Teresa Orozco

Humana PCO – Dallas, TX

September 16, 2024 – Present

• Educate members on Senior Primary Care services, benefits, and preventive programs through inbound and outbound calls.

• Coordinate member care by scheduling appointments, verifying eligibility, and connecting patients with clinical services.

• Perform needs assessments to identify care gaps and support Medicare quality initiatives.

• Meet quality, compliance, and productivity standards while delivering exceptional customer service.

• Document member interactions accurately to support reporting, operations, and outreach efforts.

• Collaborate with care teams to ensure timely follow-up and personalized support for members.

• Assist in closing quality gaps by providing education on screenings, preventive care, and appointment reminders.

• Train physicians and staff members for 28 different practice locations on quality and risk adjustments to increase their human capital performance improvement efforts.
• Build and facilitate provider communication management processes to manage daily providers and their practice needs
• Facilitate monthly meetings at provider offices to provide dynamic on-the-job and hybrid training to ensure staff meet metrics and goals
• Cultivate exceptional standards and a talented team atmosphere through mentoring and coaching opportunities
• Coordinate training plans and evaluate staff at various locations
• Establish a collaborative professional team environment by using stakeholder relationship management skills to develop trusting relationships with staff across multiple locations
• Develop strategic performance solutions on demand to address network and performance issues to improve the provider network
• Strategically problem-solve to provider performance hindrances to lessen their impact as it relates to the ability to deliver services
• Respond to network management requests and respond to inquiries using professional knowledge and industry experience
• Train employees on network management policies and procedures, to ensure employees operate within full compliance
• Facilitate provider communication updates and activities and make recommendations for improvements
• Facilitate performance reporting evaluations and analyses, using work performance improvement principles, strategies, and frameworks to exceed performance goals and metrics
• Analyze performance metrics for training data tracking and reporting
• Consistently communicate and train employees through quick rapport and credibility-building efforts to cultivate lasting professional

• Built quick rapport and provided exceptional customer service for in-person and phone support for high-volume patient care.
• Led and managed daily receptionist and clerical office coordination
• Coordinated and maintained patient record keeping, ensuring data entry is completed according to HIPPA regulation
• Leveraged medical coding knowledge and communication skills to successfully advocate for patients with insurers
• Provided patient progress updates and feedback to the medical team
• Managed medical documentation in accordance with Quality Assurance guidelines to ensure 100% compliance
• Served as a patient care coordinator and retrieved phone messages for interprofessional staff team members
• Managed patients’ appointments and facilitated office scheduling using advanced technology software and care coordination skills
• Ensured 100% adherence to patients’ safety and privacy guidelines to provide adequate and quality patient care.

• Managed accounts payable, patients’ records, invoices, balance sheets, and expense reconciliations for the medical organization
• Resolved complex patient concerns and issues as a practice administrative leader using outstanding personalized customer service, empathy, and professional communication
• Served as a subject matter expert for staff and patients, educated them on insurance, benefits, and claims information
• Supported the billing department by completing medical billing, coding, claims, and the management of patients’ financial records
• Consistently communicated with patients and staff to obtain and disseminate information in a coherent and effective manner
• Developed, managed, and evaluated billing department processes to maximize timeliness of account processing
• Built quick rapport with stakeholders to carry out office tasks
• Organized and maintained the administrative support processes, including scheduling, billing, insurance verifications, and finance departmental needs
• Managed and monitored claims using software and patient databases
• Coordinated HIPPA training and facilitated medical record and training audits to ensure compliance was consistently met
• Completed marketing analyses and developed outreach efforts to increase patient volumes in the Hispanic community
• Built and cultivated lasting relationships with customers to create an inclusive and welcoming healthcare environment
• Managed various reporting tasks, using software and databases to analyze and collect data used for organizational purposes
• Maintained excellent data management, including tr