Adriana Christian
Sacramento,CA
Summary
Secure a responsible career opportunity and expand learnings, knowledge and skills while making a significant contribution to the success of the company. Highly organized, efficient and communicative Surveillance Utilization Liaison with strong background coordinating business operations with internal and external customers. Effective in serving as middle person in streamlining processes, resolving issues and improving communications.
Overview
20
20
years of professional experience
Work History
State Government Program S/URS Liaison
Delta Dental of California
05.2021 - 05.2024
- Profile potential abuse by Medi-Cal Dental providers and make recommendations based on findings
- Compiles and analyzes statistical data, analyzes internally available information and review patient records on the profiled cases
- Act as a liaison with providers, DHCS (Department of Health Care Services) and MDSD (Medi-Cal Dental Services Division)
- Collaborate with team members on workload selection/management distribution.
- Managed approximately 30 incoming calls, emails per day from providers
State Government Program Operation Specialist SURs
Delta Dental of CA
04.2021 - Jan2020
- Prepare agenda for QRC (Quality Review Committee) and CRC (Case Review Committee)
- Record, Capture and Distribute minutes from QRC and CRC meetings
- Participate in QRC/CRC, core and team meetings
- Generate, mail Clarification, Sanction and 1st Term letters to providers
- Enter findings in PS/SC tracking data base and CDMMIS
- Process PA/SC TAR’s, Claim’s and CIF’s.
- Prioritized tasked, allowing Liaison and senior staff to concentrate on profiling to reduce the inventory
State Government Program Paraprofessional
Delta Dental of CA
11.2004 - 01.2020
- Process (Treatment Authorization Request) Claims and CIF’s (Claim Inquiring Form) Resubmission Turnaround Documents.
- Process Skilled Nursing Facility and Intermediated Care Facility documents
- Research and call providers to verify information in order to clear duplicated treatment authorization request.
- Average Documents Per Hour: 69.06 YTD 552.50 DPD
- Quality Control Percentage YTD 99.91%
Education
X-ray License -
Sacramento City College
Sacramento, CA08.1994
Skills
- Over 20 years of the Medi-Cal Dental Criteria
- Strong Knowledge of the Access database, CDMMIS, and Thin Client
- Public Speaking skills
- Conflict resolutions with Medi-Cal Dental Providers
Timeline
State Government Program S/URS Liaison
Delta Dental of California
05.2021 - 05.2024
State Government Program Operation Specialist SURs
Delta Dental of CA
04.2021 - Jan2020
State Government Program Paraprofessional
Delta Dental of CA
11.2004 - 01.2020
X-ray License -
Sacramento City College
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