Veronica Barcena
Santa Clarita,CA
Summary
Accomplished Senior Litigation Paralegal at Blue Shield of California, adept in legal research and representing the company in small claims court, showcases outstanding analytical skills and independent management of complex litigation cases. Excelled in regulatory compliance and Medicare expertise, demonstrating exceptional verbal and written communication. Achieved significant process improvements through strategic training and case management.
Overview
14
14
years of professional experience
Work History
Senior Litigation Paralegal
Blue Shield of California
Woodland Hills, CA
01.2016 - Current
- Assist BSC attorneys in the Dispute Resolution Group of the Law Department, and work with outside attorneys representing the company. Assist with the discovery and gathering of facts and information needed to respond to threatened and pending litigation brought by members and providers of services.
- I work with our internal business units to ensure we receive the documents needed to properly defend the case in court. I gather and analyze data trends to provide to our outside counsel, to discuss the next steps in our defense.
- I lead and drive internal prep meetings in preparation for external meetings with our outside counsel.
- Maintain reports for different lines of business for tracking purposes, e.g., CMS, FEP, and IFP.
- Provided support to attorneys in all aspects of litigation from initial client contact through post-trial activities.
- Identified key facts from depositions, interrogatories, answers to requests for admissions and document production responses.
- In addition, I represent the company in Small Claims Court proceedings by working on all Small Claims Court matters and appearing in courts throughout Southern California.
- Conduct fact and legal research into the claims made against Blue Shield of California in Small Claims Court; recommend settlements when appropriate; and negotiate settlements within the authority given.
- Lastly, I assist attorneys in responding to regulatory agencies on regulatory compliance investigations, subpoenas, and DMHC enforcements.
Performance & Learning Trainer
Blue Shield of California
Woodland Hills, CA
10.2014 - 01.2016
- Responsible for being the subject matter expert on functional operational workflows, claim systems, databases, and documentation for the purpose of enhancing operating efficiency, quality, and technical skill levels of staff.
- Analyze training needs, develop curriculum, and deliver courses to trainees, which also includes evaluating the trainees' needs for the effectiveness of training and individual employee growth.
- Provide proactive solutions that are integrated into the strategic planning process to improve business performance.
- Maintained up-to-date records of all trainings conducted within the organization.
- Coordinated with subject matter experts to develop relevant course content. I was the Medicare AGD subject matter expert and trained several of the newly hired MAGD coordinators.
- I worked with the management to align training programs with organizational goals. I also provided feedback and guidance on skill development.
- Leverage digital tools to create interactive learning experiences and stay updated on the latest trends in technology.
- Ensure all training materials comply with industry regulations and company policies.
Senior Medicare Appeals & Grievance Coordinator
Blue Shield of California
Woodland Hills, CA
01.2013 - 10.2014
- To manage and provide the resolution of member grievances, inquiries, executive inquiries, claim issues, and appeals to the member, provider, or member's authorized representative.
- I provided training, coaching, and reviewed the letters for the newer staff members before they were sent to our members.
- I wrote up clinical case forms for standard and expedited appeals for the nurses and medical directors to review.
- I collect all pertinent and relevant information from the member and/or provider regarding the grievance or appeal to determine the appropriate resolution of the grievance or appeal per Medicare guidelines, as well as standard policies and procedures.
- I analyze appeal cases and complex issues, and work with different internal departments within the company to obtain the necessary information needed to make a determination on the case.
- I wrote up and transferred the appropriate appeal cases to our regulatory team so they can be reviewed by our federal regulators.
- I also helped with the Medicare Appeals and Grievance Department's transition and implementation of a tracking system for cases.
- Additionally, I focused on process improvements and made recommendations to management, which included the restructuring of the training for the coordinators to increase their effectiveness and quality in processing cases.
Medicare Member Representative
Blue Shield of California
Woodland Hills, CA
07.2011 - 01.2013
- Answer incoming calls from Medicare members and assist them with benefit questions and requests for changing medical groups or primary care physician changes.
- Accurately and promptly address written requests from members, or providers.
- Resolve various customer inquiries via telephone, correspondence, and resolve claim problems within established production and quality standards.
- In addition, research, and coordinate with other departments to ensure timely and appropriate responses.
- Expedite and resolve complex issues, and initiate claim adjustments.
- Educate members on the Blue Shield product, and provide an explanation of benefits.
Pre-Hearing Case Manager
Disability Group Inc. Law Firm
Los Angeles, CA
06.2011 - 07.2011
- To satisfy our client’s financial needs in a timely manner, responsibilities include meeting daily goals for supportive medical evidence submission each day, follow up on outstanding medical support request as necessary, making multiple outbound calls and performing client updates, meeting daily goals for appeals completed and maintaining client records consistent with the established system and firm standards.
Education
UCLA Paralegal Certificate - Legal
University of California - Los Angeles
Los Angeles, CA02.2017
Bachelor of Arts Degree - Sociology
Mount St Mary's University
Los Angeles, CA12-2011
Skills
- I have appeared in several small claim courts all over Southern California, where I have defended the company
- I have outstanding analytical skills, excellent verbal and written communication skills
- I can also create presentations for all levels of management, and work independently under limited supervision
- I am a Medicare subject matter expert
- I have experience working with regulatory agencies like MAXIMUS and the Department of Managed Health Care
- I have experience working with Medicare members, medical directors, and attorneys on Medicare cases, and other cases for different lines of business
- Prepare materials for both internal and external provider meetings
Timeline
Senior Litigation Paralegal
Blue Shield of California
01.2016 - Current
Performance & Learning Trainer
Blue Shield of California
10.2014 - 01.2016
Senior Medicare Appeals & Grievance Coordinator
Blue Shield of California
01.2013 - 10.2014
Medicare Member Representative
Blue Shield of California
07.2011 - 01.2013
Pre-Hearing Case Manager
Disability Group Inc. Law Firm
06.2011 - 07.2011
UCLA Paralegal Certificate - Legal
University of California - Los Angeles
Bachelor of Arts Degree - Sociology
Mount St Mary's University
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