Nicole De La Barrera
Huntersville,NC
Summary
Compassionate and detail-oriented professional with a comprehensive background in educating individuals on achieving healthy living, collaborating with healthcare professionals, and offering assistance for a range of health concerns. Skilled in managing insurance policies, specializing in insurance verification, clearing referrals, coordinating surgical dates, and providing guidance to patients. Demonstrated ability to navigate complex healthcare systems and provide support to both patients and their families. Proficient in efficiently answering phone calls and resolving issues in a timely manner. Articulate communicator with strong interpersonal, planning, problem-solving, multitasking, time management, and organizational skills.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Retrieval Specialist
Robert Half
03.2024 - Current
- Followed all company policies and procedures to deliver quality work.
- Improved customer satisfaction rates through proactive problem-solving and efficient complaint resolution.
- Implemented new training programs for staff, leading to higher employee retention rates and better overall performance.
- Implemented customer feedback system to inform product development.
- Enhanced the quality of HEDIS measurements through meticulous medical record abstraction and documentation.
- Promoted a culture of quality improvement within healthcare settings by emphasizing the importance of accurate HEDIS measure adherence during site visits.
- Utilized advanced software tools to maintain organized and accurate documentation of field review findings, supporting effective reporting processes.
- Demonstrated strong attention to detail and analytical skills when identifying trends or patterns in HEDIS measurement data, enabling informed decision-making by organizational leaders.
- Maintained strict confidentiality of patient information, adhering to HIPAA regulations throughout the review process.
- Improved HEDIS reporting accuracy by conducting thorough field reviews and data validation.
- Collaborated with team members to develop consistent methodologies for HEDIS data collection and analysis.
- Retrieved medical data for physicians and patients.
HEDIS Stars Advocate
Avmed Health Plans
01.2022 - 01.2024
- Improve Medicare Star metric by conducting member and provider outreach campaign
- Notify members on approvals and denials as needed
- Maintain databases to support internal and external reporting by monitoring and documenting results of outreach initiatives
- Research, analyze, and investigate active insurance policies to determine expired numbers and incoming claims
- Deliver specialized service over multiple channels by acting as a single point of contact, maintaining ownership of member resolution and navigating optimal care
- Optimized rating from 3 to 4 stars rating by providing efficient services
- Achieved organizational objectives by collaborating with internal and external departments
- Educated members on medical options and assisted in obtaining appropriate follow-up care
- Manage and coordinate elevated member issue resolution (access to care, provider selection, outreach, surprise bill) with confidence and sense of urgency
- Provide concierge-level guidance for members involving their benefit plan throughout their healthcare journey
- Collects medical records and reports from provider offices
- Abstract medical records
- Have knowledge of each members open GAPS
- Empowered to advocate for members by providing knowledge, expertise and innovative problem solving to proactively identify solutions that elevate the member experience
- Take ownership of the member experience from beginning to end, minimizing handoffs to ensure service continuity and reduce effort for the member
- Expert in benefits administration and healthcare solutions
- Interaction with members, clinicians, and service providers
- Knowledge of Medication Adherence
- Aid members with pharmacy inquiries utilizing Caremark
Supervisor Main Medical Assistant
Miami OBGYN
01.2019 - 12.2021
- Performed multiple tasks diligently, such as assisting patient access supervisors and management team with overseeing day-to-day activities of all medical assistants
- Trained new employees
- Record patients' medical history, vital statistics, or information such as test results in medical records
- Prepare treatment rooms for patient examinations, keeping the rooms neat and clean
- Interview patients to obtain medical information and measure their vital signs, weight, and height
- Authorize drug refills and provide prescription information to pharmacies
- Clean and sterilize instruments and dispose of contaminated supplies
- Prepare and administer medications as directed by a physician
- Show patients to examination rooms and prepare them for the physician
- Explain treatment procedures, medications, diets, or physicians' instructions to patients
- Help physicians examine and treat patients, handing them instruments or materials or performing such tasks as giving injections or removing sutures
- Collect blood, tissue, or other laboratory specimens, log the specimens, and prepare them for testing
- Perform routine laboratory tests and sample analyses
- Schedule appointments for patients
- Ordering supplies
- Assisting with in office surgeries (hysteroscopies)
- Finding coverage for assistants who will be out of town or called out
Surgical Coordinator/Medical Assistant
SOMI OBGYN
01.2016 - 12.2019
- Coordinated surgical date with patients and OR as well as received charts with surgical orders
- Utilized CPT codes to manage codes procedures
- Guided patient regarding Hospital, physician, and Anesthesia surgical fees
- Engaged in numerous duties, such as creating fee arrangement forms, checking in and checking out surgeries, interviewing patients before surgery, and arranging surgical cases
- Coordinated and scheduled more than 20 surgeries every week
- Ensured verification of benefits and obtained authorizations for surgery by contacting insurance companies
- Provided top-notch customer service by responding to emails and telephone calls from patients with surgical questions
- Record patients' medical history, vital statistics, or information such as test results in medical records
- Prepare treatment rooms for patient examinations, keeping the rooms neat and clean
- Interview patients to obtain medical information and measure their vital signs, weight, and height
- Authorize drug refills and provide prescription information to pharmacies
- Clean and sterilize instruments and dispose of contaminated supplies
- Prepare and administer medications as directed by a physician
- Show patients to examination rooms and prepare them for the physician
- Explain treatment procedures, medications, diets, or physicians' instructions to patients
- Help physicians examine and treat patients, handing them instruments or materials or performing such tasks as giving injections or removing sutures
- Collect blood, tissue, or other laboratory specimens, log the specimens, and prepare them for testing
- Perform routine laboratory tests and sample analyses
- Schedule appointments for patients
- Obtain insurance authorizations
- Call and confirm appointments
- Medical records specialist
Education
Certified Medical Assistant -
Everest Institute
Miami, FloridaSkills
- Health Counselling
- Conflict Resolution
- Process Improvement
- Patient Assessment
- Customer Service
- Clinical Documentation
- Risk Assessment
- Insurance Verification
- Abstracting Documents
- Analytical thinking
- Quality assurance
- Proficient in many EPIC/CERNER/ECW
- Team collaboration
Certification
Certified Medical Assistant, Everest Institute, Miami, Florida
Timeline
Retrieval Specialist
Robert Half
03.2024 - Current
HEDIS Stars Advocate
Avmed Health Plans
01.2022 - 01.2024
Supervisor Main Medical Assistant
Miami OBGYN
01.2019 - 12.2021
Surgical Coordinator/Medical Assistant
SOMI OBGYN
01.2016 - 12.2019
Certified Medical Assistant -
Everest Institute
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