Olivia Plascencia Valencia
Antioch,CA
Summary
Results-driven healthcare professional with 19 years of experience in medical administration and revenue cycle. Working for Optum, supporting John Muir, has been a rewarding experience, one that has me pursuing higher education. Proven track record of improving operational efficiency, optimizing billing processes, and supporting cross-functional healthcare teams. I hold a Bachelor of Science in Healthcare Administration, and I am currently pursuing a Master of Science in Healthcare Administration to advance into leadership roles. I am passionate about driving systemic improvements that enhance patient care, support providers, and serve the community.
Overview
2
2
Languages
21
21
years of professional experience
Work History
Lead Reimbursement Specialist
Optum
Concord, CA
05.2019 - Current
- Responded promptly to internal staff inquiries regarding reimbursement policies and procedures.
- Analyzed trends in denied claims to enhance accuracy in payment submissions.
- Participated in interdepartmental meetings focused on improving customer satisfaction while achieving profitability.
- Reviewed provider contracts, fee schedules, and managed care agreements for compliance with reimbursement regulations.
- Researched complex billing codes from third-party payers to maximize revenue collections.
- Identified opportunities for process improvements to increase efficiencies in reimbursement.
Medical Billing Manager
Diabetes And Endocrinology Specialists
Concord, CA
07.2016 - 05.2019
- Developed strategies to enhance collections performance across multiple sites.
- Analyzed financial data to identify discrepancies and reported findings to senior leadership.
- Managed medical billing staff, ensuring accuracy in patient account management.
- Created reports outlining trends in revenue cycle management, including denials and rejections.
- Coordinated interdepartmental efforts on patient follow-up activities related to denials.
- Resolved issues associated with denied or rejected payments from insurance companies.
- Reviewed appeals processes and assisted in preparing necessary appeal letters.
- Identified improvement areas within the medical billing process and implemented changes.
Medical Coding and Billing Specialist
Bay Imaging Consultants Medical Group
Walnut Creek, CA
01.2006 - 07.2011
- Researched denied claims to identify error causes and implemented necessary corrections.
- Trained new employees in medical coding practices to enhance team competencies.
- Monitored Medicare, Medicaid, and private insurer regulatory updates for compliance.
- Analyzed denial trends to recommend process improvements, reducing overall denial rates.
- Provided customer service support via phone and email for billing inquiries and account balances.
- Ensured compliance with HIPAA regulations when handling confidential patient information.
- Verified patient data, including medical history and insurance coverage, for accurate coding.
- Maintained up-to-date knowledge of CPT and ICD-10 coding principles and third-party billing requirements.
Medical Assistant
Dr. Louis Enrique
Antioch, CA
06.2005 - 12.2006
- Conducted laboratory tests including urinalysis and blood glucose levels under physician or nurse supervision.
- Managed inventory of medical supplies, restocking exam rooms as necessary.
- Maintained accurate medical records through filing, charting, and data entry into electronic health record system.
- Administered injections and medications following physician directives.
- Filed insurance claims forms in compliance with regulations.
- Ensured proper cleaning of instruments used during exams according to protocols.
- Adhered to HIPAA regulations for safeguarding confidential patient information.
- Accurately registered new patients into practice management software, entering demographic details.
Education
Bachelor of Science - Health Care Administration
California State University, East Bay
Hayward, CA12-2018
Some College (No Degree) - Undergrad
Holy Names University
Oakland, CA12-2013
Associate of Science - Medical Assistant
Carrington College
Pleasant Hill, CA06-2005
Skills
- Revenue cycle Specialist
- Claims analysis and review
- Billing practices and systems
- Contract negotiation
- Staff training and development
- Customer service excellence
- Team leadership and collaboration
- Denial management strategies
- Process improvement methodologies
- HIPAA compliance expertise
- Analytical problem solving skills
- Medical billing proficiency
- Insurance collaboration techniques
Languages
English
Native/ Bilingual
Spanish
Native/ Bilingual
Timeline
Lead Reimbursement Specialist
Optum
05.2019 - Current
Medical Billing Manager
Diabetes And Endocrinology Specialists
07.2016 - 05.2019
Medical Coding and Billing Specialist
Bay Imaging Consultants Medical Group
01.2006 - 07.2011
Medical Assistant
Dr. Louis Enrique
06.2005 - 12.2006
Bachelor of Science - Health Care Administration
California State University, East Bay
Some College (No Degree) - Undergrad
Holy Names University
Associate of Science - Medical Assistant
Carrington College