Alpyniky ( Niky ) Galindo

Experience

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  HealthSmart MSO Inc.

  Nov 2001 - Sept 2002

  Member Service/ Capitations/ Eligibility Specialist

  Responsible for the IPA's of the Regent Medial Group and St. Peter Medical Group. Assisted members and providers in accessing satisfaction studies. Addressed and resolved complaints/grievances and dis-enrollments. Handled quarterly mail out of specialty rosters. Mailed health plan/IPA correspondence to PCP's. Maintained correspondence logs for assigned IPA's. Responsible for the capitation/eligibility maintenance. Assisted other departments with member/provider issues, as needed, by adding eligible members to the system, verifying conflicting eligibility, editing PMW with correct eligibility, and verifying eligibility discrepancies for date of services. Show less

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  Navigant Cymetrix

  Sept 2002 - Oct 2009

  Project Supervisor

  Responsibilities for training in appeal process follow-up. Implementing all appeal procures to make each account is billed; status coded, noted, and followed up on according to the company's and client's needs. Staff Monitoring: Maintaining the staff with time and attendance — keeping track of each employee's tardies and absence. I was the immediate contact for account questions and problem as well as simple employees' issues like supplies, I/S problems, trouble accounts and media request. Making sure that each employee follows and understands company policies and procedures. Cash Flow: Understanding what the monthly goal is and every attempt to ensure it is met. Account Inventory Flow and Maintenance: Keeping track of what accounts are in the branch of business and filtering out troublesome accounts. Running and reviewing inventory reports for immediate cash flow and accounts rotation Show less

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  The Oncology Instutite of Hope and Innovation

  Oct 2009 - Jul 2013

  Executive Assistane

  Responsible for overseeing medical office daily deliverables, implementing and enforcing policies and procedures. Communicate directly with all contracted hospitals and medical staff departments to ensure all Medical Providers are compliant with set standards. Serve as liaison for escalated patient complaints, ensuring that all patient needs are met. Daily interaction with all levels of Management, staff and outside vendors. Provide various general administrative support to Department leads, including organizing company events, scheduling appointments, event/meeting planning coordination and catering, creating PowerPoint meeting presentations, invoice tracking and processing. Maintain records of all office business expenses, mail distribution, ordering office supplies, file maintenance, presentation folders and website maintenance. Coordinate all monthly staff and management meetings including scheduling, preparing agendas and meeting documents, tracking action items, and communicating with meeting attendees. Show less

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  Vantage Oncology Now Part of The US Oncology Network

  Aug 2013 - Dec 2013

  Billing and Collections Supervisor

  Monitor billing and collection processes and work flows to determine improvement opportunities and encourage team-based results. Responsible for meeting established performance targets and goals. Prepare/oversee preparation of scheduled reports to management, physicians, and executives, as well as ad hoc requests; Evaluate current reporting requirements and analyze to improve quality and value of both the reporting process and final product. Ensure compliance with state and federal laws and regulations for managed care, government programs and other third party payers. Oversee Billings and Collections team, including interviewing, hiring, and training direct reports; planning, assigning, and directing work; rewarding and disciplining employees; addressing complaints and resolving problems Show less

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  MedAssets

  Aug 2014 - Nov 2014

  Billing Supervisor ( Temp )

  Monitor staff performance and quality and address any training or performance issues on a regular basis. Effectively functions as a liaison among Hospital managers in coordinating inter- departmental billing efforts and addressing major charge and billing and reimbursement matters. Provide assistance/resolution to client inquiries. Responsible for reporting any detected trends in payments or denials, as well as procedural problems and makes recommendations regarding the correction of these trends or problems. Conduct routine account activity quality audits to verify accounts are being worked appropriately. Monitor internal processes for all functions of the unit, revise and develop consistentprotocols for all business that meet the needs and are aligned appropriately with the core values of the unit. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact patient accounting. Develops effective internal controls that promote adherence to these guideline and programs. Seeks advice and guidance as necessary to ensure proper understanding. Demonstrates correct and safe technique in the use of equipment according to the specific product information and hospital policies and procedure. Provide cumulative reports on a daily, weekly or monthly basis, as required and other reports as assigned to track productivity and performance. Show less

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  Lakewood Eye Physicians and Surgeons

  Apr 2015 - Sept 2016

  Billing Representative

  Responsible for all secondary insurance billing for 2 facilities including a Surgical Center. Obtain LOA on any non contracted providers secondary to Medi-Cal or Medicare and pursue for payment for services rendered. Solely handle all accounts that reflect patient responsibility once insurance has paid per contract. Ensure patient is knowledgeable on balance due, focus on closing account with payment in full or set up monthly payment plan to ensure all accounts remain current and up to date. Establish once account reaches a delinquent status and ensure account is properly transferred to a designated collection agency. Show less

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  IV League

  Sept 2016 - Feb 2018

  Authorizations Specialist

  Responsible for all BlueShield billing and collections as well as L.A. Care Health Plan insurance collections. Appeals for any denied claims. Ensures that all conditions for payment receipt have been satisfied, which includes, but is not limited to, accurate charges and financial class; authorization/certification/TAR information; claims address; ICD-9 and CPT-4 coding; patient insurance eligibility, patient benefit coverage; patient responsibility. Responds timely and accurately to all incoming correspondence and inquiries from payers, patients, and other appropriate parties. Evaluates accounts to determine any write-offs or corrections required, including duplicate charges. Handles in a professional and confidential manner all correspondence, documentation, and files. Reviews various reports to identify denials and edits; corrects claims; suggest action plans to eliminate these denials/edits in the future; determines appropriateness for appeal. Prepares write-offs requests for denied claims which cannot be appealed. Verify patient eligibility. Determine benefits and coverage. Document patient account and communicate to intake coordinator gathered information. Obtain prior authorization for home health services and ensure pharmacy gets orders and schedules delivery within a 4 hour turn around time Show less

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  Premier Infusion and Healthcare Services, Inc.

  Feb 2018 - Mar 2020

  Intake Coordinator

  Coordinated infusion and nursing services for pharmacy which included handling incoming referral calls and completing referral forms. Responsible for the clinical management and coordination of home infusion services to patients/clients. Also collaborated with Clinical Pharmacists in resolving patient care issues. Served as liaison between home health agencies and case management /utilization review departments, played a key role in quality assurance monitoring for infusion services.