Guadalupe Terrones Email & Phone Number

Santa Maria, Ca, Us

Bakersfield, Ca, Us

Bakersfield, Ca, Us

Bakersfield, Ca, Us

• Consulted with clients to determine their needs and priorities.• Reviewed status reports prepared by project personnel and modified schedules/plans as required.• Prepared project reports for management, clients and others.• Detailed knowledge of Medicare, Medicaid, Managed Care, HMO's, PPO's, Workers Compensation and BC/BS insurances.• Partnered with centers as needed to ensure accuracy along with other key metrics • Developed comprehensive Provider Manuals• Created robust quality goals and metrics for physician groups and health plans.• Established comprehensive Bonus Criteria for physicians meeting strict financial/quality goals• Completed quality review of and editing to schedules as needed Instrumental in rolling out new scheduling program to financial center leaders• Assisted the region in conducting knowledge checks with financial center leaders in order to mitigate audit risk. • Conducted training sessions with financial center leaders on the new scheduling tool and served as them field support for questions/escalations identify the right opportunities in your operations and develop the customized improvement plan to support your business objectives. • Conduct on-site inspections and staff trainings for health care facilities to ensure facility-wide health and safety. • Provide on-site and off-site consulting and educational support for OSHA, HIPAA, CDC/Infection Control, JCAHO, and industry accepted standards for risk management. • Revise policies and procedures in accordance with changes in local, state and federal laws and regulations. • Creating client manuals and site-specific deficiency reports. • Assist in the company development of training materials and new programs. • Review and prepare updates for company manuals and survey tools. • Perform chart audits, confirming they accurately and completely describe care provide

Redesigned policy and procedures manual in alignment with current FQHC, State regulatory guidelines; maintaining and stabilizing medication management processes in conjunction with the California State Pharmacy Board. Medicare experience in application of policy guidelines, quality monitoring, data trending and analysis, developing and implementing training programs, project management, Medicare Provider Enrollment/PECOS; Maintenance of both, provider and multi facility NPI #’s and organization(s) PECOS database; Conducts regulatory training and provides guidance on compliance matters. Performs oversight and analysis and activity coordination. Ensuring program integrity by establishing an audit process that is efficient and effective in monitoring operations, and compliance with Federal, State laws and regulations, CMS, OIG, as well as contractual obligations. Works with Regulatory Compliance to ensure or provide Medicare Programs documents are in compliance with CMS rules and regulations Review, research and interprets CMS manuals and guidelines, understanding the full scope of the regulations and submits materials and filings specific to Medicare business areas.

San Francisco, Ca, Us

Thorough knowledge of the principals and practices of a Rural Health Center, (RHC), Federally Qualified Health Center, (FQHC) and community clinic/health center administration, as well as working knowledge of business office, billing procedures, DHCS Medi-Cal Prospective Payment System, (PPS), rate setting/reconciliation reporting, and Medicare related cost reporting for each of these designations. Responsible for licensing and certification of new clinics, working closely with CDPH Central Applications Unit and District Office in Ventura, CA and assuring continual malpractice/liability insurance coverage for existing and new healthcare providers under PCCHC. Coordinated with Vice President to plan, implement and assess clinic projects and initiatives. Supervised all educational, clinical and business operations. Measured quality assurance, productivity and performance through periodic data collection and analysis; prepare and evaluate provider RVU’s, (relative value units), to ensure productivity standards are being met on a quarterly basis. Compliance with CA H&S 1204A & Title 22: applicable Federal and State laws and guidelines. Assessed current administrative and technical operations in the performance of contractual workload and requirements to identify and rectify barriers, problem areas and inefficiencies.

• Responsible for all human resource functions, i.e.: orientation, training, supervision, evaluation and development of office personnel, for front and back office positions, as well as, salary assessment and performance• Create and implement office procedures for front and back office• Maintain fee schedule using the current resource based relative values scale• Ensure the quality and timeliness of medical reports• Manage and monitor quality of contractual services, including all aspects of provider credentialing• Create and manage financial statements• Maintain inventory and ordering of supplies• Handle all correspondence, office billing, accounts receivable and general ledger

• Oversee day to day operations• Supervised front office, back office, medical records and nursing staff• Back up support to CEO, CFO, Administration and Business Office• Create ad-hoc reports as needed using Microsoft Access; Generate reports, such as production revenue, patient encounter data for provider support office• Assist business office with end of day/end of month reports• Balance all charges, adjustments and payments for all site locations• Monitored and documented all insurance batching in preparation for payment processing• Back up for quality assurance and contracting departments• Maintaining procurement policies and procedures, program evaluation, RFP writing, project management, strategic planning, sustainability planning federal and state program and audits • Responsible for completing county quarterly monitoring and submission reports, in addition to any other reports county may request.