Pamela Dukes
Yorba Linda,CA
Summary
With over 25 years of experience in healthcare and executive administration, I am a versatile and dedicated healthcare administrator. I pride myself on my proactive approach and self-motivation, always taking ownership of assignments and seeing them through to completion. Even in high-pressure situations, I maintain poise and discretion, effectively managing any challenges that arise. My strong interpersonal skills allow me to work seamlessly with executives, coworkers, associates, and customers of all levels. Throughout my career, I have honed my expertise in areas such as patient advocacy, provider recruitment, and operations coordination. Additionally, I excel in risk management and ensure compliance in quality and risk management. With a focus on customer service, I possess excellent communication skills that enable me to provide exceptional care to patients. I am also adept at process improvement, policy development, and fostering positive provider relations. In summary, my extensive experience and proficiency make me a valuable asset in any healthcare setting, particularly in senior care. Service-oriented and resourceful with in-depth clinical skills and assessment training. Support patient personal care and hygiene needs with diligent assistance. Organized in keeping supplies stocked and equipment sterilized for use.
Overview
40
40
years of professional experience
1
1
Certification
Work History
Provider Relations and Patient Concierge
Caduceus Medical Group and PDQ Urgent care and More
2023.01 - Current
- Liaison between the company and the Provider to resolve questions or concerns regarding contractual interpretation and Program implementation
- Implement strategies with Providers to improve Provider performance and coordinate care with all aspects of care and outside vendors and care teams
- Responsible for maximizing case volume from all credentialed physicians
- Establishes and maintains long-term physician and office staff relationships
- Regularly visits physician offices to meet with physician and his/her staff to assess any needs that will result in increased case volume
- Responsible for engaging partner providers and facilities on a variety of patient Experience, Quality, Risk Adjustment activities
- Continually search for opportunities to streamline and improve workflows and operations
- Provides support for regional marketing events, conventions and symposia.
Covid Manager
Caduceus Medical Group
2020.01 - 2023.01
- Testing team coordination Oversee onsite testing events to ensure operations are running according to plan
- Ensure all patients have the appropriate medical coverage for COVID testing and follow up appointments
- (Medi-Caid PPO, HMO)
- Contact all new and current patient population
- Monitoring care, scheduling preventative and follow-up visits, and assisting the patient with goal setting and the management of their care
- Work with Outreach and Enrollment Supervisor to problem solve and enhance workflow
- Coordinate and work closely with all patient and Providers to assure proper patient care and address any concerns
- Proactively prevent patient and family concerns and grievances
- Ensure the rights of the family and patients are respected according to HIPPA guidelines.
Business Development /Marketing
Caduceus Medical Group
2019.04 - 2020.01
- Planning and overseeing new marketing initiatives
- Work with providers to assist with continuity of care issues
- Coordinate community outreach programs and Health Care Fairs
- Oversee the New Patient Experience Program
- Researching organizations and individuals to find new opportunities
- Developing goals for the development team and business growth and ensuring they are met
- Increasing the value of current customers while attracting new ones
- Attending conferences, meetings, and industry events
- Working closely with the Head of Marketing to support programs and initiatives at clinics with specific focus on adding value in the long term.
Risk Management & Concierge
Caduceus Medical Group
2016.08 - 2019.01
- Analyze patient utilization to determine legitimacy of patient compliance, treatment, and follow-up / post-treatment care
- Input patient healthcare facilities to comply with government and insurance companies to ensure patients received proper care and to follow reimbursement policies
- Analyze daily patients’ follow-up care and assure accrediting agency standards to determine criteria concerning patient care and satisfaction, treatment, and continuity of care
- Work with MDs and practitioners to guarantee accurate charting and ensure quality patient outcomes
- Promote our services, highlight our impact, and build our relationships with the community
- Develop and actively manage referral bases.
Owner, Operator
It’s All About You, LLC.
2014.12 - 2016.01
- It’s All About You is a company with a unique mission to serve the elderly and those in need of professional advocacy in San Diego County, including care management and non-medical caregiving services
- Ensures that Clients are set up for a successful health maintenance year through their necessary annual wellness and follow up visits
- Provide the best client service and communicate with the families with excellent interpersonal skills
- Assist clients with proper meals, involve clients to participate in community events and assist with transportation to all medical appointments
- Coordinate Health Care benefits with Clients Medical Team
- Advocate for client to guarantee best practice and benefits and follow up care
- Demonstrates excellent communication skills
- Communicates with client and family in a clear, concise, and understandable manner.
