RENATA GUERRERO
Milford,IL
Summary
A seasoned healthcare administrator with comprehensive expertise in regulatory compliance, operational efficiency, and financial analysis. Adept at overseeing daily operations and guiding cross-functional teams to elevate performance and optimize reimbursement metrics. Skilled in data analysis, the execution of strategic initiatives, and upholding regulatory standards to improve patient experience while driving revenue growth. Results-driven health insurance professional with 5+ years of experience managing claims, ensuring regulatory compliance, and building strong client relationships. Proven track record of exceeding performance metrics while navigating complex plan types like HMOs, PPOs, and Medicare Advantage.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Executive Director
Iroquois Memorial Resident Home
08.2023 - 03.2025
- Directed operations of a skilled nursing facility, ensuring adherence to quality standards and regulatory requirements.
- Provided leadership to a team of 20 healthcare professionals, fostering ongoing staff development.
- Supervised state investigations and implemented corrective actions to maintain compliance.
- Enhanced Medicaid reimbursement through strategic care delivery and accurate reporting.
- Evaluated performance metrics to optimize operational efficiency and elevate resident satisfaction.
- Conducted comprehensive evaluations of nursing staff, emphasizing continuous professional growth.
- Oversaw staff management, administrative functions, financial operations, and project execution.
- Administered hiring, onboarding, coaching, payroll processes, and daily staffing management.
- Acted as a liaison among clinical, hospital, and departmental teams to facilitate seamless process completion.
- Maintained precise payroll records and advanced revenue cycle initiatives.
- Sustained collaborative relationships with physicians, departmental leaders, and administrative, academic, clinical, and research stakeholders to address operational, marketing, and strategic objectives.
- Translated departmental, medical group, hospital, and medical center strategies into actionable business initiatives.
- Engaged physicians in activities supporting established clinical protocols and effective management of clinical and financial resources.
- Assessed industry developments, identified opportunities and threats, recommended strategies, collaborated on best practices, and evaluated resource investments to support potential service line expansion.
Executive Director
Petersen Health Care
03.2022 - 08.2023
- Directed departmental operations to support residential and skilled care services.
- Designed and launched programs to boost resident engagement and satisfaction.
- Ensured compliance with regulatory standards.
- Streamlined processes through collaboration with dietary, clinical, and administrative teams.
- Pursued ongoing professional development in healthcare administration.
- Resolved resident complaints using performance and financial data.
- Managed budget adherence.
- Supervised staff training and development.
- Encouraged cross-training to expand staff capabilities.
- Enhanced communication and coordination among departments.
- Improved operational procedures for greater efficiency.
- Confirmed all staff received appropriate orientation and training.
- Evaluated industry trends and provided strategic recommendations for growth.
- Proposed initiatives to improve market position, patient experience, safety, and efficiency, incorporating leadership feedback.
- Oversaw clinical, business, and academic operations to achieve quality and safety goals.
- Monitored performance metrics and financial reports, communicated findings and recommended corrective actions to leadership.
Medical Assistant to the Program Director of the Residential Clinic
Riverside Medical Center
09.2019 - 03.2022
- Patient Interaction, greet and check in patients, ensuring a welcoming environment.
- Collect and update patient information, while maintaining confidentiality.
- Schedule and cancel appointments to optimize patient flow.
- Serve as a liaison between the patient and the healthcare professionals.
- Customer service to provide a positive patient experience.
- Strong communication to interact effectively with patients.
- Familiar with electronic health care records within the Epic System.
- Assisted the program director and the resident physicians.
- EKG's
- Vitals
- Covid swabs
- Urine tests
Customer Service Representative
CIGNA Health Insurance
09.2013 - 09.2019
- Assisted clients with health insurance questions and enrollment.
- Advised clients on complex health insurance options, successfully enrolling an average of 15 new clients monthly and tailoring plans to meet their specific needs.
- Ensured full HIPAA compliance by conducting regular audits and training staff in new regulatory standards, resulting in a 20% reduction in compliance-related errors.
- Advised clients on various plan types (HMO, PPO, HAS, and Flex Spending), educating them on coverage options and maximizing benefits, which resulted in a 95% client satisfaction rating.
Education
Master of Business Administration - Healthcare Management
Olivet Nazarene University
11.2022
Bachelor of Science - Health Care Administration
Olivet Nazarene University
05.2021
Skills
- Business & Finance: Business Administration, Financial Management, Budgeting, Data Analysis
- Operations & Technical: Operations Strategy, Process Improvement, Epic Software
- Healthcare Management & Compliance: Patient Care, Healthcare Administration, Regulatory Compliance (Federal & State), Medicaid, Reimbursement, Quality & Risk Management, Policy Implementation
- Leadership & Team Management: Team Leadership, Staff Development, Performance Review, Corrective Action, Crisis & Service Management
- Technical skills: Claims processing and adjudication, Eligibility and benefits verification, Prior authorization, Enrollment and policy administration, Software, HIPAA regulations, and regulatory compliance
- Health Insurance Knowledge: HMO, PPO, HSA, and Flex Spending Medicare and Medicaid, Group and individual health plans, and Supplemental insurance
Certification
- Substitute Teacher: I work as a substitute for both Junior High and High School levels.
- Temporary Nursing Home Administrator License: Holder of a temporary license to manage Skilled Nursing facilities, with knowledge of State, Federal, and local regulations.
LANGUAGES
English (Fluent)
Timeline
Executive Director
Iroquois Memorial Resident Home
08.2023 - 03.2025
Executive Director
Petersen Health Care
03.2022 - 08.2023
Medical Assistant to the Program Director of the Residential Clinic
Riverside Medical Center
09.2019 - 03.2022
Customer Service Representative
CIGNA Health Insurance
09.2013 - 09.2019
Bachelor of Science - Health Care Administration
Olivet Nazarene University
Master of Business Administration - Healthcare Management
Olivet Nazarene University
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