Theresa (Quezada) Payan Email & Phone Number

Glendale, Az, Us

Phoenix, Arizona Area

ALTCS Tribal Case Management Coordinator • Responsible for the case management records and medical records of members on the AHCCCS Long Term Care Program, including oversight of case management standards for ALTCS/Tribal Contractors.• Operational Review (OR) and ALTCS Case Management Service Review (CMSR) to assess compliance with AHCCCS’ case management standards for ALTCS/Tribal Contractors.• Monitoring of member participation in and/or Contractor compliance with specialized programs.• Development of training materials used to educate ALTCS/Tribal Contractors on policy issues. • Review and analysis of reports and program specific data; and identification of problem areas and recommendations for course of action to resolve issues.• Attends division/agency meetings.• Processes for Corrective Action Plan development implementation and evaluation.• Reviewing case documentation in order to evaluate the appropriateness of placements and services for ALTCS members.• Strong interpersonal skills in working with people of diverse cultures and socioeconomic backgrounds and those in crisis.• Effective written communication, including writing of reports and general correspondence; and ability to communicate program compliance findings in objective, non-threatening way to contractors and providers.• Effective presentation skills in order to provide technical assistance and training to contractors and staff.• Strong time management and initiative, with ability to work with little or no supervision; and organization and prioritization of multiple tasks and ability to re-prioritize as necessary.

Phoenix, Arizona Area

Programs Projects Specialist 1 PCS Auditor2013 to Feb - 2017• Verify the board certification in conjunction with the Office of Inspector General and the 60% in conjunction with the BI Group. • Validate Providers credentials up to date.• Center for Medicare and Medicaid Services (CMS) criteria is meet Accreditation for Attest additional payment.• Conducts audits of PCP offices to determine if all eligibility requirements are being used to calculate in the 60% billing requirement for Medicaid services.• Assist in the development of procedures and methods for implementation of the program and with any policy development required.• Produce reports and recommendation on resolution of issues.• Interface with AHCCCS Business Intelligence group on data needed to conduct audits.• Participate in the establishment of guidelines and policies.• Management and procedures analysis techniques and principles.• Principles and practices of auditing.• Familiarity with IHS and 638s and how they function.• Oral and written communication.• Analyze issues that arise during auditing and make recommendations for resolution.• Interpret rules and regulations, policies and procedures as relate to the program.• Time management to complete audits special projects timely.• Develop procedures, analyze problems and design effective plans for program improvement.•Federal auditing guidelines.• PMMIS, Fortis, Right Fax.• Conducts special projects for Claims Policy & Audit Manager with regard to the EHR Incentive Payment Program.• Federal and State laws, rules and regulations as pertain to PCP Enhanced Fee Payment Program.• Administrative rules and regulations, AHCCCS policies and procedures.• Apply and interpret federal and state laws, rules and regulations as they pertain to program operations and activities. Identify a pattern of inappropriate billing and reporting, which may indicate fraud.

Glendale, Az

Massage EnvyLMT – License Massage Therapist 10/2017 to presentDel Sol ChiropracticLMT – License Massage Therapist 04/2015 to 09/2016Private Clients LMT – License Massage Therapist 09/2015 to presentMassage HavenLMT – License Massage Therapist 09/2015 to 09/2016Adjust Me Chiropractic LMT – License Massage Therapist 07/2015 to 10/1015Cortiva Masage Insitute Clinic Student Massage Therapist 10/2014- 08/2015Maintain a personal client base, offering wide range therapy options and in Pregnancy Massage, Back Massage, trigger points and Deep Tissue Massage. • Worked with clients MVA and sports injury.• Meet with every new client to develop a therapy plan based on there individual needs and wants. • Maintain Client Confidentiality and sensitivity to age and gender related issues during all clientinteractions.• Maintain the highest standards of professionalism and hygiene at all times.• Demonstrate excellent communication and listening skills.• Discuss with clients regarding their medical histories and problems.• Functional knowledge of executing professional boundaries with clients.• Decide which massage technique will be most useful.• Apply finger and hand force to exact points of the body.• Develop and suggest client healing plans that state which types of massage are to be used.• Refer clients to other therapists when essential.• Maintain clients’ treatment records.• Special talent for providing clients with guidance on how to develop posture, stretching, strengthening, and general relaxation.

8220 N. 23Rd Ave, Phoenix, Az

* Gain knowledge 10 plus years in the medical health insurance.* Process and Audit claims CMS 1500-provider office, drugs and DME, the UB82-In-Patient/Out-Patient and Dental.* Validate medical coding HCPC, CPT-4, ICD9/ICD10 CM.* Audit claims process correctly with patients contract benefits.* Validate provider’s contract, pricing, precert and medical report when it is required by patient’s contract benefits.* Process adjustments when auditing claim that was over/under price or simply paid incorrectly do to other factors providers agreement.* Validate finance according to group contracts.* Validate enrollment large and small groups and individual direct pay benefits process according the contract.* Validate provider’s credentials and contract with the insurance company, as well with facilities.* Confirm the errors where it came from, the department manually processed, data keying, system, submitted incorrectly by the agencies or provider/facility and resolved the issue for correction or educate.* Prepare and maintain documentation supporting the results of audit examinations and reports.* Complied with company contracts and other established guidelines.* Maintain strict confidentiality; adhering to all HIPAA guidelines/regulations* Maintain confidentiality and able to communicate professionally with all levels of management.* Maintain current job responsibilities while taking on additional task and meet my deadlines and priorities.* Train other employees in department and outside of the department.* Knowledgeable in Intermediate MicroSoft10.* Created desk top procedures and audits. * Kept communication with supervisor and management of all levels.* Volunteer in the company’s wellness program as a leader for our department.* Involve myself as a team player.

4329 W. Thunderbird Rd #2, Phoenix Az

Retail Associates * Attend to customers locate merchandise, events and classes.* Schedule appointments and answer questions that they may have to my best ability.* Responsible managing store opening, promotes sales, restock and inventory, balancing registers and closing the store.* Manage bookkeeping in balance monies at the end of the day.* Team player love to train new employees.

10000 N 31St Ave, Phoenix Az

* Experience 5 + years customer service Patients, Doctors Office, Attorneys, Insurance companies.* Accountable for outstanding customer service to all external and internal customers. * Develops and maintains effective relationships through effective and timely communication. * Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner. * Processes and reviews all patient information for accurate and complete insurance information. * Responsible for timely and accurate billing: electronic claim submissions, paper submission, secondary payors and any rebilling needed. * Follows all delinquent third party and self pay accounts maintaining clear records of follow- up activity. * Responds to all third party and patient inquiries, including telephone calls and written correspondence. * Identify denials and unreconciled payments by reviewing payment remittances. * Completes offsets and write-offs while maintaining the integrity of the audit trail. * Prepare and batch all payment documents for data entry. * Prepares and maintains spreadsheets related to documentation requests needed by the * Billing Department to resolve outstanding issues. * Assist management on special projects as needed. * Other duties as assigned.