Patient Service Representative III
Scripps Healthcare: General Surgery and OB/GYN
- 2014.12
- Provided exceptional customer service to assist clients feel calm and comfortable
- Managed and operated multi line phones
- Responded to customer inquiries in a timely and accurate manner
- Assisted with the scheduling, authorization, and follow-up for customers
- Maintained accurate records by advancing registration and updating customer demographics
- Coordinated departments and hospitals to schedule surgeries
- Act as liaison on behalf of the Provider and patient to assure optimal outcomes.
Administrator & Surgery Scheduler
Coronado Eye Associates
2010.12 - 2012.12
- Hired and managed a staff of five, conducted daily officer operations, and gave regular performance reviews
- Communicated with patients to assure continuity of care with post-operative appointments
- Coordinated contractors and meetings between doctors and external entities
- Scheduled surgeries and follow-ups for pre and post care
- Assured patient compliance with physician recommendations
- Reviewed and assured compliance with HIPAA regulations
- Provided data, reporting, and specialized office assistance
- Fostered a seamless and efficient service network.
West Coast National Account Manager & Administrative Coordinator
Coventry Healthcare
2007.12 - 2010.12
- Responsible for managing and supporting all aspects of Provider Relations for all reimbursement products including Medicare, Medicaid and all managed care plans
- Evaluated the provider network to ensure membership access and develop recruitment plans
- Effectively maintained relationships with other department managers and served as main liaison between care management and care management coordinators
- Managed servicing Hospital, Ancillary, and long-term Care Providers for all products offered
- Actively participated in escalated claims issues by facilitating meetings with providers and coordinating research of claims issues internally
- Provided continuous training to team members to ensure that they possessed the required knowledge and information to effectively carry out their responsibilities
- Created and maintained provider relations newsletter, provider directory, and provider manual
- Managed the process of credentialing
- Managed work plans for staff in order to accomplish objectives
- Developed provider network applications in order to efficiently run reports and manage networks.
Vice President of Provider Relations and Client Services
Primary Provider Management Company (PPMC) / Vantage Medical Group
1984.12 - 2007.01
- Selected to work with Medical Directors & Administration for knowledge of utilization review and ongoing credentialing/quality assurance for 470 medical providers in California
- Ensured all providers were knowledgeable of, and in compliance with PPMC contracts and the Department of Health Services (DHS)
- Acted as a liaison between Providers, Medical Director, and upper management
- Regulated compliance with Medicare/Medicaid rules & regulations and audited medical documentation
- Provided exceptional customer service and built effective relationships between departments and providers within the organization
- Worked with our providers on coding and documentation
- Provided excellent customer service to the Medicaid population to ensure access to care
- Developed policies, procedures and standards for all department activities and processes
- Developed and monitored departmental budget
- Ensured compliance with all CMS (Center for Medicare & Medicaid Services), and State Medicaid regulations
- Directed and implemented strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs
- Ensured that all grievances & appeals were processed in adherence to the Centers for Medicare and Medicaid (CMS) guidelines and plan policy
- Prepared case files for Medical Director Review and external (including IRE) review of grievances & appeals.
Education
Certified Paralegal, American Bar Approved (ABA) Paralegal Program -
University of San Diego
San Diego, CA01.2009
Health Care: Managed Care Executive, University of Pennsylvania, Leonard Davis Institute -
PA
01.2005
Certified Managed Care Executive -
01.2005
Business Administration -
Menlo College
01.1984
Skills
- Strong organizational skills
- Healthcare system understanding
- Patient confidentiality
- Exceed Patient Care satisfaction levels
- Communication, interpersonal, and problem-solving skills
- Active listening
- Interpersonal skills
Certification
Certified Paralegal through an ABA Program
Timeline
Provider Relations and Patient Concierge
Caduceus Medical Group and PDQ Urgent care and More
2023.01 - Current
Covid Manager
Caduceus Medical Group
2020.01 - 2023.01
Business Development /Marketing
Caduceus Medical Group
2019.04 - 2020.01
Risk Management & Concierge
Caduceus Medical Group
2016.08 - 2019.01
Owner, Operator
It’s All About You, LLC.
2014.12 - 2016.01
Administrator & Surgery Scheduler
Coronado Eye Associates
2010.12 - 2012.12
West Coast National Account Manager & Administrative Coordinator
Coventry Healthcare
2007.12 - 2010.12
Vice President of Provider Relations and Client Services
Primary Provider Management Company (PPMC) / Vantage Medical Group
1984.12 - 2007.01
Patient Service Representative III
Scripps Healthcare: General Surgery and OB/GYN
- 2014.12
Certified Paralegal, American Bar Approved (ABA) Paralegal Program -
University of San Diego
Health Care: Managed Care Executive, University of Pennsylvania, Leonard Davis Institute -
PA
Certified Managed Care Executive -
Business Administration -
Menlo College
Certified Paralegal through an ABA Program
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