Valerie Garza
Harlingen,Texas
Summary
Strong leader with excellent people skills. Detailed oriented, independently skilled, and efficient. Professional, motivating, problem-solver, dedicated to keep agency in compliance with Agency Policy and Procedures along with the Texas Administrative Code (TAC) Title 40 Chapter 47 Primary Home Care, Community Attendant Services and Family Care Programs and (TAC) Title 26 Chapter 558 Licensing Standards for Home and Community Support Services Agencies to positively impact company success.
Overview
21
21
years of professional experience
Work History
PHC/CLASS Regional Director
American Medical Home Health Services
02.2020 - Current
- Assist in recruiting and hiring of employees.
- Train and guide employees to maintain high productivity and performance. All employees are trained of job duties that comply with Agency Policy and Procedures and the Texas Administrative Code (TAC) Title 40 Chapter 47 Primary Home Care, Community Attendant Services and Family Care Programs and (TAC) Title 26 Chapter 558 Licensing Standards for Home and Community Support Services Agencies.
- Manager discussions daily on day to day operations, attendance, and issues/concerns.
- Call all branch office sites daily on day to day operations, attendance and issues/concerns.
- Call PHC Marketers weekly on day to day operations and issues/concerns.
- Call field supervisors in outskirt areas on day to day operations and issues/concerns.
- Review and verify weekly reports sent by manager for accuracy. Discuss census and every topic on the weekly report with manager.
- Discuss Time Off Requests for employees with managers for approval.
- Assist all employees on issues/concerns.
- Monitor employees performance by actively engaging in and observing day-to-day activities.
- Keep up with any new updates on HHSC for PHC, CLASS, EVV, Billing and advise staff of new changes. (Hold In-service if needed)
- Keep up with any new updates on Vesta and follow up with employees to make sure they are aware.
- Follow up with Payroll Department weekly on any issues with attendant payroll and address issues with resolution to employees.
- Review and sign employee payroll timesheets and submit to accounting.
- Monitor EVV numbers and follow up with manager to discuss meeting cut off deadline.
- Follow up with Billing Manager and Billing Team weekly on issues/concerns in reference to EVV, Authorizations and Mesav's and address issues with resolution to employees.
- Follow up with HR weekly in reference to attendant annuals and attendant applications and address issues with resolution to employees.
- Follow up with HR monthly to review LEIE for State and Federal searches for all parent agencies and sign verification monthly log.
- Assist HR with employee counseling.
- Assist and resolve any complaint calls from clients, attendants, and in-house employees.
- Assist employee who handles ANE cases with direction and review 3613 Form once completed with pertinent information before submittal to HHSC. Administrator is advised of all ANE cases.
- Assist any State Surveyors along side with Administrator for complaints.
- Audit PHC and CLASS client and attendant charts for preparation of upcoming Contract and Fiscal Compliance Monitoring Review and assist Surveyors during survey.
- Submit any Corrective Action Plans for any on site visits conducted for Complaints or Contract and Fiscal Compliance Monitoring Review.
- Back up to CLASS Director
- Assist CLASS Director on CLASS Therapy Invoices submitted by therapists. Review, prepare 3625 Form and submit to Billing Department. Once paid all forms with information needed is submitted to accounting.
- Review all CLASS Nursing Assessment, Related Conditions and ICAP information before submittal to HHSC for approval.
- Manage the Harlingen Office.
- Travel to conduct on site visits to parent agencies and branches
- Administrative Agency Assignments as needed.
Billing/Quality Assurance
American Medical Home Health Services
09.2018 - 02.2020
- Research claims by reviewing Authorizations, Mesavs and EVV on denied or rejected and resubmit claims.
- Submit billing resolutions if needed.
- Submit daily billing productivity report.
- Submit logs to Vesta to unlock EVV visits for correction.
- Work on Failed to Export Reports.
- Audit claims for Complaints and Contract and Fiscal Compliance Monitoring Reviews.
- Submit appeals to MCO's on claims being denied.
- Audit PHC and CLASS charts for preparation on upcoming Contract and Fiscal Compliance Monitoring Review for compliance.
- Audit CLASS attendant charts.
Quality Assurance
Bee First Primary Home Care
02.2015 - 09.2018
- Audited PHC, MDCP and CLASS charts along with Billing claims for compliance.
- Audited CLASS attendant charts.
Billing Clerk
Bee First Primary Home Care
03.2012 - 02.2015
- Submit Billing claims to TMHP for payment
- Research claims by reviewing Authorizations and Mesavs on denied or rejected claims and resubmit claims.
- Submit billing resolutions if needed.
- Submit daily billing productivity report.
- Audit claims for Complaints and Contract and Fiscal Compliance Monitoring Reviews.
- Submit appeals to MCO's on claims being denied.
CBA Senior Clerk
Bee First Primary Home Care
05.2009 - 03.2012
- Coordination duties - search for attendants for clients with no attendants, prepare attendant hire for RN, prepare supervisory every three months for RN, prepare annual and post hospital visits for RN, schedule visits and enter visits done which RN has conducted in Vesta, enter schedule for attendant in Vesta, verify attendants hours are correct for each pay period, audit attendant chart, keep track of respite hours being utilized for each attendant, request adaptive aids, medical supplies and minor home modifications for clients to caseworker, prepare 485 form for RN bi-annual, follow up with doctors office on 485's to meet deadline and follow up on hospitalizations.
CBA Office Manager
Bee First Primary Home Care
12.2003 - 05.2009
- Conduct weekly meetings with Department Staff and discuss census and day to day operations.
- Follow up with CBA RN on visits scheduled monthly and visits completed.
- Audited RN Nursing Assessments.
- Trained new staff on coordination duties.
- Monitor staff on productivity and job performance.
- Attend client appeal hearings.
- Attend Manager Meetings with Administrator
- Monitor CBA claims to ensure all claims are paid
Billing Clerk
Bee First Primary Home Care
08.2001 - 12.2003
- Submit Billing claims to TMHP for payment
- Research claims by reviewing Authorizations and Mesavs on denied or rejected claims and resubmit claims.
- Submit billing resolutions if needed.
- Submit daily billing productivity report.
- Audit claims for Complaints and Contract and Fiscal Compliance Monitoring Reviews.
- Submit appeals to MCO's on claims being denied.
Education
Bachelor of Science - Nursing
The University of Texas At Brownsville
Brownsville, TXBachelor of Science - Nursing
South Texas College
McAllen, TXCertificate - General Business
Texas State Technical College
Harlingen, TX08.1999
High School Diploma -
Harlingen High School
Harlingen, TX05.1991
Skills
- Computer Literate
- Vesta Web
- Microsoft Word
- Microsoft Office
- Excel
- Power Point
- Quality Assurance
- Great Communication Skills
Languages
Spanish
Timeline
PHC/CLASS Regional Director
American Medical Home Health Services
02.2020 - Current
Billing/Quality Assurance
American Medical Home Health Services
09.2018 - 02.2020
Quality Assurance
Bee First Primary Home Care
02.2015 - 09.2018
Billing Clerk
Bee First Primary Home Care
03.2012 - 02.2015
CBA Senior Clerk
Bee First Primary Home Care
05.2009 - 03.2012
CBA Office Manager
Bee First Primary Home Care
12.2003 - 05.2009
Billing Clerk
Bee First Primary Home Care
08.2001 - 12.2003
Bachelor of Science - Nursing
The University of Texas At Brownsville
Bachelor of Science - Nursing
South Texas College
Certificate - General Business
Texas State Technical College
High School Diploma -
Harlingen High School
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