Vera Silva
Miami,Florida
Summary
Dynamic and highly analytical professional with broad experience in directing all aspects of health care for over 17 years, encompassing program integrity, medical coding, and medical group billing / finance.
Overview
21
21
years of professional experience
1
1
Certification
Work History
National Clinical Operations Manager
New Health MD
Miami, Florida
01.2023 - Current
- Currently oversees 14 clinics functions
- Employed active listening and interpersonal talents to effectively interact with various individuals, including physicians, patients and fellow employees.
- Collaborated with healthcare professionals to deliver high-quality patient care.
- Oversaw daily activities and interactions with patients.
- Interviewed applicants and made recommendations for new hires.
- Encouraged high morale and staff retention through effective communication, prompt problem resolution, proactive supervisory practices and facilitation of proactive work environment
- Delegated tasks to each member of staff and oversaw task completion, offering assistance to promote success.
- Managed clinical operations and procedures, including enforcing adherence to federal and state regulations and healthcare law requirements.
- Improve policies and procedures through development, implementation, revision and evaluation of new protocols * *
- Enforced compliance with local, state and federal healthcare regulations, including Medicare and Medicaid requirements, HIPAA and OSHA.
- Coordinated weekly work schedules for all department employees
- Developed and initiated departmental goals, standards of performance, policies and procedures.
- Oversaw clinical operations and procedures while remaining current of federal and state regulations to ensure organization processes were fully compliant with new healthcare law requirements
- Introduced new departmental policies and oriented staff to facilitate adoption of changes.
- Spearheaded training and orientation for newly hired staff and university students.
Risk Adjustment Coding Analyst
Associated Medical Care
Miami, Florida
11.2021 - 01.2023
- Verified accuracy of procedure codes to ensure proper reimbursement levels.
- Maintained up-to-date knowledge of coding changes, updates, and new rules.
- Provided support for coding queries raised by coders or staff members regarding specific cases or coding issues.
- Validated accuracy of diagnosis codes as well as modifiers used on claims before final submission to payer and insurance companies.
- Maintained confidentiality of patient information according to HIPAA regulations.
- Assigned diagnosis codes based on provider documentation while adhering to established coding guidelines and conventions.
- Identified any potential risk areas or areas needing further review by physician or other staff members.
- Provided education regarding correct coding principles, practices, policies, and procedures to departmental staff members.
- Resolved discrepancies between diagnoses as stated by providers and those identified through medical record reviews.
Internal HCC Risk Adjustment Auditor
University Health Care FL
Miami
01.2021 - 01.2023
- Knowledge of HCC coding and documentation guidelines
- Reducing the gap between billing and misuse of codes to ensure quality assurance
- Responsible for accurate and complete coding according to compliance guidelines
- Guide doctors and appropriate team members on proper coding protocols
- Review EMR patient charts and physician notes to ensure proper terminology and HCC codes are being used accurately
- Daily billing audits for HCC codes
- Conduct HEDIS reporting.
Medical Assistant
MetroMed Clinic FL - Oscar L Hernandez, MD
01.2012 - 01.2017
- Recording patients' vital signs, documenting physicians' notes and changes in medical conditions
- Taking tissue and fluid samples and sending them in for laboratory analysis
- Prepping exam rooms for clinical procedures and assisting practitioners with patient care
- Assisting physicians during routine checkups, outpatient procedures and other physical exams
- Monitoring and documenting patient symptoms for physicians' review during clinical exams
- Providing compassionate patient support and care, attention, and assistance during office visits
- Preparing and administering medications under the direction of supervising physicians.
Front Desk Supervisor and Referral Coordinator
MetroMed Clinic FL - Oscar L Hernandez, MD
01.2006 - 01.2012
- Receptionist back up during high patient volume times
- Greet patients, as well as work with patients to arrange and schedule referral appointments
- Insurance Verification.
Front Desk Coordinator
MetroMed Clinic FL - Oscar L Hernandez, MD
01.2004 - 01.2006
- Greet, schedule, & confirm patient appointments
- Bookkeeping & billing
- Keep front desk paperwork organized and up to date.
Education
Master of health administration -
UNIVERSITY OF PHOENIX
01.2018
BACHELOR OF FINE ARTS -
MIAMI INTERNATIONAL UNIVERSITY OF ART AND DESIGN
01.2014
Skills
- Costs analysis
- Compliance with Health Care Regulations
- Conducting Medical Facility Inspections
- Develop Strong Physician Relationships
- Health Care Issues
- Supervise Health Insurance Processing and Physician Billing
- Medicaid and Medicare Management
- Medical Delivery and Treatment Services
- Budgeting and Controlling Expenses
- Facilitate Meeting Discussions
- Marketing and Promoting
- Operations
- Quality Control
- Negotiating Contracts
- Purchasing
- Human Resources
- ICD -10
- HCC coding experience
- Medical terminology
- Medical abbreviations
- Pharmacology
- Disease processes
- Written communication skills
- Verbal communication skills
- Remote work
- Time management skills
- Computer hardware
- Computer software
- Data processing
- Data security
Awardsandacknowledgements
Member, Upsilon Phi Delta, Health Services Administration Honors Society
Certification
- Certified Risk Adjustment Coder
Languages
Spanish
Professional
English
Professional
Timeline
National Clinical Operations Manager
New Health MD
01.2023 - Current
Risk Adjustment Coding Analyst
Associated Medical Care
11.2021 - 01.2023
Internal HCC Risk Adjustment Auditor
University Health Care FL
01.2021 - 01.2023
Medical Assistant
MetroMed Clinic FL - Oscar L Hernandez, MD
01.2012 - 01.2017
Front Desk Supervisor and Referral Coordinator
MetroMed Clinic FL - Oscar L Hernandez, MD
01.2006 - 01.2012
Front Desk Coordinator
MetroMed Clinic FL - Oscar L Hernandez, MD
01.2004 - 01.2006
Master of health administration -
UNIVERSITY OF PHOENIX
BACHELOR OF FINE ARTS -
MIAMI INTERNATIONAL UNIVERSITY OF ART AND DESIGN
- Certified Risk Adjustment Coder
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