Front Office Lead / Eligibility and Enrollment Specialist
Amador Health Center, Inc.
01.2023 - Current
Identify and implement opportunities to build patient volume. Monitor, coach, develop, and evaluate the performance of staff and interns on an ongoing basis in accordance with applicable, timely required performance standards.
Responsible for assuring customer/patient service needs are met. Monitor patient service feedback and contribute to the process of resolving complaints and service issues.
Plan, evaluate, recommend, and implement new process initiatives and cost reduction opportunities when appropriate.
Provides coverage for different positions when needed.
Conduct front office meetings monthly and regularly attend leadership meetings.
Ensures compliance with regulations and standards involving the clinical front office, including HIPAA. Maintain confidentiality of patient and financial information.
Work collaboratively and proactively to ensure timely and accurate billing for the health care clinic. Manage sliding fee payments and cash management.
Offer patients alternatives to medical coverage, which may include Medicaid, Marketplace, or DAC Indigent. Assist patient with enrollment if qualifications are met.
Manage the DAC Indigent grant; track visits, ensure encounters are completed, and bill the Doña Ana County monthly.
Maintain proficient working knowledge of reimbursement regulations and requirements.
Develop and maintain patient volume.
Ensure that patient schedules are accurate and our staffing needs are in accordance with the clinic’s volume.
Track behavioral health referrals and assigns them to the appropriate provider.
Attend monthly partner meetings with FYI+ and schedule all internal referrals.
Manage the DACC Dental Hygiene program at AHC. Assist patients with completion of forms needed for initial intake; confirm appointments; update all information and upload documents before and during patient appointments to ensure a smooth workflow.
Other tasks as assigned and needed.
Eligibility and Enrollment Specialist
Amador Health Center, Inc.
01.2022 - 01.2023
Responsible for assisting patients and community by determining eligibility for financial assistance from government programs, completing applications and other required paperwork for these programs, perform follow-up tasks as necessary and serve as a community referral source for patients.
Regularly works directly with patients and individuals of the community to ensure accurate, thorough completion of MOSAA / PE applications for medical financial assistance from appropriate government programs.
Provide information and services in a fair and impartial manner. Assist to facilitate selection in a Qualified Health Plan. Familiar with terminology used to inform individuals of a Qualified Health Plan. Is in compliance with NM Health Exchange privacy and security standards.
Completes and submits DAC / IHC applications, based on determining patient needs and eligibility, and in accordance with IHC requirements and standards.
Serves in a patient advocacy role through tasks such as providing required documentation to medical assistance agencies; educating patients about specific programs, laws, rights, responsibilities, etc.; and following up with agencies and patients as needed regarding the outcome of these processes.
Provides notification to appropriate staff when patients qualify for programs by entering data into Practice Management Software Program on a timely and accurate basis.
Provides a referral service to individuals by serving as a link between them and additional community-based resources. Assist in outreach efforts in the community.
Consistently ensures that case records, patient files, and related records remain timely, accurate and in compliance with all applicable standards.
Prepares and submits NM Primary Care Association tracking form and activity reports, related documents to management as requested. Accurately maintain NM Primary Care Association tracking form and submit in a timely manner.
Consistently demonstrates compliance with all safety regulations and all rules, policies and procedures set forth by regulatory agencies.
Eligibility Specialist
LA CLINICA DE FAMILIA, INC.
06.2018 - 12.2021
Responsible for assisting LCDF patients and community by determining eligibility for financial assistance from government programs, completing applications and other required paperwork for these programs, perform follow-up tasks as necessary and serve as a community referral source for patients.
Regularly works directly with LCDF patients and individuals to ensure accurate, thorough completion of MOSAA / PE applications for medical financial assistance from appropriate government programs.
Provide information and services in a fair and impartial manner. Assist to facilitate selection in a Qualified Health Plan. Familiar with terminology used to inform individuals of a Qualified Health Plan. Is in compliance with NM Health Exchange privacy and security standards.
