Raquel Guise

• Self-motivated, with a strong sense of personal responsibility.
• Work effectively in fast-paced environments.
• Assist with day-to-day operations, working efficiently and productively with all team members.
• Manage time efficiently in order to complete all tasks within deadlines.
• Organized and detail-oriented with a strong work ethic.

Supervise department managers and oversee daily facility operations.

• Used critical thinking to break down problems, evaluate solutions and make decisions.
• Strengthened communication skills through regular interactions with others.
• Demonstrated strong organizational and time management skills while managing multiple projects.

• Coordinated and hold daily morning meetings with all staff within the 180-bed long term, skilled nursing facility
• Completed daily audits to improve the effectiveness of the money operations within the unit
• Reported all incidents to the State of Mississippi; educate staff members on proper safety guidelines to prevent and reduce injuries
• Interview highly skilled interviewees for all positions within the facility; ensure proper onboarding and training of all personnel hired
• Worked closely with operations, case management, intake, and other personnel to manage billing, contracting, and provider credentialing issues

• Coordinated and hold daily morning meetings with all staff within the 180-bed long term, skilled nursing facility
• Completed daily audits to improve the effectiveness of the money operations within the unit
• Reported all incidents to the State of Mississippi; educate staff members on proper safety guidelines to prevent and reduce injuries
• Interview highly skilled interviewees for all positions within the facility; ensure proper onboarding and training of all personnel hired
• Worked closely with operations, case management, intake, and other personnel to manage billing, contracting, and provider credentialing issues

• Coordinated and hold daily morning meetings with all staff within the 60-bed long term, skilled nursing facility
• Completed daily audits to improve the effectiveness of the money operations within the unit
• Reported all incidents to the State of Mississippi; educate staff members on proper safety guidelines to prevent and reduce injuries
• Interview highly skilled interviewees for all positions within the facility; ensure proper onboarding and training of all personnel hired
• Worked closely with operations, case management, intake, and other personnel to manage billing, contracting, and provider credentialing issues

• Managed billing for residents and analyzed and planned budget proposals
• Planned and directed operations of the nursing home based on federal guidelines and policies established by the owner of the establishment
• Supervised all staff within the 120-bed long term, skilled nursing facility
• Monitored and maintained appropriate standards of care throughout all departments
• Researched and analyzed the insurance industry activities, payer strategy, healthcare reform and participated in legislative committee meetings to gain insight on potential state and federal impacts

• Complied with all regulations and policing, including HIPAA, infection control, safety, OSHA, and other applicable agencies
• Collaborated with other healthcare facilities and community leaders on initiatives to promote and improve the patient’s health
• Completed all tasks assigned by the nursing home administrator in a timely and effective manner
• Developed and implemented clinical programs within the facility to ensure accurate, effective, and cost-effective care to each resident
• Improved and developed procedures to certify that nursing home staff effectively treated and cared for each individual patient while complying with HIPAA guidelines

• Maintained and oversaw day to day operations, including the longevity of the clinic
• Scheduled and guided the workflow of employees in accordance with the needs of patients
• Effectively trained and supervised all scheduled employees
• Served as the primary point of contact for payments and contracting concerns
• Worked with other members of leadership to plan for development and improvements within the facility

• Verified whether a patient’s benefits covered the required procedure
• Served as a liaison between patients and insurance companies while verifying patient’s coverage under each specific insurance plan
• Educated patients on their insurance coverage, copayments, and effective date(s)
• Obtained pre-authorizations
• Collected payments from patients for collection accounts, copayments, and all other services rendered

• Operated efficiently in dynamic settings to handle substantial claim volumes.
• Maintained up-to-date knowledge of industry regulations, ensuring compliance in all aspects of claims handling.
• Improved team performance by providing ongoing training and support for Claims Associates on best practices and procedures.
• Managed high-volume claim caseloads, ensuring accurate documentation and adherence to company policies.
• Provided exceptional customer service by addressing inquiries promptly and resolving issues professionally.

• Collaborated with cross-functional teams to identify opportunities for process improvement and increased efficiency.
• Improved internal knowledge sharing by developing comprehensive documentation outlining standard operating procedures for various tasks.
• Enhanced team collaboration by providing clear communication of complex findings through visualizations and reports.
• Implemented predictive analytics techniques that enabled proactive adjustments to business strategies based on emerging trends.