Valleria Mejia
Los Angeles,CA
Summary
Seeking a position where I can utilize my extensive experience in the Healthcare Field. Able to handle multiple responsibilities, set priorities and respond positively to demanding situations.
Overview
11
11
years of professional experience
Work History
Authorization Technician
LA Care Health Plan
2022.11 - Current
- Preceptor - Train new onboarding staff on standard operating procedures, ensuring consistency across the team.
- Support the UM Specialist by handling all administrative and technical functions of the authorization process including intake and follow up
- Collect information required by clinical staff to render decisions
- Assist Manager and Director with the Medical Management regulatory time lines by maintaining an accurate database inventory of referral authorizations, retrospective reviews, and concurrent reviews and prepare UM reports
- Data entry and processing of referrals/authorizations in the system
- Authorizes requests consistent with auto auth criteria
- Assists with communication of determinations by preparing template letters for members/providers with other duties as assigned
- Process Disenrollments and Pharmacy requests
- Assist with Special Projects
- Provide training to new staff
- Monitor Authorization Queue to ensure coverage and calls are answered in a timely manner.
Customer Solution Center Project Specialist I
L.A. Care Health Plan
2020.03 - 2021.07
Customer Solution Center Project Liaison
L.A. Care Health Plan
2015.09 - 2020.03
- Analyze/Report issues that occur within the Call Center
- Prepare documents to role out new enhancements into QMEIS/MEIS/Oracle Database/IVR/Provider Portal/Legacy Member Portal/QNXT/MHC/Salesforce/CCA/MEP/QNXT
- Recommend suggestions on enhancements for our day to day programs
- Collaborate with Project Managers, Specialists, Analysts, and other units to successfully launch different projects and new programs
- Train staff on systems, process conversions and enhancements
- Create/Update Procedures and Desk Level Procedures
- Create/Update Flowcharts
- Submit Service Request Forms
- Run Oracle reports
- Edit IVR workflows
- Salesforce
- Create test documents for implementations
- Post validate deployment enhancements
- Attend meetings
- Submit Footprint Tickets
- Attend Trainings
- Conduct audits on current processes
- Manage team SharePoint
- Audit CSC incoming calls
- Health X
- Assist with HRA/HIF documentation in CCA, create DLP
- Distribute return mail to the appropriate units
- Assist with preparing documentation for state audits
- Assist with Member and Provider Communication Tracker
- Assist with OSE Intake Projects.
Lead Authorization Technician
2013.12 - 2015.09
- Assist with Special Projects
- Technology implementation and integrity, ensuring regulatory and Accreditation compliance, program utilization and outcome reporting
- Provide training to new staff
- Monitor Authorization Queue and update schedule to ensure coverage and that calls are answered in a timely manner
- Track and Trend reports on talk time
- Coordinate and assist with implementation of process improvements from unit meetings
- Assist Authorization Technicians with questions/concerns
- Monitor staff break/lunch schedules
- Compile and Prepare monthly report for state audits
- Assist with member and provider issues complaints
- Research all potential resources if gaps exist for that member within their service continuum, continuously maintaining an advocacy position
- Pre service, concurrent, and post service authorizations
- Distribute updates/processes to staff when necessary
- Assist with Behavior Health Requests
- Complex Cases.
Education
High School Diploma -
Blair High School
Pasadena, CA01.2004
Skills
- Speak, read and write fluently in Spanish
- Typing 55+ wpm
- Strong Communication and Organizational Skills
- Fast Learner
- Computer Literate – Microsoft Excel, Power Point, Word, Access Database Internet, MHC and AEVS, Tableau, Visio, SharePoint
Timeline
Authorization Technician
LA Care Health Plan
2022.11 - Current
Customer Solution Center Project Specialist I
L.A. Care Health Plan
2020.03 - 2021.07
Customer Solution Center Project Liaison
L.A. Care Health Plan
2015.09 - 2020.03
Lead Authorization Technician
2013.12 - 2015.09
High School Diploma -
Blair High School
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