Completes and submits DAC / IHC applications, based on determining patient needs and eligibility, and in accordance with IHC requirements and standards.
Serves in a patient advocacy role through tasks such as providing required documentation to medical assistance agencies; educating patients about specific programs, laws, rights, responsibilities, etc.; and following up with agencies and patients as needed regarding the outcome of these processes.
Provides notification to appropriate staff when patients qualify for programs by entering data into Practice Management Software Program on a timely and accurate basis.
Provides a referral service to individuals by serving as a link between them and additional community-based resources. Assist in outreach efforts in the community.
Consistently ensures that case records, patient files, and related records remain timely, accurate and in compliance with all applicable standards.
Prepares and submits NM Primary Care Association tracking form and activity reports, related documents to management as requested.
Accurately maintain NM Primary Care Association tracking form and submit in a timely manner.
Consistently demonstrates compliance with all safety regulations and all rules, policies and procedures set forth by regulatory agencies, LCDF and department management.
Medical / Dental Patient Representative
LA CLINICA DE FAMILIA, INC.
04.2017 - 06.2018
Provide front office support for the clinic, such as answering telephones; scheduling appointments; registering patients and guarantors; including collection and verification of demographic and insurance information; receiving and documenting patient payments; appropriately directing patients and visitors either in person or on the telephone.
Demonstrate high level of Customer Service, Team Spirit, and Confidentiality.
Staffing, recruiting, hiring new employees, and terminations.
Data entry of applicant information into computer database on time.
Held interviews with viable candidates and assessed skills, abilities and work history.
Maintain and score tests given to applicants.
Place phone calls to applicants’ references and previous workplace to determine capability and qualifications.
Analyzed any potential services which can be offered accommodate particular situations.
Assessed each client order to ensure employee arrival and customer satisfaction. Assured all client needs were met on time.
Assured the correct and timely work order entry.
Solved problems and complaints of customers and temporary associates (disciplinary actions).
Performed outside service calls to assure quality customer service and extend business. Onboarding Orientation, Drug screen, File all relevant paperwork, such as applications, insurance forms, tax forms, identification, references, etc.
Professional yet personable demeanor with clients, applicants, and coworkers.
Machine Operator/Technician
LEVITON MANUFACTURING CO.
11.1993 - 03.2013
Inspected work pieces for defects, and measured work pieces to determine accuracy of machine operation, using rulers, templates, or other measuring instruments.
Observed machine operation to detect work piece defects or machine malfunctions, adjusted machines as necessary.
Read blueprints or job orders to determine product specifications, tooling instruction, and planned operational sequences.
Made minor electrical, mechanical repairs
Started machines, turned hand wheels or valves to engage feeding, cooling, and lubricating mechanisms.
Performed minor machine maintenance, such as oiling, dies, work pieces and added coolant to machine reservoirs.
Responsible for weekly production, inventory, packaging materials, and shipping finished goods to warehouse.
Education
High School Diploma - undefined
New Mexico State University
Las Cruces, NM
Associates of Science - Business Management
Vista College
Las Cruces, NM
02.2015
Business Management Diploma - undefined
Vista College
Las Cruces, NM
06.2014
Bachelors of Science - Business Administration
University of Phoenix
Santa Teresa, NM
01.2011
Cosmetology License - undefined
Tri-State Cosmetology Institute
El Paso, TX
01.2004
Skills
Microsoft Office (Word, Excel, PowerPoint)
Web Browsers (Internet Explorer, Firefox, Google Chrome)
Studied Business Law
Strategic and Business Management
Strong Customer Service Skills
Team Leader/ Team Player
Multi-task oriented/ Well-organized
Professional/ Time Management Skills
Punctual
Flexible/ Reliable
Work well under pressure
Dedicated
Communicate effectively and clearly in writing and orally, both in one-on-one and group presentation situations
Bilingual (English/Spanish)
Timeline
Front Office Lead / Eligibility and Enrollment Specialist