Shella Gutierrez
Union City,CA
Summary
To utilize my knowledge, experience and skills and work for an establishment with stability, challenging positions and room for growth
Operations professional with solid background in streamlining processes and enhancing operational efficiency. Known for effective team collaboration and achieving results in dynamic environments. Skilled in process optimization and problem-solving, with reliable and adaptable approach to changing needs.
Experienced with operational process improvements and streamlining workflows for efficiency. Utilizes strong problem-solving skills and collaborative approaches to meet organizational goals. Track record of effective resource management and implementing best practices for operational success.
Operations professional with substantial experience in optimizing processes and driving operational efficiency. Expertise in project management, process improvement, and logistics coordination. Strong focus on team collaboration and achieving measurable results. Known for adaptability and reliability in dynamic environments.
Overview
19
19
years of professional experience
Work History
Access Operations Specialist
Stanford Health Care
11.2015 - Current
- Respond to a high-volume of incoming and outgoing telephone calls and faxed referrals.
- Assist patients in registering, scheduling, changing, and canceling appointments.
- Facilitate communication between the patient and the physician or clinic.
- Deliver expert knowledge regarding clinic-specific processes.
- Identify urgent customer needs or operational issues, and escalate appropriately.
- Efficiently navigate medical records and ensure patient information is up-to-date and accurately entered in the correct location.
- Communicate with care team and support staff on various patient issues.
- Follow documented protocols and guidelines.
- Meet and exceed departmental quality assurance standards.
- Use reference documents and online knowledge base tools to clearly articulate accurate information regarding SHC services.
- Streamlined operational workflows to enhance patient care efficiency.
- Coordinated scheduling for clinical staff, ensuring optimal coverage and resource allocation.
Payor Authorization Representative
Stanford Health Care
07.2013 - 11.2015
- Manage patient work queue database
- Collaborate with insurance companies and clinical staff to obtain prior authorizations for consults, procedures, laboratory services, in-patient chemotherapy treatment and diagnostic radiological exams
- Correspond with insurance companies to give clinical and medical necessity information
- Assist coverage with other department
- Authorize and provide prescription information to pharmacies
- Contact medical facilities and departments to schedule patients for diagnostic testing and/or radiology procedures
- Correspond with patients to obtain insurance demographics
- Assist patients in financial assistance applications
Department Coordinator I
Palo Alto Medical Foundation
03.2011 - 03.2013
- Schedule surgeries for Cardiothoracic surgeons with the facility including emergency admissions and surgery
- Ensures that all paperwork is completed and coordinated between facility, staff and physicians
- Schedule patient’s consult, pre and post operative appointments
- Serves as a liaison between Sequoia, El Camino, Mills Peninsula and Dominican Hospital
- Calls for pre-authorization to insurance companies and health plans office. Ensures that authorization is obtained for surgical procedures DME, MRI, CT scan, outside referrals or other authorizations as assigned.
- Present all non-clinical pre-operative instructions to patient and counsels patient regarding schedule and pre-op.
- Communicates with physicians and patients to resolve billing problems and counsels patients on billing questions.
- Serves as a department purchasing agent
- Purchases supplies for office and clinical needs
- Create on-call schedules for all surgeons, physician assistants and RNs and forward to all contracted hospitals
- Billing and Coding Procedures
- Participated in Project Transformation (convert IDX & other office application systems into Epic)
Patient Service Representative
Palo Alto Medical Foundation
06.2010 - 03.2011
- Customer Service
- Greets and check in patients
- Schedule appointments within the guidelines of advanced access like IDX & EMR system
- Responsible for coordinating contact between patient and the nurse and/or physicians
- Recognize nature of patients request and determine appropriate action
- Sending prescription refills, orders, referrals, results to patient’s primary care
- Completes and performs editing functions for the department providers
- Check assigned doctors daily schedule for accuracy & efficiency
- First Call Resolve certified
- Checking all doctor’s availability for next day schedule
- Print daily schedule for Nutrition and Internal Medicine Department
Quality Analyst
Sutter Physician Services
10.2007 - 05.2010
- Analyze and audit the Business Accounts Receivable, Manage Care and Customer Service Department
- Audit the following departments in BAR: Credit Balance, Deposits, Recoveries, Payment Posting, and Charge Corrections
- Perform random audits on daily basis for payments, credits, deposits, adjustments and posting were performed correctly to the correct account, fund using the appropriate codes.
- Perform comprehensive audits on those employees that fall below department standard and training audits on new employees.
- Track employee scores and preparing monthly certificates for employees that have met company quality standard.
- Track error trends for the departments and communicate to management any trends found.
- Develop weekly and monthly reports on various departments being audited and distribute to appropriate leadership team.
- Assist with the transition of the new Customer Service Dept to Salt Lake City, Utah
- Trained new Auditor & analyst to the new Customer Service Dept from Salt Lake City, Utah
Account Representative II
Sutter Physician Services
09.2006 - 10.2007
- Responsible for effective Billing and Accounts Receivable management of outstanding claims, revenue recycle management, registration, insurance, appointments, scheduling
- Research and follow up on unpaid claims, denials, & tracers
- Coordinate with insurance companies to resolve patient billing/carrier issues to ensure expected payment
- Respond inquiries and correspondence related to outstanding charges from payers such as Medical, Medicare, Health Net, etc
- Ability to ensure accurate payments and adjustments on all Billing and account receivables invoices
- Write appeals to health plans and medical groups
- Complete understanding of various Health Maintenance Organizations, plan carve outs, Division of Financial Responsibilities, capitation and authorization requirements in order to fulfill responsibilities
Education
CPC Certification/Class -
UC Davis Extension Continuing Education
Sacramento, CABachelor Science - Health Information Management
Capella University
10.2025
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Heald College
Hayward, CA05.2008
Skills
- Experienced in EPIC, EMR, IDX, Advance Web, MS Word, Excel, Access, Power Point & Outlook
- Excellent research capabilities with Explanation of Benefits, Division of Financial Responsibility using CPT & ICD-9 with proven success in dispute resolution
- Strong interpersonal and communication skills resulting in excellent support of internal and external clients/patients
- Excellent public interaction skills, and team support skills
- Operational efficiency
- Planning and coordination
- Cross-functional communication
- Project management
- Operations coordination
- Risk mitigation
Timeline
Access Operations Specialist
Stanford Health Care
11.2015 - Current
Payor Authorization Representative
Stanford Health Care
07.2013 - 11.2015
Department Coordinator I
Palo Alto Medical Foundation
03.2011 - 03.2013
Patient Service Representative
Palo Alto Medical Foundation
06.2010 - 03.2011
Quality Analyst
Sutter Physician Services
10.2007 - 05.2010
Account Representative II
Sutter Physician Services
09.2006 - 10.2007
Bachelor Science - Health Information Management
Capella University
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Heald College
CPC Certification/Class -
UC Davis Extension Continuing Education