Miranda Hernandez Email & Phone Number

Triwest Healthcare Alliance

With the startup of the Veteran Affairs Patient Centered Community Care Contract (PC3) and Choice programs, excellent customer service has been provided to our veterans, VA staff and providers. The review process for approving CPT codes for payment includes evaluation of approval from the Veterans Affairs, authorization entry in the medical management system, medical documentation review and entry from medical services provided to veterans.Enter a large number of authorizations with the correct CPT codes provided the appointing staff to appoint veterans with the correct provider and services needed. When the authorization is entered into the system accurately this greatly reduces the absence of the appointer appointing the veteran incorrectly and also aides in accurate and timely processing of claims. A great amount of medical documentation is reviewed and must be documented accurately into authorizations. This also aides in delivering the medical reports to the Veterans Affairs and provides accurate payment to health care providers. Critical findings found in the medical documentation must be reported to the VA immediately.

Proficient in problem solving, researching, and communication skills. Flexible to changes in responsibility and procedures on a persistent basis provides excellent time management skills. Knowledge in coding and medical terminology provides guidance to accurate entry of authorizations and medical documentation entry. With the use of organization skills and upkeep of procedure changes I am able to provide excellent customer service to our veterans, VA staff and our providers.

Phoenix, Arizona Area

: Constantly proficient in problem solving, analytical research, communication skills, accurate reporting and designing spreadsheets, confidence in providing solutions to problematic entries and ability to acknowledge trends. Applied skills also include the ability to implement changes to procedures and provide training material to staff members and conduct quality reviews that provide educational feedback. Extensive experience in the healthcare industry, with emphasis in analytical tracking and reporting include the following responsibilities:• Problem solving and analytical research • Develop procedures for Analyst & staff• Critical data verification • Provide training to Analysts & staff• Coach corrections as needed • Knowledge of dept. contractual guidelines• Track and report all dept statistics • Prompt & flexible at learning new computer skills • Governmental reporting accuracy • Excellent communication & team leadership skills• Data reporting coordination • Develop & implement departmental contests• Six Sigma – yellow belt methodology • Departmental morale committee member• Process quality assessments • Tech. Proficiencies: MS Word, Excel & PowerPoint

Work hand in hand with Analyst, Supervisors, and Team Leads to ensure consistency in knowledge of the department’s processes. Maintains a schedule of tasks and work is completed before or by the time it is expected on a routine basis. Worksheets are organized for easy reading and findings of data needed. Provide training materials needed to help consult trackers reach their potential and provide a positive atmosphere. -Quality and TrainingImplement and maintain the department’s structure for tracking productivity stats and quality. Improve processes in areas that effect performance and customer service. Review and document the Consult Trackers productivity and quality performance stats. Conduct quality reviews weekly and provide coaching feedback for corrections. Identify and improve processes, desktop procedures and training materials. Primary trainer for multiple Analysts which provided them to become independent in a proficient timely manner while completing daily duties.-ReportingProficient in Microsoft Excel, including but not limited to sorting, graphing and analyzing data that is reported to internal and external customers including the government. Reporting of the department’s overall performance and compliance is documented in spreadsheets and graphs to show daily, weekly and monthly stats for various customers. Request of new or adhoc reports are completed in a proficient and timely manner.Received Six Sigma Yellow Belt Training April 12, 2007Six Sigma project, demonstrated the total daily hours it would take if the Analysts were to complete a quality review for all of the Consult Trackers in the field. It was determined that it is more beneficial to have the corporate office receive all the reports so the quality reviews can be completed for 25-28 Consult Trackers rather than 116 Consult Trackers from different locations.

Assist health care professional in enrollment process for patients with low or no income for Glaxo Smith Kline’s patient assistant prescription drug coverage.

• LeadershipDesign, manage and present operational training materials and procedures. The team’s workload, schedules and progress was monitored and provided individual based coaching. Developed and analyzed reports for various business functions. Received and resolved escalated issues received from CSR’s and external customers. • Quality AssuranceMaintain strong working knowledge of entire program for use in training, support, and mentoring. Monitor CSR’s calls to ensure expected requirements requested by the customer Glaxo Smith Klein are met.Take incoming calls from CSR’s to assist with operational issues, program questions, and escalated issues.Assist supervisor with daily tasks. Provide coaching and feedback to CSR’s.• Senior Customer Service Representative III Assist health care professional in enrollment process for patients with low or no income for Glaxo Smith Kline’s patient assistant prescription drug coverage.