Veronica Alvarenga
Staten Island,NY
Summary
Dedicated medical professional with 20+ year experience in clinical environment management/ medical administrative tasks and proven track record of enhancing patient care. Exceptional communication skills and strong foundation in medical terminology and healthcare procedures. Driven in promoting team success through attention to detail and excellent organizational skills.
Overview
21
21
years of professional experience
Work History
MDS Clerk
Carmel Richmond Nursing Home
Staten Island , NY
07.2018 - Current
- Answered multi-line telephone system and routed calls to appropriate personnel.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Generated appropriate forms for MDS Coordinators, enters demographic data onto MDS assessment in Wellsky.
- Maintained current working knowledge of PDPM, CPT, and ICD-10 coding principles, government regulations, protocols, and third-party billing requirements.
- Entered coded data into electronic health record (EHR) systems.
- Coordinated with billing department to clarify billing issues related to coding.
- Performed data entry of Minimum Data Set 2 (MDS) and transmits information to the State.
- Prepared monthly MDS schedules and ensures CP and CCP meetings are scheduled within Medicare guidelines. Pulls all of the daily submissions from Wellsky.
- Coordinates timely submission of all required documents, including Minimum Data Set forms, Quarterly and Annual Assessment Reconciliation, and other regulatory paperwork.
- Runs reports in Wellsky EHR and enters billing information into the Simple system. Submits data to CMS.
- Review validation report and bring to the attention of an MDS Coordinator any issues/concerns regarding an MDS not being accepted by CMS.
- Audited monthly MDS submissions for accuracy, timeliness, completeness, and compliance with applicable regulations.
- Generates non-coverage letters for any resident coming off Medicare. Exhausting letters when a resident reaches 100 days of Medicare, and letters for residents coming off of Medicare and remaining in the facility long term.
- Managed multiple projects simultaneously while meeting tight deadlines.
- Facilitated team meetings with members from other departments, such as Social Services, Dietary, Activities, and Rehabilitation services, to discuss short-term and long-term resident issues and concerns related to the MDS process.
- Followed standard operating procedures to perform quality control audits.
- Participated in survey preparation activities by ensuring that all necessary documents were available during surveys conducted by state agencies or accreditation organizations.
- Processed incoming medical records requests from Livanta for Medicare and HMO Appeals, validating medical records for upload following established protocols.
Unit Clerk
Carmel Richmond Nursing Home
Staten Island, NY
07.2015 - 06.2018
- Provided customer service by greeting visitors, answering inquiries and directing them to the appropriate department or personnel.
- Maintained accurate inventory of medical supplies and equipment.
- Verified patient information, such as name, address, phone number, and insurance information, prior to scheduling appointments.
- Provided assistance in coordinating transfers between units or facilities when necessary.
- Attended training sessions on new policies, regulations or procedures relating to medical unit operations.
- Demonstrated knowledge in medical terminology to accurately transcribe physician orders.
- Managed the organization and cleanliness of the nursing station and patient areas.
- Trained new unit clerks and volunteers, fostering a collaborative and knowledgeable team environment.
- Coordinated scheduling of patient admissions/discharges, appointments, tests, and procedures, optimizing department workflow.
Medical Office Manager
Alvaro Rodriguez MD
Staten Island, NY
06.2004 - 07.2015
- Maintained accurate patient data, including medical history, laboratory results, billing information and other relevant documents.
- Handled general office duties to support administrative staff during peak hours.
- Registered new patients into practice management software program accurately entering demographic information.
- Assisted physicians with patient care by taking vital signs, patient histories and preparing patients for examinations.
- Performed basic laboratory tests such as urinalysis and blood glucose levels under direct supervision of a physician or registered nurse.
- Prepared laboratory specimens for analysis and organized lab results for review by the physician.
- Processed orders for medical supplies and lab equipment.
- Conducted EKGs, spirometry testing, and blood drawing as requested by the physician.
- Ensured that all instruments used during exams were cleaned properly after each use according to established protocols.
- Kept examination rooms clean, stocked with necessary supplies and prepared for incoming patients.
- Coordinated with insurance companies to verify coverage of services rendered.
- Monitored regulatory updates from Medicare and Medicaid programs as well as private insurers.
- Assigned appropriate codes using ICD-10-CM for diagnosis, CPT for procedures, HCPCS for supplies and modifiers as required by payers.
- Answered phones, scheduled appointments and managed patient flow while greeting visitors in a professional manner.
- Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
- Contacted pharmacies to submit and refill patients' prescriptions.
- Transmitted information or documents to customers through email, mailings or facsimile machine.
- Purged inactive files and destroyed obsolete files following procedures.
- Trained new staff on office procedures, software programs and customer service protocols.
- Provided support to physicians by organizing patient charts prior to scheduled appointments.
- Conducted regular audits of medical records to ensure accuracy and completeness of documentation.
- Monitored inventory levels of supplies necessary for daily operations of the office.
- Reviewed employee time sheets for accuracy before submitting them for payroll processing.
- Collaborated with marketing team on campaigns designed to increase awareness of the practice among potential patients.
- Managed staff scheduling and set patient scheduling policy.
- Developed and implemented office policies and procedures while adhering to HIPAA and OSHA regulations.
- Performed data entry and processing into system databases and troubleshot minor computer issues.
- Interviewed, hired and trained medical office teams and conducted performance reviews.
Care Manager
Richmond University Medical Center / Bayley Seton
Staten Island, NY
11.2014 - 02.2015
- Worked with insurance companies to obtain prior authorizations for inpatient behavioral health services, according to clinical information given by providers.
- Monitored and reported on patient activities, mental status, and progress to the insurance company to provide a clinical review to substantiate admission and concurrent stay.
- Participated in treatment team meetings with physicians and clinical staff (social worker and discharge planner) regarding patient diagnosis, service justification, length of treatment, case documentation, and discharge planning.
- Responsible to arrange Peer-to-Peer teleconference meetings as requested by treating physicians, as well as insurance company, to obtain concurrent stay authorizations according to criteria for medical necessity level of care.
- Managed the assigned workload for two mental health units within established performance standards.
- Performed monthly utilization review reports to the supervisor in accordance with all state-mandated regulations.
- Maintained accurate records of client visits and progress notes in accordance with agency policies and procedures.
Education
Certificates - Medical Assistant
Willsey Institute
09-2004
Bachelor of Arts - Psychology
College Of Staten Island
01-1999
Skills
- Strong communication skills in Spanish, English
- Multitasking, management capabilities
- Able to calmly handle crisis situations and work under pressure due to strong background developed through coursework in psychology and sociology
- Extensive background in medical assistance and office administration
- Comprehensive understanding of insurance eligibility, authorization procedures, and referrals
- Familiarity with medical terminology
- Solid knowledge of medical billing/coding rules and regulations, PDMP, ICD-9, 10 CM/CPT, HCPCS coding, and CM-1500 form
- Computer/software skills: Medisoft, Sigma Care, Wellsky, Simple, Point Right, Microsoft Office (Word, Excel, Outlook), research, and Internet
Languages
Spanish
Native/ Bilingual
Timeline
MDS Clerk
Carmel Richmond Nursing Home
07.2018 - Current
Unit Clerk
Carmel Richmond Nursing Home
07.2015 - 06.2018
Care Manager
Richmond University Medical Center / Bayley Seton
11.2014 - 02.2015
Medical Office Manager
Alvaro Rodriguez MD
06.2004 - 07.2015
Certificates - Medical Assistant
Willsey Institute
Bachelor of Arts - Psychology
College Of Staten Island
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