Uyen Anh Pham
Huntington Beach,CA
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Skilled in working under pressure and adapting to new situations and challenges with vast direct and indirect knowledge in the Healthcare Businesses. Including and not limit to patients' care, customer relations, network providers, and regulatory agencies such as DHCS, CMS and NCQA.
Overview
11
11
years of professional experience
Work History
CalOptima Customer Service Dept – E&R Team
CalOptima
2017.12 - Current
- Prepare and create reporting tools
- Knowledgeable and work independently with Contracting Dept to process LOA’s (Letter of Agreement)
- Assists Contracting Dept in entering LOA UWM on Facets
- Update LOA requests and monitor LOA reports daily
- Coordinate processes that include strategic provider assignments, eligibility analysis for the Medi-Cal program
- Knowledgeable and work independently with Provider Relation to process CCN PCP/Practitioner Term Change Member Impact
- Data reporting, analysis and reconciliation
- Ensures processes are accurate and compliant with the regulatory requirements by maintaining and documenting the process workflows, desktop procedures, and policies and procedures
- Process and conducts quality assurance audits to validate accuracy of Protected Health Information
- Knowledgeable and work independently with Case Management to identify members with Incorrect VIP Code
- Process ImageNet Health Network Selection Forms submitted by members as well as performing outreach to ensure member is assigned to a HN and PCP in a timely manner
- Process and submit member’s application to CMS in a timely manner
- Knowledge of processing application requirement s for Center for Medicare and Medicaid (CMS)
- Knowledge of process for Daily Transaction Reply Report via CMS
- Conduct Daily Transaction Reply Report audit to ensure transactions are processed in a timely manner
- Other projects and duties assigned.
Nhan Hoa Comprehensive Care Clinic
Nhan Hoa
2013.01 - 2017.12
- PCMH Lead – Project Coordinator
- Leads planning, development and the certification process for Nhan Hoa to become PCMH recognized
- Once recognized works to maintain the recognition
- Provides expert advice to PCMH program staff on the development, communication, and implementation of key issues related to PCMH
- Represent Nhan Hoa as a liaison within and outside of the organization
- Conduct quality assurance audits
- Act as liaison between members and organization
- Assist Physicians to develop policies and procedure in compliance with PCMH standards
- QI/QA Coordinator
- Conduct monthly QI/QA team meeting and QI/QA audit
- Monitor the effectiveness of care services provided
- Conduct regular chart reviews of member files to verify compliance with clinical standards regulations
- Interpret UDS data and ensure the organization is in compliance with regulatory requirements
- Conduct quality assurance audits
- Care Management - Personal Care Coordinator
- Conduct telephonic HRAs
- Communicate with patients/members to determine problems, functional status, goals and need for specific services
- Effectively communicate with licensed professional and interdisciplinary team in the development of care plan and assessment findings
- Maintain documentation of member’s case and care plan and interdisciplinary care team within Nhan Hoa medical management team
- Collaborate with licensed professionals and health care teams to ensure timely communication of member’s clinical information and findings
- Communicate effectively with individuals from various ethnic and culture background
- Rapport and effective communication with members and internal as well as external contacts
- Collaborate with interdisciplinary team to resolve member concerns
- Identify member needs and referrals to Long Term Support Services (LTSS) and community resources.
Education
Bachelor of Science - Health Care Administration
California State University - Long Beach
Long Beach, CA2026-06
Associate Degree - Health & Science
Golden West College
05.2011
Medical Assistant -
Corinthian College
07.2000
Skills
- Knowledgeable of SharePoint
- Knowledge of DHCS and CMS regulations
- Knowledge of Medical/Medicaid eligibility and benefits
- Worked with licensed certified professionals
- Knowledge of general information relevant to professional or administrative responsibilities in the department
- Knowledge of HEDIS, NCQA
- Knowledge of Long Term services and supports
- Interdepartmental Communication
- Data Management
- Status Updates
- Medical Terminology Knowledge
- Customer Service Excellence
- Customer Account Management
- Professional Telephone Demeanor
- Team Management
- Policy Enforcement
- Telephone Etiquette
- Client Engagement
- Complaint Resolution
- Business Writing
- Customer Relations
- Customer Service
- Training Materials
- Meeting Facilitation
SKILLS AND PROFICIENCY
Windows, MS Word, MS Excel, MS Outlook, Visual Basic, C-programing, and Web Design
LANGUAGES
- English and Vietnamese - Oral and Written
Timeline
CalOptima Customer Service Dept – E&R Team
CalOptima
2017.12 - Current
Nhan Hoa Comprehensive Care Clinic
Nhan Hoa
2013.01 - 2017.12
Bachelor of Science - Health Care Administration
California State University - Long Beach
Associate Degree - Health & Science
Golden West College
Medical Assistant -
Corinthian College
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