Offers strong administrative, relationship-building and problem-solving abilities.
Overview
8
8
years of professional experience
Work History
Star Plus Waiver Specialist
Molina Healthcare
01.2022 - Current
- Responsible for tracking the renewal dates to ensure all Member reassessment activities have been completed and posted on the LTC online portal 45 days prior to the expiration date of the Community Medical Necessity and Level of Care Assessment
- Monitor progress of submitted forms in TMHP LTC Portal
- Research eligibility issues and discrepancies
- Audit assessment forms submitted for quality assurance and accuracy that meets the state guidelines
- Submit Members Individual Service Plan in TMHP LTC portal
- Facilitate communication between Waiver coordinators and the state Program Support Unit.
- Retrieve incoming waiver transfer packets and assign to the Star Plus Waiver Specialist based on alpha range.
- Retrieve and process incoming Star kids transfer packets, verify eligibility and task LTSS leadership to review if Star Kid Age Outs qualify for HCBS waiver.
- Retrieve Amerigroup FTP transfer file from IPswitch once monthly and upload all packets and task the assigned Star Plus Waiver Specialist in CCA and email Managers and Directors the spreadsheet to ensure all services are in place
- Assisted in the implementation of a new system as a Subject Matter Expert
- Provide support to the team as needed as needed
- Stay up to date with State Guidelines and policies
- Research and provide a written status for each member whose ISP expires within 45 days, indicating the status of the member’s reassessment once a month during Scan Call meeting with PSU staff
Star Plus Waiver Admin
Cigna
04.2018 - 12.2021
Medical Practice Administrator
Parkland Hospital
08.2015 - 04.2018
- Managed daily practice operations to optimize appointment scheduling, patient records management and billing functions.
- Provided outstanding support to entire staff which helped improve process flow and boosted efficiency.
- Ordered all office supplies and kept check on inventory levels.
- Addressed and remedied all patient or team member issues.
- Assessed processes and procedures, complying with OSHA, and HIPAA regulations.
- Trained interns and newly hired team members on office procedures and computer system.
- Communicated closely with patients, ensuring medical information was kept private.
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
Education
Associate of Science - Health Information Management
Rasmussen University
Online09.2020
Skills
- Training and Development
- Workflow Processes
- Verbal and Written Communication
- Medical Billing
- Data Management Familiarity
- Creative Thinking
- HIPAA Regulations
- Special Projects
- Research
- Attention to Detail
- Microsoft Access
- Data Quality
- Data and Analytics
- ICD-9
- Work Prioritization
- CMS-1500 Billing Forms
- ICD-10
- Billing Codes
- Data Entry
- HIPAA Compliance
- Claims Review
- Auditing Proficiency
- Time Management
- Operations Support
- Regulatory Compliance
- Healthcare Terminology
- Medicare and Medicaid Processes
- 3M Encoder
- Patient Information Management
- Knowledgeable about Diseases
- Health Information System Administration
- Problem Resolution
- Government Regulations
- Electronic Health Record Applications
- EMR Systems
- Health Data Management
- Protected Health Information
Languages
Spanish
Native or Bilingual
Timeline
Star Plus Waiver Specialist
Molina Healthcare
01.2022 - Current
Star Plus Waiver Admin
Cigna
04.2018 - 12.2021
Medical Practice Administrator
Parkland Hospital
08.2015 - 04.2018
Associate of Science - Health Information Management
Rasmussen University
Similar Profiles
Mayra GarciaMayra Garcia
Claims Auditor at Bright Healthcare Plan & Molina Healthcare PlanClaims Auditor at Bright Healthcare Plan & Molina Healthcare Plan
Katrevia CarrKatrevia Carr
Healthcare Customer Service Representative at Molina HealthcareHealthcare Customer Service Representative at Molina Healthcare
Jenasi VelaJenasi Vela
Member Engagement Representative at Molina HealthcareMember Engagement Representative at Molina Healthcare
Reagan BisaillonReagan Bisaillon
Case Manager Supervisor at Molina HealthcareCase Manager Supervisor at Molina Healthcare
Garrett DodsonGarrett Dodson
Store Manager at Chicken ExpressStore Manager at Chicken Express