Sandra Monsalve

WORK HISTORY

EDUCATION

ABOUT SANDRA MONSALVE

Objective: A challenging, growth-oriented position in Health Care where my skills, experience and commitment will be utilized and advanced. Developed alternative courses of action related to Health Care Reform, Women Health care Reform, Autism Mandate and State Mandates, identification of all CPT codes and diagnosis codes required for implementation of the above state and national mandates to ensure the company is aligned with the different mandates and claims are processed correctly. Workflow analysis and redesign of various internal processes in order to increase productivity. such as, assistant surgeon, co-surgeon and team surgeon claim adjudication and clinical records review. Responsible for a Bi-Annual analysis to determine Current Procedural Terminology (CPT) codes and modifiers, International Classification of Diseases (ICD10) diagnosis codes changes to update the clinical software for our nurses and physicians, claims software, PreAuth software. Part of the team who redesigned of the new Prior-Approval table for all different LOB\'s depending on the benefit offered. Ensure documentation compliance with federal regulations for state Medicaid and national Medicare. Research, review, and analyze new medical procedures, new technology, new medical equipment, in order to assign corresponding CPT/HCPCS (Healthcare Common Procedure Coding System) codes; gather input from providers; recommend coverage and reimbursement consistent with state and federal law. Manage the coding updates of EmblemHealth clinical policies to maintain coding compliance and retrieve information from specialty sites regarding reimbursement and coding updates.